# Does Medicaid Cover Spravato? Virginia Medicaid Explained

> Does Medicaid cover Spravato? It can, but it depends on your state and plan. Learn how Virginia Medicaid (Cardinal Care) works and what to ask before you start.

URL: https://foundationmedicalgroup.org/does-medicaid-cover-spravato/
Published: 2026-09-19
Updated: 2026-09-19

Medicaid can cover Spravato, but coverage depends on your state and your health plan. And insurance plans usually want to review your case first. In Virginia, Medicaid is called Cardinal Care, and most members get care through a managed care health plan. So does Medicaid cover Spravato for you? Call your plan and the clinic to confirm coverage before treatment starts.
What Is Spravato Treatment, and Why Does Medicaid Coverage Work Differently? Spravato (esketamine) is a prescription nasal spray for adult patients with treatment resistant depression. According to the prescribing information on DailyMed, it can be used alone or with an oral antidepressant. It’s also used, with an oral antidepressant, for adults with depression who have acute suicidal thoughts or actions.
In the studies for treatment-resistant depression, patients hadn’t responded well enough to at least two different antidepressants, taken at a good dose for long enough. So Spravato treatment is meant for people whose depression didn’t improve enough with traditional antidepressants. If that’s you, you’ve likely been through a lot already. Sorting out insurance on top of that? Frustrating is putting it mildly.
Here’s why Medicaid coverage works differently. Spravato is an esketamine treatment that’s given only in REMS-certified healthcare settings, with monitoring after each dose. That means coverage involves both the medicine and the clinic visit. To learn more about esketamine therapy itself, read how Spravato works.
Side note, because this catches people off guard. Most of us picture a nasal spray as something you grab at the pharmacy and use at home, like an allergy spray. Spravato isn’t that. You use it at the clinic, staff keep an eye on you afterward, and you stay until the monitoring period ends. Strange for a nasal spray? A little. But it’s the same reason the clinic visit shows up in the coverage picture at all. Anyway, back to Medicaid.
Does Medicaid Cover Spravato? Medicaid is public insurance run by each state. So the rules for Spravato coverage shift from one state to the next, and again from one health plan to another.
There’s a federal layer too. Medicaid.gov explains that every state and the District of Columbia covers prescription drugs under the Medicaid Drug Rebate Program. In that program, drug makers sign a rebate agreement in exchange for state Medicaid coverage of most of their drugs. Sounds simple. It isn’t quite. MACPAC, the Medicaid and CHIP Payment and Access Commission, notes that states may still limit some drugs through preferred drug lists, prior authorization and quantity limits. So “covered” and “approved for you” aren’t the same thing.
In practice, insurers often check medical necessity before they sign off on a treatment like this, weighing your health history against their own clinical criteria to decide which members count as eligible patients. Your plan makes the final call. Odd, when you think about it: a reviewer who has never met you weighs in on your care. That’s how the system is built, though, and knowing it ahead of time takes a little of the sting out.
In Virginia, the state Medicaid agency (DMAS) says that service authorizations for behavioral health services go through Acentra Health (formerly Kepro). That’s general context about how approvals work. It isn’t a Spravato rule.
Many Medicaid patients wonder whether their plan will pay for Spravato. Sound familiar? Start with three calls:
Your health plan first, using the phone number on your insurance card. Your prescriber, who can spell out your diagnosis and walk through your treatment history (which antidepressants you’ve tried, and how they went). Then the certified clinic. It can help you check your coverage. Is Spravato Covered by Medicaid in Virginia? Virginia Medicaid is called Cardinal Care. According to DMAS, all managed care and fee-for-service Medicaid and FAMIS members in Virginia are part of Cardinal Care.
