Does Insurance Cover Spravato in Connecticut? Prior Authorization and Cost, Explained

Cost is the question people are most afraid to ask about Spravato, so New Horizon Behavioral Health in West Hartford answers it before anyone is in the treatment room. This is how coverage, prior authorization and billing for Spravato (esketamine) actually work in Connecticut.

Is Spravato covered?

Spravato is FDA approved for treatment-resistant depression in adults, and that approval gives insurers a defined coverage pathway. Many commercial plans and Medicare plans cover it. Coverage is decided by your specific plan, not by the practice, and it nearly always requires prior authorization. The office contacts your plan with your member information and confirms coverage and any authorization requirements before you are scheduled.

What the prior authorization has to show

The authorization turns on your treatment history. It has to document which antidepressants you have already tried, at what dose, and for how long, because the label indication is depression that has not responded to at least two antidepressants at an adequate dose and duration. That is why the first visit, a psychiatric evaluation, reconstructs every psychiatric medication you have taken.

New Horizon's office assembles that record and files the authorization. You do not chase your insurer. If you have old records, discharge paperwork or a pharmacy printout, bring them. If you do not, come anyway and the office works from what you remember.

Two visits, two charges

The evaluation that decides whether Spravato is appropriate is billed as a psychiatric visit. Dosing sessions are billed separately, per session, as in-office drug administration. Your share depends on your deductible, copay and coinsurance for each. The office verifies benefits and gives you the expected number in writing before your first dosing session.

Manufacturer support

The manufacturer runs a patient support program for Spravato that some patients qualify for. The office tells you whether it applies to you rather than leaving you to find it.

Referring providers

New Horizon accepts Spravato referrals from psychiatrists, APRNs, primary care and therapists across Connecticut. Send the diagnosis, the antidepressant trial history with dose and duration, current medications, insurance information, and relevant medical history, particularly blood pressure and cardiovascular issues. Clinical records go by secure fax, not the web form. The office handles the authorization and reports back.

What happens in order

1. You call (860) 838-8799 or send the request form. No referral is needed.
2. The office calls back, confirms what you are looking for, and checks that an evaluation is the right first step.
3. Benefits are verified and the prior authorization is filed. For Spravato this step takes longer than for a therapy visit, because of the trial history it has to document.
4. You get your expected cost in writing, then an evaluation time.
5. The evaluation decides candidacy. No medication is given that day.
6. If approved, dosing sessions are scheduled. You need a ride home from every one.

Self-pay

Ask the office for current self-pay rates if your plan is out of network or you prefer not to bill insurance.

Details on treatment itself are on the Spravato page. To start, request an appointment or call.

New Horizon Behavioral Health
10 Princeton St, Ste N, West Hartford, CT 06110
Phone: (860) 838-8799
Email: info@newhorizonbehavioralhealth.com
By appointment, Monday through Friday. In person only. Adults 18 and over.
In a crisis, call or text 988, or call 911.