Yes, Medicare Covers Spravato - Here's How It Works

If you're on Medicare and struggling with treatment-resistant depression, you can access Spravato treatment. At Next Step Psychiatry, we've helped many Medicare beneficiaries get covered.

Medicare Part D Coverage

Spravato is covered under Medicare Part D (prescription drug coverage). Here's what you need to know:

Coverage requirements:

Valid diagnosis of treatment-resistant depression
Documentation of failed antidepressant trials
Treatment at a REMS-certified facility
Prior authorization approval

What Medicare Beneficiaries Pay

Typical costs:

Part D deductible: $0-$545 (2025)
Copay during initial coverage: 25% of drug cost
Copay after coverage gap: Reduced rates
Catastrophic coverage: 5% of drug cost

Average out-of-pocket: $50-$200 per session after deductible

Medicare Advantage (Part C) Plans

If you have a Medicare Advantage plan, Spravato coverage varies by plan. Most MA plans cover Spravato, but:

Copays may differ from Original Medicare
Network restrictions may apply
Prior authorization requirements vary

Extra Help (Low-Income Subsidy)

If you qualify for Medicare's Extra Help program, your Spravato costs could be:

$0 copay for full Extra Help
Reduced copay for partial Extra Help

We help patients at Next Step Psychiatry apply for Extra Help when eligible.

Getting Medicare Approval for Spravato

Step 1: Initial evaluation at our clinic Step 2: We document your treatment history Step 3: We submit prior authorization to your Part D plan Step 4: Approval typically within 7-14 days Step 5: Begin treatment

Medicare and Spravato: FAQs

Q: Is there an age limit for Spravato? A: No. Spravato is approved for adults of all ages, including seniors.

Q: Will Medicare cover the monitoring period? A: Yes, both the medication and required monitoring are covered.

Q: Can I use Medigap to reduce costs? A: Medigap doesn't cover Part D medications, but it may help with other treatment costs.

Start Your Medicare-Covered Spravato Treatment

At Next Step Psychiatry, we're experienced with Medicare billing and can help you understand your exact costs before starting treatment.

Call (678) 437-1659 or schedule online for a Medicare benefits verification.

Does Medicare Cover Spravato? Complete Medicare Coverage Guide