For individuals struggling with treatment-resistant depression (TRD), finding an effective solution can often feel overwhelming. If you’ve gone through multiple antidepressants and therapies without success, you might be exploring ketamine-based options such as Spravato (esketamine). However, you may feel concerned about covering the costs.
At McLean Neuropsychiatric Treatment Center (NTC), we’re here to help you understand how Medicaid can support your journey toward mental health. This guide will walk you through the coverage options available for Spravato and other depression treatments.
What Is Ketamine Therapy for Depression?
Ketamine therapy involves using ketamine, a medication historically used as an anesthetic, to help treat mental health disorders, particularly depression.
Several studies show ketamine can offer rapid-acting, sustained relief from symptoms of mood disorders, including major depressive disorder (MDD). It has shown to be particularly beneficial for those who haven’t previously responded to traditional antidepressants.
Unlike antidepressants, ketamine works by increasing the release of glutamate, a chemical messenger. This is believed to increase neuroplasticity—the brain’s ability to form new connections and repair damaged ones—helping people overcome rigid negative thinking and unhealthy behavioral patterns.
Ketamine therapy involves two main treatment types: ketamine infusions and Spravato. For ketamine infusions, patients receive intravenous injections of ketamine for around 40 minutes. For Spravato, patients self-administer two to three doses of esketamine (a derivative of ketamine) intranasally, with around five minutes between each dose.
Patients will be under clinical supervision during both these treatments, allowing vital signs to be closely monitored and ensuring patient safety. Many patients report feeling benefits within hours of ketamine and Spravato treatment.
Does Medicaid Cover Ketamine Therapy in Virginia?
Medicaid is one of the major healthcare insurers in the US, providing coverage to nearly one in every five Americans. Medicare is part of the same government-funded program but provides health coverage for older adults. While a federal program, Medicaid is administered by individual states, allowing for variations in covered services and costs.
Medicaid in Virginia does not cover the cost of ketamine infusions, but it does cover the costs for Spravato. This is because ketamine infusions are provided “off-label” for depression, meaning the FDA hasn’t approved the drug for this use.
Spravato, on the other hand, was FDA-approved for both TRD and major depressive disorder (MDD) with suicidal ideation in 2019. This means the FDA recognizes Spravato as a safe and effective treatment and has outlined specific guidelines for its use. As such, patients can seek financial compensation for Spravato use from several insurance companies, such as Medicaid (Virginia). Other insurance companies that cover the cost of Spravato in Virginia include:
- Anthem/Blue Cross Blue Shield
- United Healthcare
- Aetna
- Cigna
- Humana
- Virginia Premier
- Kaiser
How to Verify Medicaid Coverage for Spravato in McLean, VA
Eligibility for Spravato
Spravato is only available for those with TRD and MDD with suicidal ideation. Those with TRD will have tried at least two different first-line antidepressants at adequate doses for at least six to ten weeks.
Speak with McLean NTC
At McLean NTC, we can help verify your coverage and guide you through the process of accessing Spravato under your Medicaid plan. We’ll be able to assess whether you’re eligible for Spravato and ensure that you understand your payment options.
What If Medicaid Doesn’t Cover Spravato? Alternative Payment Options
In the rare case that Medicaid doesn’t cover Spravato, there may still be ways to access innovative yet financially accessible therapies for depression. McLean NTC can help you understand your options and any costs that might be involved, helping you make an informed decision about your treatment. We may be able to help you with flexible payment plans and alternative financial assistance.
You can request a consultation through our website to speak with one of our team members.
Why Choose McLean NTC for Your Treatment in McLean, VA?
At McLean NTC, we are committed to offering innovative solutions for patients with treatment-resistant depression. Our approach is personalized, focusing on your unique needs and circumstances. Here’s why so many patients in McLean and throughout Virginia trust us:
- Experienced Care: Our healthcare providers are trained and certified in administering Spravato treatments and managing complex cases of treatment-resistant depression.
- Patient-Centered Approach: We believe in putting patients first. From initial consultations to post-treatment care, our team is dedicated to supporting you every step of the way.
- Insurance Assistance: We know navigating insurance can be difficult, so we help patients verify coverage and understand their benefits.
Key Takeaways:
- Medicaid in Virginia often covers Spravato (esketamine) for patients with treatment-resistant depression.
- McLean NTC in McLean, VA, accepts Virginia Medicaid and Medicare, helping you navigate insurance and access advanced care.
- If Medicaid doesn’t cover your treatment, there are alternative payment options available, including payment plans and financial assistance.
Sources
- https://www.dmas.virginia.gov/
- https://www.spravato.com/insurance-coverage/
- https://pubmed.ncbi.nlm.nih.gov/32387141/