Most members get their care through managed care. DMAS says managed care serves over 90 percent of members through five health plans. These are the five Cardinal Care plans. For each plan below, call to confirm coverage:
Aetna Better Health of Virginia Anthem HealthKeepers Plus Humana Healthy Horizons in Virginia Sentara Health Plans UnitedHealthcare Community Plan of Virginia Like other insurance companies, each plan decides what it covers. It may also want Spravato prior authorization before your first dose. Find out whether prior authorization is required and which forms it needs.
On the pharmacy side, DMAS lists a Preferred Drug List and service authorizations for fee-for-service members, plus a separate drug formulary for each managed care plan. Which list is yours? That depends on how you’re enrolled, so ask your plan which list and which approval steps apply to Spravato.
Foundation Medical Group accepts Virginia Medicaid (Cardinal Care) at our Richmond clinic. Your own plan still decides, so call to confirm coverage. Cardinal Care runs on different rules from the major insurance plans people often get through a job, so ask even if you’ve used other insurance plans before.
What Should Medicaid Patients Ask Before Starting Spravato? Before you start, phone your health plan and ask these five questions:
Is Spravato covered under my plan? Do I need Spravato prior authorization? Is it billed under the medical benefit or the pharmacy benefit? Is there a copay for the medicine or the clinic visit? Does my plan accept the clinic I want to use? That last one you can partly check yourself. DMAS’s Find a Provider page offers a provider search for fee-for-service members, and it points managed care members to the enrollment website to find providers in their plan.
Write down the date, the name of the person you spoke with, and what they said about your insurance coverage. It sounds fussy, a bit like keeping the receipt for a toaster. Still, if there’s a mix-up later, those scribbled notes can spare you a maddening second round of calls.
Next, bring your healthcare providers into it. Ask them: Have I tried enough antidepressants for Spravato to make sense? Is my diagnosis treatment-resistant depression? Their answers help your plan review your case.
You may also hear about a manufacturer support program called Spravato withMe, sometimes described as the Spravato withMe savings program. Rules for a savings program can be different when you have government insurance like Medicaid. Don’t guess on this one. Check with the program directly about what applies to you, and jot that answer down too.
How Do REMS Rules Affect Spravato Therapy and Coverage? The FDA lists a safety program for Spravato, called a REMS. According to MedlinePlus, the patient, the prescriber and the pharmacy or clinic must all be enrolled. Patients take each dose at a certified clinic, not at home. DailyMed adds that the healthcare setting must be REMS-certified.
After each dose, patients are monitored for at least 2 hours. You can’t drive until the next day, after a restful sleep. So line up a ride home ahead of time. Yes, even if you feel fine. A friend, a partner, a neighbor who owes you a favor: whoever it is, book them before the appointment, not after.
The dosing schedule also shows why Spravato therapy means many visits. MedlinePlus describes doses twice a week in weeks 1 to 4, once a week in weeks 5 to 8, and then once a week or every 2 weeks. Per DailyMed, your prescriber checks whether the therapy is helping at the end of the 4-week first phase. So with this treatment, coverage has to stretch across a series of visits, which is a lot of appointments to juggle when you’re already worn down. That’s why it helps to ask your plan about the whole course, not just the first dose. Tedious? Absolutely. But a single well-aimed question now beats a surprise bill halfway through.
Medicaid, Commercial Insurance, and Medicare Coverage for Spravato at a Glance Will your insurance cover Spravato? Depends on the kind of plan you carry. Here’s a simple view of the three main types.
Insurance type Who runs it What to ask At FMG Richmond, VA Medicaid (Virginia: Cardinal Care) The state, mostly through managed care plans Is Spravato covered? Is prior authorization needed? Cardinal Care accepted; call to confirm coverage Commercial insurance Private insurance companies Medical or pharmacy benefit? Copay? Prior authorization? Aetna, Anthem, Cigna, UnitedHealthcare, TRICARE, Sentara: call to confirm coverage for each Medicare (Part B, Part D, Medicare Advantage) Federal program and private plans Which part covers it? Medicare is not accepted at the Virginia clinic This table is general. Call your plan and our team to confirm coverage.
