Ketamine Nasal Spray vs. Spravato: Cost, Coverage, How It Works (2026)

I prescribe nasal ketamine for two very different problems: treatment-resistant depression and chronic pain syndromes. Patients ask me about it almost every week, usually because they have heard of Spravato and want to know whether it is the same thing as the compounded sprays some clinics advertise. It is not, and the difference matters for both cost and access. Below I walk through what nasal ketamine actually is, how Spravato (esketamine) is covered by insurance, what the supervised treatment process looks like, and where compounded nasal sprays fit for chronic pain.

What is Spravato?

Spravato, the FDA-approved nasal spray formulation of esketamine, is specifically designed for adults with treatment-resistant depression. Unlike traditional antidepressants that may take weeks to show results, Spravato works quickly, often providing relief within hours to days. It is used in conjunction with an oral antidepressant and administered under medical supervision in a certified healthcare setting.

Insurance Coverage for Spravato

Because Spravato is FDA-approved, some insurance plans cover it, but coverage is far from automatic. Most carriers require prior authorization, and the approval process can take days to weeks and is not always successful. When coverage is granted, copays typically fall in the $150-$300 per session range, though some patients with strong commercial plans see lower out-of-pocket costs. Without insurance, list price runs $600-$900 per session, see our Spravato vs. compounded ketamine cost comparison for how that stacks up against a $250/month at-home program.

The realistic expectation is this: Spravato is the only ketamine product with a reasonable shot at insurance coverage, but you should plan for a paperwork battle and budget for meaningful copays even if approval comes through. Check directly with your insurer for your specific plan. For a fuller comparison of Spravato versus compounded nasal sprays (including head-to-head cost, dose ranges, and clinical use cases), see our 2026 ketamine nasal spray guide.

Side Effects of Nasal Ketamine Compared to Other Methods

Nasal ketamine, like all forms of ketamine, can cause side effects, but its profile differs from oral or intravenous (IV) administration. Common side effects of nasal ketamine include:

• Dizziness and lightheadedness: Often mild and temporary, more frequent with nasal spray due to rapid absorption.
• Dissociation: A feeling of detachment from reality, typically more pronounced with IV ketamine.
• Nasal irritation: Specific to nasal administration, caused by repeated use of the spray.
• Nausea: Less common with nasal ketamine compared to oral forms.

Nasal ketamine has a quicker onset and is more convenient, while oral ketamine gives a slower, more sustained effect. Which one suits you is worth talking through with your prescribing provider.

The Supervised Treatment Process

Spravato treatment involves a carefully monitored process to ensure safety and efficacy. In practice, patients move through a few distinct stages.

Initial Consultation

A psychiatrist or qualified healthcare provider evaluates the patient to confirm suitability for Spravato therapy.

Induction Phase

Patients attend twice-weekly sessions for the first four weeks. Each session involves administering the nasal spray under supervision, followed by a two-hour observation period to monitor for side effects such as dizziness or dissociation.

Maintenance Phase

After the induction phase, sessions are gradually reduced in frequency based on the patient's response, often transitioning to weekly or biweekly visits.

Follow-Up

Regular assessments ensure the treatment continues to meet the patient's needs while managing any side effects.

Compounded Nasal Ketamine Sprays for Chronic Pain

While Spravato is designed for depression, compounded ketamine nasal sprays have gained traction in managing chronic pain syndromes such as neuropathy, fibromyalgia, and migraines. These sprays are prepared by licensed compounding pharmacies, tailoring the formulation to individual patient needs.

The benefits of compounded nasal ketamine include:

• PRN (As Needed) Use: Unlike oral tablets, compounded sprays can be used as needed, providing immediate relief for flare-ups.
• Customization: Dosages can be easily adjusted to meet specific requirements, enhancing comfort and minimizing side effects.
• Accessibility: Although compounded sprays are typically not covered by insurance, their cost-effectiveness and convenience make them an appealing option for many patients.

Risks: Higher risk of tolerance and abuse potential compared to oral tablets.

Is Nasal Ketamine Right for You?

Whether nasal ketamine makes sense comes down to what you are treating and what you can afford. If you have treatment-resistant depression and solid commercial insurance, Spravato is worth pursuing despite the paperwork, because it is the one option with a real chance at coverage. If you are dealing with chronic pain, or if out-of-pocket cost is the deciding factor, compounded nasal ketamine is usually the more practical route. Condition severity, your insurance situation, and how you weigh cost against FDA-approved status all feed into that decision, and it is a conversation worth having with a prescribing physician rather than settling alone.

