Is Spravato covered by insurance?

Insurance Forum
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I’ve seen online that the copay for Spravato can be as low as $10, but has anyone actually gotten that price? How difficult was it? I have BCBS, but a copay that low seems too good to be true.

When asking your doctor for an approval letter for insurance, what reactions did you get? Were they judgmental or open to it? Do most psychiatrists seem willing to help with this?

Lastly, what is the treatment procedure like? Do you need to go in for monitoring? Can you do it through telehealth, and does insurance cover that as well?

I’ve been researching Spravato for years and think it might be exactly what I need, but the cost has always been the main issue. I’m curious about how much insurance can really help with this.

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My clinic sets its own observation fee, which does not include the cost of Spravato. I pay for the Spravato directly through my insurance prescription plan at the specialty pharmacy where it is ordered. Thanks to my participation in the Janssen program, my copay for Spravato is now $10 per dose, down from $40. I have received Spravato treatment at four different locations: initially at a residential program, then at a hospital while attending a PHP nearby, followed by a month at a clinic in a neighboring county, and finally at a clinic in my own county.

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It is possible to get a copay as low as $10 for Spravato through the Spravato withMe Savings Program. This program is designed to help eligible patients with commercial insurance, like BCBS, reduce their out-of-pocket costs.

In addition, the treatment procedure is:

  • Administration: Spravato is administered as a nasal spray in a certified treatment center.
  • Monitoring: After administration, you will need to be monitored for at least 2 hours due to potential side effects like sedation and dissociation.
  • Frequency: The initial phase involves twice-weekly treatments for the first four weeks, followed by weekly treatments for the next four weeks, and then maintenance treatments as needed
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Spravato Cost and Insurance:

$10 Copay Possibility: Achieving a $10 copay for Spravato depends on factors such as your specific BCBS plan design, negotiations through the Spravato withMe Savings Program, and meeting program eligibility criteria.

Spravato withMe Savings Program: Janssen Pharmaceuticals offers the withMe Savings Program to assist with copayments. Check their website (SPRAVATO® withMe Patient Support Program | SPRAVATO® (esketamine) Nasal Spray) or contact them directly to determine eligibility and potential copay reductions.

BCBS Coverage: Coverage for Spravato varies among BCBS plans. Contact your BCBS provider to understand the specifics of your plan, including copay amounts, prior authorization requirements, and approved treatment settings.

Doctor’s Approval Letter:

Doctor Engagement: Psychiatrists are typically knowledgeable about Spravato as a treatment for treatment-resistant depression. Their main concern is your well-being and evaluating if Spravato is suitable for your specific condition.

Communication Transparency: Discuss your research on Spravato and your depression symptoms openly with your doctor.

Approval Process: Doctors often require supportive documentation for insurance approval, which may include a detailed letter outlining your diagnosis, treatment history, and why Spravato is considered necessary for your treatment.

Spravato Treatment Procedure:

Treatment Environment: Spravato is usually administered in a certified healthcare facility due to potential side effects. Some insurance plans may cover at-home treatment with appropriate monitoring.

Monitoring: Healthcare professionals typically observe patients for several hours post-administration during treatment sessions.

Telehealth Considerations: While telehealth consultations with your doctor might be covered, Spravato administration generally requires in-person monitoring at a certified facility. Verify coverage specifics with your BCBS provider

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In my experience from interactions with some patients, most psychiatrists familiar with Spravato understand its benefits and are generally supportive in helping patients obtain it, including writing approval letters for insurance coverage.

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My Humana Medicare Insurance here in VA covers it 100%. Johnson and Johnson has a patient assistance program that provides it free for life if you qualify. Its income based. Doesnt matter what insurance you have. You can fill out the form on their website and choose Spravato as the medication. I faxed in my form and got a response in 72 hours. Its an excellent program