Medicare has several parts, including Medicare Part B, Part D and Medicare Advantage. Ask Medicare or your plan which part, if any, covers Spravato.
How Is Spravato Different From Ketamine Therapy for Coverage? Spravato is an FDA-approved nasal spray given in a certified healthcare setting. An IV ketamine infusion is a separate treatment, given through a vein rather than the nose. Ketamine treatment and Spravato are paid for in different ways, too.
At Foundation Medical Group in Richmond, ketamine therapy (IV and IM) is used for treatment-resistant depression, chronic PTSD and severe anxiety. For patients, ketamine therapy is self-pay, and some plans cover a portion. Don’t assume your Medicaid plan will pay for ketamine therapy. Ask first.
Weighing depression treatment options side by side? Look at the total cost and coverage of each mental health treatment across the full course, not only one visit. Our Spravato cost guide explains what shapes the Spravato cost.
Spravato Treatment in Richmond, VA: Checking Your Medicaid Coverage With FMG Foundation Medical Group offers Spravato treatment at our Richmond, Virginia clinic only: 11600 Busy Street, Suite 203, Richmond, VA 23236. Spravato is not offered at our clinics in Utah, Georgia or Texas.
We accept Virginia Medicaid (Cardinal Care); call to confirm coverage. Medicare is not accepted at the Virginia clinic. Patients can call us first, so they know what to ask their plan. Our team can also check your benefits and help with the prior authorization paperwork, so you aren’t untangling all of it by yourself. If you’ve ever spent an afternoon on hold with an insurer, you’ll know why that matters. Your plan still makes the final call.
Learn more on our Spravato treatment in Richmond, VA page or our Virginia clinic page. The Richmond office also offers psychiatry and talk therapy as part of your mental health care.
Key Takeaways Medicaid may pay for Spravato for eligible patients, but the rules depend on your state and your health plan. In Virginia, Medicaid is Cardinal Care, and most members are in one of five managed care plans. Spravato is given only in REMS-certified clinics, with at least 2 hours of monitoring. Ask your insurance plan about prior authorization and which benefit covers it. Foundation Medical Group offers Spravato in Richmond, VA only. Medicare is not accepted there. Call to confirm coverage. FAQ Is Spravato covered by Medicaid in Virginia? It can be. Virginia Medicaid is Cardinal Care, and your health plan decides. Foundation Medical Group accepts Cardinal Care at our Richmond clinic, so call to confirm coverage before you start.
Does Medicaid cover esketamine nasal spray? Esketamine is the medicine in Spravato. Coverage for patients depends on the state and the health plan, and prior approval is often part of the process. Ask your plan first.
What insurance covers Spravato? Many commercial plans and some Medicaid plans may cover Spravato. In Virginia, common plans include Aetna, Anthem, Cigna and UnitedHealthcare. For each one, call to confirm coverage.
Does Medicare Part D cover Spravato? The answer depends on your Medicare plan, so ask Medicare or your plan directly. Foundation Medical Group does not accept Medicare at our Virginia clinic.
Sources MedlinePlus (NIH), Esketamine Nasal Spray. DailyMed (NIH), SPRAVATO (esketamine) nasal spray prescribing information. U.S. Food and Drug Administration, Approved Risk Evaluation and Mitigation Strategies (REMS): Spravato. Virginia Department of Medical Assistance Services, Cardinal Care Members. Virginia Department of Medical Assistance Services, Cardinal Care Managed Care. Virginia Department of Medical Assistance Services, Behavioral Health. Virginia Department of Medical Assistance Services, Pharmacy and Drug Formularies. Virginia Department of Medical Assistance Services, Find a Provider. Medicaid.gov (CMS), Medicaid Drug Rebate Program (MDRP). Medicaid and CHIP Payment and Access Commission (MACPAC), Prescription Drugs.