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High Cost of Spravato (Esketamine) For Depression!

Ketamine has been in the headlines for its unusual antidepressant effect. Now esketamine is approved. Will the high cost of Spravato make it hard to access?

The first really new antidepressant in decades won FDA approval for treatment-resistant depression in March, 2019. Esketamine nasal spray is sold under the brand name Spravato. Physicians and patients were excited about this new type of antidepressant. That’s largely because existing antidepressants don’t help everyone and often take weeks to go to work. This nasal spray should start working within hours or days. But at what price? Has the high cost of Spravato limited access to this drug?

The High Cost of Spravato Could Be a Deterrent:

Patients may be shocked by the high cost of Spravato. People starting on this medication will need twice-a-week dosing for the first month. The list price is roughly $600 to nearly $900 per dose. That means the initial month could cost as much as $6,800.

After that, people will require once weekly or twice monthly nasal spray administration. At the end of a year, Spravato could end up costing $45,000. Some insurance companies may balk at that expense.

A Clinical Trial Volunteer is Left in the Cold Because of the High Cost of Spravato:

Q. I was a participant in a phase 3 clinical trial for esketamine, which came to market as the nasal spray Spravato. The FDA approved it for treatment-resistant major depression, a condition I’ve suffered from for 15+ years.

The effect was profound; an immediate relief of all suicidal ideation and brain fog and great improvement in mood. When the study ended, I relapsed within a month.

My psychiatrist then prescribed generic ketamine, compounded as a nasal spray by a local pharmacy. It cost about $50 for a month’s supply. RELIEF again, and no hallucinations or negative side effects.

Despite the positive effects, my doctor was uneasy about prescribing ketamine off-label and stopped. Spravato came on the market, but it’s prohibitively expensive–about $4000-$6000 a month for the dose/frequency I need. I am currently as depressed as I’ve ever been. It’s heartbreaking to know that the ketamine cure is out there, but I cannot access it.

A. Ketamine was developed as an injectable anesthetic agent and approved by the FDA in 1970 under the brand name Ketalar. It is still used as an anesthetic.

In 2002, Japanese researchers reported that small doses of ketamine:

“improved the postoperative depressive state and relieved postoperative pain in depressed patients” (Anesthesia and Analgesia, July, 2002).

Since then, many other studies have shown that this old medication appears to have fast-acting anti-depressant activity.

Esketamine (Spravato) is a chemical cousin of ketamine. It was approved for major depression in 2019. A meta-analysis confirms that this nasal spray does improve treatment-resistant major depression (Clinical Psychopharmacology and Neuroscience, May 31, 2021). 

Spravato is very expensive. You may qualify for the J&J patient assistance program, though. If you are not eligible, your physician might continue to prescribe ketamine off-label if he better understood your circumstances.

More About Spravato

Is the high cost of Spravato worth it? Most people never find out the actual effectiveness of a drug their doctor prescribes. They may also miss out on the side effects. 

Here is a link to an article we have written on this topic:

What Should You Know about New Antidepressant Spravato?

If you take the time to read the article above you will learn that two clinical trials with esketamine did not demonstrate that it was better than placebo. The FDA apparently ignored those studies. 

What About Ketamine Nasal Spray?

What the FDA is not talking about is the generic drug ketamine. It has been on the market since 1970. Here are some articles we have written about ketamine and depression:

Could Suicide Be Prevented with Better Access to Ketamine?

You can get an insider’s view of the history of ketamine at this link:

Some physicians are prescribing ketamine as a nasal spray. It is prepared by compounding pharmacies. This is completely off label. We suspect that the FDA would frown at such use. Although we have done no real cost comparison we suspect that such products are far less expensive than the high cost of Spravato. 

Share your own experience with depression below in the comment section. Has your doctor prescribed ketamine? How well did it work? What about side effects? If your doctor has prescribed Spravato, did your insurance company pay for it without objection? 

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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