Side-by-side comparison of Spravato, IV ketamine, and at-home ketamine treatment for depression across 1,400+ U.S. clinics.
|
Spravato
esketamine, FDA-approved
|
IV Ketamine
off-label infusion
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At-Home Ketamine
oral lozenges, telehealth
|
|
|---|---|---|---|
| Setting | In-clinic, REMS-certified | In-clinic infusion suite | At home, video check-in |
| Cost per session | $590–$885 | $400–$800 | $50–$90 |
| Insurance covered | Yes — with prior auth | Rarely (cash-pay) | No |
| FDA indication | Treatment-resistant depression | Off-label | Off-label |
| Session length | 2 hours (monitored) | 40–60 minutes | 45–60 minutes |
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IV ketamine infusions typically run $400–$800 per session, with most patients completing 6 sessions in the first month ($2,400–$4,800 total). Spravato (esketamine) runs $590–$885 per dose but is covered by most insurance for treatment-resistant depression. At-home ketamine programs (oral lozenges) average $200–$350/month.
Spravato is FDA-approved for treatment-resistant depression and is covered by Medicare, Medicaid, and most commercial insurers when prior authorization is approved. IV ketamine is considered off-label and is rarely covered — most clinics are cash-pay. At-home ketamine is not covered by insurance.
Spravato (esketamine) is an FDA-approved nasal spray containing the S-enantiomer of ketamine. It is administered in-clinic under REMS supervision. IV ketamine uses racemic ketamine off-label, typically infused over 40 minutes. Both target the NMDA receptor; Spravato has the FDA depression indication, IV ketamine has more published efficacy data.
When administered in a clinical setting by licensed providers, ketamine therapy has a well-documented safety profile. Common side effects: dissociation, nausea, and transient blood pressure elevation during the session. All Spravato clinics operate under FDA REMS protocols requiring 2-hour monitoring post-dose.