NJ Spravato Treatment Costs: What Your Insurance Covers

1. The Basics of Spravato Treatment

Spravato, a nasal spray form of esketamine, is FDA-approved for treatment-resistant depression and major depressive disorder with suicidal thoughts or actions. It’s administered in a controlled healthcare setting and often used in conjunction with oral antidepressants.

2. Average Costs of Spravato Treatment in New Jersey

Without insurance, Spravato treatment can be expensive. The medication itself typically costs between $590 to $885 per treatment session, depending on the dosage. Additionally, there are costs associated with the administration and monitoring required during each session. In New Jersey, the total cost per session can range from $700 to $1,200 or more.

3. Insurance Coverage: A Game-Changer for Accessibility

The good news? Almost every insurance plan in New Jersey is now covering Spravato treatment. However, coverage varies widely between providers and specific plans. Here’s what you need to know:

• Major Insurers: Companies like Aetna, Cigna, UnitedHealthcare, and Horizon Blue Cross Blue Shield of New Jersey often provide some level of coverage for Spravato.
• Medicare and Medicaid: Both Medicare Part B and New Jersey Medicaid now cover Spravato for eligible patients when the treatment is administered in a participating Certified Spravato Treatment Center.
• Prior Authorization: Most insurance plans require prior authorization before approving coverage for Spravato.

4. Navigating the Prior Authorization Process

Obtaining prior authorization can be complex, but it’s essential for securing coverage. Your healthcare provider will need to demonstrate:

• Your diagnosis of treatment-resistant depression
• Previous unsuccessful attempts with other antidepressants
• Medical necessity for Spravato treatment

Pro Tip: Work closely with your doctor and the treatment center to gather all necessary documentation for a smooth authorization process.

5. Understanding Your Out-of-Pocket Costs

Even with insurance coverage, you may still have some out-of-pocket expenses:

• Copayments: Typically range from $25 to $40 per session
• Coinsurance: You might be responsible for 10-30% of the treatment cost, though the SpravatoWithMe program will often pick up this cost if the treatment center processes the paperwork properly.
• Deductibles: Ensure you understand your plan’s deductible and how it applies to Spravato treatment. Oftentimes, the SpravatoWithMe program will pick up this cost if the treatment center processes the paperwork properly.

6. Financial Assistance Programs: A Lifeline for Many

Don’t let costs deter you from exploring Spravato. Several programs can help make treatment more affordable:

• Janssen SpravatoWithMe: The manufacturer of Spravato offers a savings program that can reduce out-of-pocket costs to as little as $10 per treatment for eligible patients.
• Patient Assistance Programs: Some treatment centers offer sliding scale fees or payment plans.
• Nonprofit Organizations: Organizations like the Depression and Bipolar Support Alliance may offer grants or financial assistance for mental health treatments.

7. The Long-Term Value Proposition

While the upfront costs of Spravato may seem high, it’s essential to consider the long-term benefits:

• Potential for rapid improvement in depressive symptoms
• Reduced need for hospitalizations or emergency care
• Improved quality of life and ability to work or study
• Decreased reliance on other medications over time

One study found that patients who responded well to esketamine treatment had 32% lower total healthcare costs in the following six months compared to non-responders.