The People's Perspective on Medicine

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 recently won FDA approval for treatment-resistant depression. Esketamine nasal spray will be sold under the brand name Spravato. Physicians and patients have been eagerly awaiting the arrival of this new type of antidepressant. That’s largely because there has been a lot of hype around the new drug. Perhaps another reason is that traditional antidepressants take weeks to go to work. This nasal spray should start working within hours or days. But at what cost? Will the high cost of Spravato prevent patient access?

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. Those costs would range from $2300 to $3500. At the end of a year, Spravato could end up costing $45,000. Some insurance companies may balk at that expense.

What’s the Story on 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 a recent 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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Our IV ketamine clinic in Akron has looked into Spravato–there are ways to reduce the cost for patients but it’s a lot of paperwork for everyone, and the data just isn’t as good as for the IV formulation. We’re talking to compounding pharmacies to see if that form of nasal ketamine is a better solution, even if insurance won’t cover it.

IV Ketamine turned my 15 year TRD around in a few hours. I was the first one treated in my area and establishing dose and frequency was a learning experience for all involved. A maintenance regimen was established, I enjoyed a ten year remission, no side effects, and no other antidepressants. I regained a life that I never thought was possible. I only wish it was that successful for everyone, but that is not the case.
Life was good until my doctor retired and the clinic discontinued the treatment. Now I am right back where I was ten years ago. Lack of availability and cost are a huge deterrent to achieving another remission!

I am really sick of long-lasting depression and anxiety that really took all the joy away from my life. Being partially treated with typical SSRI Drugs, I really missed the true me. I am really optimistic that the cost will go down as time progresses, especially since other treatment alternatives are coming to the market, such as psilocybin. The existing cost of eskatimine is a price that the average person cannot afford so it is not a practical solution to the problem. I wish psychology experts truly understood that depressed people are suffering and looking for reasonable treatments to live a normal life.

I’m curious, does any insurance actually cover this? Where is off-label use accessible? Thank you for any feedback you may have!

Had it twice for operations. Yes, it can, and often does, cause nightmarish thoughts and feelings. The second time I had told them not to use it, but they goofed up and did anyway.

I have suffered severe depression for over 20 years. I even had ECT treatments which only caused harm. Had blackouts for over a year after ECT. I am hoping and praying I can have access to this nose spray. I saw an article that said a compounding place in Atlanta was making this nose spray for 49.00 dollars. Of course this would still have to be ordered through Dr. and used in their office. Although this might not be the price we would pay, I’m sure those of you, who like me, dread every day of life are thinking of this as a life-saving drug. Hopefully, all who need it can get it soon. I do feel your pain!!!!!!

Praying for all of you who suffer from this life-destroying illness. For those of you that do not, this is not a choice, although my family thinks it is.

I am commenting this for Walt Lupo please! I was extremely interested and hopeful after reading your comment! If you don’t mind I would be very grateful if you would email me and advise how i can go about doing what you suggested. I apologize if I sound stupid, but I am so desperately looking for something to help me with this crippling depression so maybe I can have a will to live again! Thanks so much for your time!

I just started taking ketamine IV two weeks ago after hearing all about the hype on the Spravato. After a few days ..holy moly. I’m a person again! I haven’t really laughed and enjoyed anything at all for more than 20 years, my entire adult life. I just got a life gifted back to me and all I feel now is hope and gratefulness. Nothing has been even close to how ketamine has transformed me.

I’ve been on over a dozen antidepressants that entire time with half a dozen psychiatrists, and while some things helped, this doesn’t come close. This isn’t placebo. No way. I’ve never had any desire to abuse or use anything illicit in my life. So what if you feel a little euphoria during? It’s not going to result in everyone everywhere abusing it when prescribed selectively.

I’ve sure suffered enough, long enough, and have grappled with suicide for years. That’s all gone now. There’s probably so many people out there suffering. This medication saved my life. I don’t really care how much that costs. Nothing is more important. So to the above poster, yes, to me this indeed is like a life saving chemo. It needs to be accessible to everyone that needs it, yes, but, all I can think now is this: It’s sure exciting to be alive! Thanks ketamine.

I had high hopes for this drug, but it’s getting to be a joke! It’s a nasal spray, for crying out loud, not chemotherapy. If someone is truly disabled by chronic, treatment-resistant depression, where are they supposed to get $600.00 to $900.00 per dose to pay for this medication? If you can’t work, you probably don’t have private ins. so Janssen’s much-hyped savings card won’t help you. You might as well get an off-label ketamine infusion. A local clinic near me charges about half as much.

So Johnson & Johnson offers to provide the drug free of charge IF you can prove that you already spend at least 4% of your paltry income (after rent, food, utilities, etc.) on prescription drugs! Makes me sorry I put so much effort into trying to save money, because (in spite of paying my doctor out-of-pocket, since nobody accepts Medicare) I apparently don’t spend ENOUGH! And nobody has even mentioned the doctor’s charges for 2 hours of observation in his office. They are bragging about prescription assistance and teasing the public with something they can never have. When I called for information, the rep. I spoke to didn’t even know what the drug was and tried to tell me I was looking at the wrong website.

Oh, and if you’re uninsured, they refer you to Medicaid or Healthcare.gov. How noble! Maybe the copay is only about $300.00 per dose! Even if it is a “wonder” drug, it won’t matter if patients can’t afford it.

Try Niacin!!!! I have been taking it for about a month now. Depression and anxiety nearly gone.

you wanna talk price!!! me as an individual [not a huge BigPharma corp.] can purchase enough ketamine to produce over 1700 bottles [1 dose = 1 bottle = 2x 28mg sprays] for under $600.00 Now that is not totally accurate… Ketamine is made up of two isomers [as well as every other molecule on the planet] the R-isomer and the S-isomer [organic chemistry i wont bore you!!] now es-ketamine is the “es”-isomer of ketamine…get it. The point, 56mg ketamine and 56mg esketamine not exactly the same but very close you could think of 56mg ketamine being made up of 28mg R and 28mg S isomers which is pretty accurate most times. If you dont have time to do math thats roughly 0.35 cents a bottle !

Sounds like another Opioid crisis waiting to happen. Heroine like medications, now ketamine like medications? How can these addictive substances help ? Without creating another problem.

There sure seems to be a lot of “mights” and “maybes” in the studies drug companies use to tout their new “wonder” drugs. One thing we can always be SURE of is lots of money for the company.

My experience with ketamine was as a hospital rep for Parke Davis, the company that first marketed the drug. It was a novel anesthetic that was quite safe because it had a wide therapeutic index. ( Effective dose versus toxic dose.) It ended up being only used in special situations because of the emergence reactions that it caused. Read bad trips. It was very disappointing because many anesthesiologists felt this would be the answer to safe anesthesia.

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