Spravato: the next step insurance often covers.
Esketamine nasal spray, FDA-approved since 2019 for treatment-resistant depression, given only in certified healthcare settings under a doctor's supervision, with progress measured at every visit.
Often covered by commercial plans, MO HealthNet, TRICARE and Medicare, subject to prior authorization and our participation with your plan. 3934 Union Rd, St. Louis, MO 63125.
Safety informationFDA-approved since 2019
For treatment-resistant depression. SPRAVATO Prescribing Information, section 1.
Often covered by commercial plans, MO HealthNet, TRICARE and Medicare, subject to prior authorization and our participation with your plan.
It's never sent home.
Spravato is given only in certified healthcare settings under its REMS program.
SPRAVATO Medication Guide, revised 09/2026.
Esketamine nasal spray, FDA-approved since 2019 for treatment-resistant depression, given only in certified healthcare settings under a doctor's supervision, with progress measured at every visit.
FDA-approved since 2019
For treatment-resistant depression. SPRAVATO Prescribing Information, section 1.
It's never sent home.
Spravato is given only in certified healthcare settings under its REMS program.
Healthcare merchant certification, approved September 25, 2026.
What is Spravato?
Spravato (esketamine) is an FDA-approved nasal-spray medication for adults with treatment-resistant depression, and for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior.
Esketamine is the S-enantiomer of racemic ketamine.
SPRAVATO Prescribing Information, sections 11 and 12.1.1
It is a Schedule III medication.
SPRAVATO Prescribing Information, section 9.1.2
Spravato is given only in certified healthcare settings under its REMS program. It's never sent home.
SPRAVATO Prescribing Information, section 5.5.3
What the FDA has approved
“SPRAVATO is indicated for the treatment of: Treatment-resistant depression (TRD) in adults as monotherapy or in conjunction with an oral antidepressant; Depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior in conjunction with an oral antidepressant.”
SPRAVATO Prescribing Information, section 1.4
“The effectiveness of SPRAVATO in preventing suicide or in reducing suicidal ideation or behavior has not been demonstrated. Use of SPRAVATO does not preclude the need for hospitalization if clinically warranted, even if patients experience improvement after an initial dose of SPRAVATO.”
SPRAVATO Prescribing Information, section 1, Limitations of Use.4
If you're in crisis right now, call or text 988 (Suicide & Crisis Lifeline), or go to your nearest emergency room. Brain Recovery Centers is not an emergency service.
You may qualify if you've tried just two antidepressants.
Fewer than two trials? The screener will say “not yet” - and the doctor letter makes your next prescription count toward qualifying.
You're an adult with depression that's still winning.
You've had two or more adequate antidepressant trials - the most common insurance bar.
Spravato (esketamine) is FDA-approved for treatment-resistant depression on its own or with an oral antidepressant.
SPRAVATO is not recommended during pregnancy. You should not breastfeed during treatment with SPRAVATO.
SPRAVATO Prescribing Information, section 8.1, and Medication Guide.6
No history of psychosis; blood pressure controlled - the medical evaluation confirms the rest.
Coverage does the heavy lifting.
Two things decide what you pay: whether your plan covers Spravato (esketamine), and whether we participate with your plan. We confirm both for you in writing before anything is scheduled.
Prior auths, denials, appeals - ours. Where we participate with your plan, we file them. That is the job.
The evaluation fee is $99, and it is refundable if you do not qualify for treatment.
See coverage by plan typeWe are pursuing participation with these plans, and none of it is in place yet.
Commercial plans
Anthem, UnitedHealthcare, Cigna, Aetna
MO HealthNet plans
Healthy Blue, Home State Health, UnitedHealthcare Community Plan
Federal programs
TRICARE, Medicare
In crisis right now? Call or text 988. This form is not monitored for emergencies.
What a treatment day looks like.
Check in
Quick symptom measures and blood pressure.
The medication
You administer the nasal spray yourself, with the clinician right there. No IVs, no needles.