At Discreet Ketamine we prescribe compounded ketamine nasal sprays for chronic pain, and we tailor the formulation and dosing to each patient. If you want to know whether this fits your situation, reach out and we can talk it through.

At Discreet Ketamine, we do not offer Spravato.

Frequently Asked Questions

How much does ketamine nasal spray cost?

It depends on the type. Spravato (FDA-approved esketamine) runs $600-$900 per session at list price, or roughly $150-$300 per session if your insurance approves coverage after prior authorization. Compounded nasal ketamine, used off-label for chronic pain, is generally not covered by insurance and is priced by the compounding pharmacy (often $80-$200 per bottle, depending on concentration and quantity). The clinical care fee from your prescribing program is separate from medication cost.

Does insurance cover ketamine nasal spray?

Sometimes. Spravato is the only ketamine nasal spray with FDA approval, which means it's the only one with any reasonable shot at coverage; even then, most plans require prior authorization, and approval is far from guaranteed. Compounded nasal ketamine for chronic pain is essentially never covered by insurance because it's an off-label compounded preparation.

Is Spravato the same as ketamine nasal spray?

Not quite. Spravato is a specific FDA-approved esketamine (the S-enantiomer of ketamine) nasal spray made by Janssen, restricted to certified clinics under a REMS program. "Ketamine nasal spray" colloquially also refers to compounded racemic or S-ketamine nasal preparations made by compounding pharmacies for off-label use, particularly for chronic pain. The two products share an active drug class but differ in formulation, regulation, and how they're prescribed.

Can you get a ketamine nasal spray for chronic pain?

Yes, through compounded nasal ketamine prescribed by a physician working with a U.S. compounding pharmacy. This is most commonly used for neuropathic pain, fibromyalgia, CRPS, and migraine flares. Spravato is FDA-approved only for treatment-resistant depression and is not used for pain. For chronic pain, compounded nasal ketamine or sublingual ketamine are the realistic options.

How does Spravato compare to compounded nasal ketamine?

Spravato is FDA-approved, REMS-regulated, administered in a certified clinic under direct supervision, and (sometimes) covered by insurance. Compounded nasal ketamine is off-label, prescribed for use at home, costs less out of pocket, but isn't covered by insurance and isn't FDA-approved for any specific indication. Spravato is the right answer for a patient with treatment-resistant depression who has good insurance and wants the FDA-cleared pathway. Compounded nasal ketamine is the right answer for chronic pain or when out-of-pocket cost matters more than FDA-approved status.

Why is Spravato so expensive?

Two reasons. First, Spravato has REMS-mandated supervised administration in a certified clinic, meaning you pay for clinic time, nursing supervision, and a two-hour observation period after each dose. Second, the drug itself carries a brand-pharmaceutical price tag rather than a compounded-pharmacy price. Compounded nasal ketamine avoids both costs but trades that for not having FDA approval, no REMS oversight, and no insurance coverage.

References

1. Daly EJ, Trivedi MH, Janik A, et al. Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry. 2019;76(9):893-903. PubMed: 31166571 Establishes Spravato (esketamine nasal spray) as FDA-approved for TRD as add-on to an oral antidepressant. Source for the body's claims about Spravato's FDA-approval pathway and supervised in-clinic administration model.

2. Fu DJ, Ionescu DF, Li X, et al. Esketamine Nasal Spray for Rapid Reduction of Major Depressive Disorder Symptoms in Patients Who Have Active Suicidal Ideation With Intent: Double-Blind, Randomized Study (ASPIRE I). J Clin Psychiatry. 2020;81(3):19m13191. PubMed: 32412700 Phase 3 trial supporting Spravato's broader indication for MDD with active suicidal ideation, the basis for the body's framing of Spravato as FDA-approved nasal-spray esketamine.

3. Sanacora G, Frye MA, McDonald W, et al. A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders. JAMA Psychiatry. 2017;74(4):399-405. PubMed: 28249076 APA-task-force consensus on screening, dosing, monitoring, and the framework distinguishing FDA-approved esketamine from off-label compounded racemic ketamine across routes.

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Discreet Ketamine provides at-home ketamine therapy to residents of Florida, New Jersey, and California. All treatments are supervised by Dr. Ben Soffer, a board-certified physician.