Spravato (Esketamine) Treatment in DC, Maryland & Virginia
FDA-approved nasal spray for treatment-resistant depression, delivered in-clinic at all five Avesta locations. In-network with Aetna, Cigna, and the VA.
Spravato (esketamine) is an FDA-approved nasal spray indicated for treatment-resistant depression in adults, as monotherapy or alongside an oral antidepressant, and for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior, in conjunction with an oral antidepressant[1]. It is given in a certified clinic under medical supervision, never at home. At Avesta, Spravato is available at all five locations, and we are in-network with Aetna, Cigna, the VA, and Medicaid in both Maryland and Virginia. Below: what it costs, what the side effects are, how a session works, and how to check your coverage.
How much does Spravato cost?
With insurance, most Avesta patients pay $0 for the Spravato medication itself plus a $0 to $250 office visit, depending on plan and deductible. Without insurance, Spravato at Avesta is [[SELF-PAY PRICE GOES HERE. DO NOT PUBLISH UNTIL FILLED]] per session. The medication is billed separately from the monitoring visit, which is why two patients on the same plan can pay different amounts. See our insurance page for coverage by payer, or full ketamine therapy pricing across every treatment type.
What drives the cost of Spravato
Three things set what you pay: whether your plan covers the medication, whether your plan covers the in-clinic monitoring visit, and where you are in your deductible year. Induction is twice weekly for the first four weeks, then weekly, then every one to two weeks, so the first month costs the most.
What are the side effects of Spravato?
The most commonly reported side effects of Spravato in treatment-resistant depression are dissociation, dizziness, nausea, sedation, vertigo, reduced sensation, anxiety, lethargy, increased blood pressure, vomiting, and headache[1]. Most begin shortly after dosing and resolve the same day. This is why every Spravato session includes at least two hours of monitoring by our clinical staff before you are cleared to leave, and why you should not drive until the next day after a restful night of sleep.
Short-term side effects
Dissociation is the most commonly reported effect, described as a temporary sense of detachment from your surroundings. It typically peaks around 40 minutes after dosing and fades within the monitoring window. Blood pressure rises for most patients and is checked before dosing, at roughly 40 minutes, and again before discharge. Nausea, dizziness, and sedation are common and usually mild. The full list of adverse reactions is in the prescribing information[1].
Longer-term considerations
Spravato is dispensed only under a restricted program called the Spravato REMS, which requires that the medication be administered in a certified healthcare setting with direct provider observation and at least two hours of monitoring afterward[2]. Your Avesta prescriber reviews cardiovascular history, blood pressure control, and current medications before starting, and reassesses at every visit.
Who should not take Spravato
Spravato is contraindicated in people with aneurysmal vascular disease, an arteriovenous malformation, a history of intracerebral hemorrhage, or hypersensitivity to esketamine, ketamine, or any of the product’s other ingredients[1]. Your prescriber will review your full medical history at the consultation.
Is Spravato covered by insurance?
Yes, more often than any other form of ketamine care. Spravato is FDA-approved, so most commercial plans cover it with prior authorization, while IV ketamine remains off-label and is usually not a covered benefit. Avesta is in-network for Spravato with Aetna, Cigna, the VA, Maryland Medicaid, and Virginia Medicaid, and we handle prior authorization for you. Medicare is out-of-network for all plans and services. Full detail on our insurance page.
| Payer | Spravato | Where |
|---|---|---|
| Aetna | In-network | All 5 locations |
| Cigna, including NALC | In-network | All 5 locations |
| VA | In-network, authorization required | All 5 locations |
| Maryland Medicaid, including UnitedHealthcare plans | In-network | Bethesda, Columbia |
| Virginia Medicaid via Anthem HealthKeepers or Aetna Better Health | In-network | Tysons, Norfolk |
| Workers’ Compensation | In-network, authorization required | All 5 locations |
| Medicare | Out-of-network, all plans | Not applicable |
What happens during a Spravato treatment session?
You self-administer the nasal spray in our clinic under staff supervision, then stay for at least two hours while we monitor your blood pressure and how you are feeling. Most patients rest quietly. Bring headphones if music helps you settle. You will need a ride home, and you should not drive again until the next day after a restful night of sleep.
Treatment schedule
Weeks one through four: two sessions per week. Weeks five through eight: one session per week. From week nine onward: one session every one or two weeks, based on your response. Your prescriber adjusts this to you.
Which Avesta treatment is right for you?
Spravato is FDA-approved and usually covered by insurance. IV ketamine is off-label, dosed by weight, and gives your prescriber more control over dose and duration. Many Avesta patients start with whichever their plan covers and switch if response is limited. For a full comparison of the two, see Spravato vs ketamine.
Spravato treatment near you
Avesta offers Spravato at all five of our clinics: Washington, DC, Bethesda, MD, Columbia, MD, Tysons, VA, and Norfolk, VA. Each is a certified Spravato treatment center with on-site monitoring.
Frequently asked questions
How much does Spravato cost with insurance?
Most Avesta patients with coverage pay $0 for the medication plus a $0 to $250 office visit. The exact amount depends on your plan and where you are in your deductible year.
How long do Spravato side effects last?
Most side effects begin within minutes of dosing and resolve within the two-hour monitoring window. Dissociation typically peaks around 40 minutes and fades before you are cleared to leave the clinic.
Is Spravato the same as ketamine?
Not quite. Spravato is esketamine, the S-enantiomer of ketamine, delivered as a nasal spray and FDA-approved for treatment-resistant depression. Racemic ketamine contains both the S and R forms and is used off-label.
Can I drive after a Spravato session?
No. Arrange transportation home, and do not drive or operate machinery until the next day after a restful night of sleep.
How many Spravato sessions will I need?
Induction is twice weekly for four weeks, then weekly for four weeks, then every one to two weeks based on your response.
Does Medicaid cover Spravato?
Yes at Avesta, in both states. Maryland Medicaid is covered at our Bethesda and Columbia clinics, and Virginia Medicaid through Anthem HealthKeepers or Aetna Better Health at our Tysons and Norfolk clinics.
Can Spravato be used on its own?
For treatment-resistant depression, yes. The FDA label allows Spravato as monotherapy or alongside an oral antidepressant. For depressive symptoms with acute suicidal ideation or behavior, it is used together with an oral antidepressant[1].
References
- Janssen Pharmaceuticals, Inc. SPRAVATO (esketamine) nasal spray, CIII. Highlights of Prescribing Information. Revised March 2026. Accessed August 21, 2026.
- Spravato REMS Program. Requirements for certified healthcare settings and patient monitoring. Accessed August 21, 2026.