Rest and monitoring
Every dose is observed by a healthcare provider, with two-hour post-dose monitoring and blood-pressure checks before you leave.
Home - with a ride
Patients arrange a ride and do not drive until the next day.
We read the trials so you can read the trials.
Not everyone responds. Not a cure, and not a promise.
Standard antidepressants act on serotonin and norepinephrine over weeks and typically take 6 to 8 weeks to judge. Esketamine works on a different brain system, and when it works, people often notice change in days to weeks.
Change from baseline in MADRS total score at week 4
Study 1, adults with treatment-resistant depression. Scores on the MADRS range from 0 to 60, with higher scores indicating more severe depression.
- SPRAVATO + oral antidepressant (114 patients)
- Placebo nasal spray + oral antidepressant (109 patients)
Difference between the groups: -4.0 points (95% CI -7.3 to -0.6).
Between 24 hours and Day 28, both the SPRAVATO and placebo groups continued to improve; the difference between the groups generally remained but did not appear to increase over time through Day 28.
Show the numbers
Between 24 hours and Day 28, both the SPRAVATO and placebo groups continued to improve; the difference between the groups generally remained but did not appear to increase over time through Day 28.
| Treatment group | Number of patients | Mean baseline score (SD) | LS mean change from baseline to end of week 4 (SE) | LS mean difference (95% CI) |
|---|---|---|---|---|
| SPRAVATO (56 mg or 84 mg) + oral AD | 114 | 37.0 (5.7) | -19.8 (1.3) | -4.0 (-7.3; -0.6) |
| Placebo nasal spray + oral AD | 109 | 37.3 (5.7) | -15.8 (1.3) |
Source: SPRAVATO Prescribing Information, section 14.1, Table 10 (DailyMed). Numbers are copied from the label; checked October 6, 2026.5
Straight answers.
Safety informationWill my insurance really cover it?
Often covered by commercial plans, MO HealthNet, TRICARE and Medicare, subject to prior authorization and our participation with your plan. We verify benefits and handle prior authorization before anything is scheduled.
How often are visits?
Twice a week for the first four weeks, then weekly, then every week or two as maintenance. There is no single stepping-down schedule: your prescriber sets and adjusts the taper around how you respond, and tracks you through it so the depression does not come back as you step down.
How long is each visit?
Plan on a little over two hours: a quick check-in, the medication, then a monitored rest period before your ride home.
What does it feel like?
Most people describe feeling floaty, dreamlike, or detached for 30 to 60 minutes. It fades before you leave. Some people get nausea or a headache; we manage both.
What disqualifies someone?
The main ones are uncontrolled or untreated high blood pressure; an aneurysm anywhere in the body; an arteriovenous malformation (an abnormal tangle of blood vessels, sometimes called an AVM); a history of bleeding in the brain; a history of psychosis; and pregnancy. The screener checks gently; the medical evaluation checks thoroughly.
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I am looking into in-clinic Spravato (esketamine) treatment in St. Louis. Using Brain Recovery Centers' website (brainrecoverycenters.com), summarize what the clinic is built around, where patients are seen, whether insurance plans cover Spravato and whether the clinic participates with them, and who medically reviews the site.
Two minutes tells you if this is your next step.
See if you qualifyBook a free consultA real person calls you back within one business day.
We are seeing patients for clinical evaluations and consultations at our South County clinic now. Spravato treatment sessions begin only after our REMS healthcare-setting certification is in hand, no earlier than November 3, 2026.
References
- SPRAVATO (esketamine) nasal spray, CIII. Prescribing Information, sections 11 and 12.1. Janssen Pharmaceuticals, Inc. Prescribing Information PDF.
- SPRAVATO Prescribing Information, section 9.1.
- SPRAVATO Prescribing Information, section 5.5.
- SPRAVATO Prescribing Information, section 1.
- SPRAVATO Prescribing Information, section 14.1, Table 10. DailyMed setid d81a6a79-a74a-44b7-822c-0dfa3036eaed.
- SPRAVATO Medication Guide, revised 09/2026, in the Prescribing Information PDF.