Spravato (Esketamine) Treatment in Scottsdale

Spravato is the brand name for esketamine, the S-enantiomer of racemic ketamine. It is administered as a nasal spray that the patient self-administers under the direct observation of a healthcare provider, and it is not dispensed for home use. [FDA label]

The prescribing information describes esketamine as a non-selective, non-competitive NMDA receptor antagonist and states that the mechanism by which it produces its antidepressant effect is unknown. Every session includes a monitoring period of at least two hours, and patients cannot drive until the next day after a restful sleep.

For a fuller explanation, see what is Spravato in our Knowledge Center.

The approved labeling covers two adult indications:

• Treatment-resistant depression in adults — as monotherapy or in conjunction with an oral antidepressant. [FDA label] The monotherapy option was added by FDA supplement approval on January 17, 2025. [FDA approval letter]
• Depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior — in conjunction with an oral antidepressant.

The labeling attaches explicit limitations to that second indication:

• 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.
• Spravato is not approved as an anesthetic agent.

Spravato is not a substitute for emergency psychiatric care. If you may be in immediate danger, call 911 or go to the nearest emergency department.

Fitting an FDA indication is a starting point, not a decision. The trials supporting the treatment-resistant depression indication enrolled adults who had an inadequate response to at least two antidepressants at adequate dose and duration during the current depressive episode. [Am J Psychiatry]

The labeling also lists three contraindications: aneurysmal vascular disease or arteriovenous malformation; a history of intracerebral hemorrhage; and hypersensitivity to esketamine, ketamine, or any of the excipients. Blood pressure, pregnancy and reproductive plans, substance use history, and other medications are additional considerations rather than automatic exclusions.

Not everyone who asks about Spravato will be a candidate for it, and insurance criteria can differ from FDA labeling. Final eligibility requires an individualized clinician evaluation. See who qualifies for Spravato and safety, warnings, and contraindications.

The structure of a session is set by the FDA-approved labeling and the REMS program, and is the same at any certified setting: [FDA label]

• Avoid food for at least 2 hours and liquids for at least 30 minutes before administration; nasal corticosteroids or decongestants, if needed, at least 1 hour before.
• Blood pressure is checked before dosing.
• You self-administer the nasal spray under direct observation — two devices for 56 mg, three for 84 mg, with a five-minute rest between devices.
• Blood pressure is checked again at approximately 40 minutes, when the increase peaks, and monitored until it declines.
• You are monitored for at least two hours, including respiratory status, then assessed for clinical stability before discharge.

The labeled schedule for treatment-resistant depression is twice weekly for weeks 1 through 4, once weekly for weeks 5 through 8, then once weekly or every two weeks, individualized to the least frequent dosing that maintains remission or response. The regimen for the acute suicidal ideation indication is different: 84 mg twice weekly for four weeks with an oral antidepressant, and use beyond four weeks has not been systematically evaluated. See how often treatment is given and what to expect at your first appointment.

Two requirements apply to every session, at every stage of treatment: [FDA label]

• Monitoring for a minimum of two hours after administration, followed by an assessment of clinical stability before you are discharged.
• No driving or operating machinery until the next day, after a restful sleep.

Please arrange a driver or rideshare before each appointment. Our suite is on the ground floor with direct access from the adjacent surface parking lot — see our Scottsdale clinic page for directions.

Because Spravato has FDA-approved labeling for specific indications, most plans have a written coverage policy for it — and nearly all require prior authorization before treatment begins. A plan may process it under the medical benefit or the pharmacy benefit, which affects how it is billed.

Insurers commonly ask for diagnosis codes, documentation of the current episode, and a record of prior antidepressant trials with doses and durations. Approvals are usually granted for a defined period and must be renewed.

What you pay depends on your plan’s deductible, coinsurance or copay, network status, and out-of-pocket maximum. We cannot promise that your plan will approve coverage, and we cannot predict your out-of-pocket cost. Call (623) 343-3466 to discuss how billing would work for your plan.

Detail on both topics is in does insurance cover Spravato and Spravato prior authorization.

“What will this cost me?” is the question we get most, and the honest answer is that it depends on your plan rather than on our pricing. Spravato billed through insurance is not a fixed price the way a cash-pay infusion is, and we would rather tell you that than quote a number that turns out not to apply to you.

The two things that decide your share

Both are questions for your insurer, not for us — but knowing which one applies explains most of the variation between patients.

• Where you are in your plan year. If your deductible is unmet, you may pay the negotiated rate for early sessions and substantially less once it is met. If you have already hit your out-of-pocket maximum, covered services are generally paid at 100%. Because Spravato is given twice weekly at first, this cost falls repeatedly rather than once.
• Medical benefit or pharmacy benefit. As described above, plans handle Spravato either way. That choice determines which deductible applies, whether you owe a percentage (coinsurance) or a flat amount (copay), and whether a specialty pharmacy bills you separately from the clinic visit. Ask your plan which applies to you.

The most useful thing you can do

Call your insurer before your first appointment and ask three questions: is Spravato (esketamine) covered under my medical or pharmacy benefit, what is my remaining deductible and out-of-pocket maximum, and is prior authorization required. The answers determine your cost more than anything on this page.

We are glad to talk through how billing would work for your plan before you commit to treatment. Call (623) 343-3466. We cannot quote a price for you until your plan responds, and we will not pretend otherwise.

Innerbloom Medical is a veteran-owned, physician-led clinic at 4388 N. Civic Center Plaza, Suite 101, in Old Town Scottsdale, serving patients across the Phoenix metro area. Treatment is supervised by Dr. Andrew Zabel, a board-certified Emergency Medicine physician, in a private treatment room.

Innerbloom Medical is certified in the Spravato REMS program, which is a requirement for any setting that provides Spravato — it permits us to offer the medication and is not a mark of distinction between certified clinics. What the certification does guarantee is that the observation, monitoring, and dispensing rules described above are followed here. [SPRAVATO REMS]

In-depth, source-cited articles on eligibility, safety, treatment schedules, insurance, and how Spravato compares with IV ketamine. Browse all articles →