The Thrive Journal · Advanced care
IV Ketamine vs Spravato®: cost, insurance, and how to choose
By Dr. Jason Borrego, DNP, PMHNP-BC, CRNA · Coral Gables, FL
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They come from the same molecule
Ketamine is made of two mirror-image molecules. Spravato® is esketamine — the patented S-half — FDA-approved as a nasal spray for treatment-resistant depression and taken with an oral antidepressant. IV ketamine uses the complete molecule, infused slowly with weight-based dosing that can be adjusted in real time. Both are given in a monitored medical setting; neither is take-home.
The cost question, answered directly
Spravato® is often covered by insurance because it’s FDA-approved — at a REMS-certified site like ours, many patients pay a specialist copay per visit. IV ketamine for depression is an off-label use of an FDA-approved anesthetic, so it’s self-pay: at Let’s Thrive, from $549 per infusion or $2,999 for a series of six, with financing available. Superbills are provided for out-of-network reimbursement.
How people actually choose
Insurance-first patients usually start with Spravato®. Patients who want maximum dosing precision — or who didn’t respond fully to esketamine — often choose IV. Some do both across their treatment course. The honest answer is that a consultation should decide it: your history, your cardiovascular picture, your prior medication trials, and your goals. At our practice both options live under one roof, delivered by a clinician dual-trained in psychiatry and anesthesia, so the recommendation isn’t biased by what we’re able to offer.
One more thing worth knowing: either way, a ride home is required, side effects like dissociation and blood-pressure changes are usually temporary, and results in trials — while sometimes rapid — are never guaranteed for an individual. Any clinic that promises otherwise is selling, not treating.
Read more on our IV Ketamine & Spravato® page, including the full side-by-side comparison and an honest fit filter.
Wondering what the right next step is for you?