What changes state to state
Three things change when you cross a state line: the Medicaid program and how its drug list treats Spravato, the board that licenses your clinician, and how far you are from a certified treatment center. The federal rules stay the same. Ketamine is a Schedule III controlled substance under federal law. Doctors may prescribe an approved drug for an unapproved use when they judge it medically appropriate, and a prescription for a controlled substance may be written only by a practitioner who is registered with the DEA and authorized to prescribe controlled substances by their state. Spravato® (esketamine) nasal spray is FDA-approved and can only be given in a healthcare setting certified in its REMS safety program.
Does Medicaid cover Spravato®? Our coverage page puts these East Coast Medicaid programs in one table, next to Medicare and eight commercial insurers.
If you are weighing at-home ketamine prescribed over telehealth, first read what the FDA’s compounding risk alert means on our safety page.
Tools that work in every state
Find a certified Spravato treatment center
Spravato is taken under the direct observation of a healthcare provider, followed by at least two hours of monitoring, and it is never dispensed for home use. Only healthcare settings certified in the Spravato REMS program can give it. The manufacturer’s Find a Center tool lists certified treatment centers by location. The drugmaker runs it, not a government agency, so treat it as a starting list and ask any center you call how it bills your insurance.
Check a clinician’s license
Each state on this page has an official online license lookup for physicians. Search the prescriber’s name and confirm the license is active before you book. Nurse practitioners, physician assistants, and in some states osteopathic physicians are licensed by a different board; if you cannot find a prescriber, ask which board licenses them and check that board. The lookup for each state is the last link in its card below.
Search clinical trials
ClinicalTrials.gov, a registry from the National Library of Medicine at the National Institutes of Health, lists ketamine and esketamine studies in depression. You can filter by location and by whether a study is recruiting. According to ClinicalTrials.gov, many studies pay for the study treatment and research-related tests and visits, and some pay participants; you or your insurance still pay for your regular health care. Some studies compare a drug with a placebo, so you may not receive the active drug.
Find mental health treatment near you
FindTreatment.gov, from the federal Substance Abuse and Mental Health Services Administration, is a confidential and anonymous locator for mental health and substance use treatment facilities in the United States and its territories.
State by state
Each card gives the Medicaid program name, what the state’s current drug list or prior authorization criteria say about Spravato, and the dated documents behind it. We checked every document on October 12, 2026. These lists are revised often. North Carolina’s, for example, was revised four times between February and July 2026, so open the linked document before relying on it.
When a card says Spravato is not listed, it is missing from the state’s preferred drug list or, for New York, from the preferred-drug tables. That does not settle the question. Virginia and Florida publish separate Spravato criteria, and North Carolina lists it in a physician-administered drug catalog. Read the whole card, not just the first line.
On these lists, non-preferred does not mean not covered. The lists we checked say non-preferred drugs need prior authorization, often after trying preferred drugs first.
The cards cover Medicaid and Spravato only. They do not address off-label ketamine. If you have other insurance, ask your plan how it covers Spravato.
Maine
Medicaid program: MaineCare
Spravato: Listed as non-preferred, prior authorization required, on the MaineCare Preferred Drug List (effective October 1, 2026). The criteria printed in the same list include that Spravato be prescribed by or in consultation with a psychiatrist.
Compare Maine with other states’ Medicaid rules for Spravato
New Hampshire
Medicaid program: NH Medicaid (Medical Assistance)
Spravato: Listed as non-preferred, with an additional clinical prior authorization required, on the fee-for-service Preferred Drug List (effective October 1, 2026). A separate state criteria document for Spravato, approved June 5, 2025, sets the requirements. If your Medicaid coverage comes through a health plan, ask the plan which drug list and criteria apply to you.
Compare New Hampshire with other states’ Medicaid rules for Spravato
- New Hampshire DHHS — NH Medicaid (Medical Assistance)
- New Hampshire DHHS Fee-for-Service Medicaid Preferred Drug List, effective October 1, 2026 (PDF)
- New Hampshire Medicaid Fee-for-Service Program — Spravato® (esketamine) Criteria, approved June 5, 2025 (PDF)
- New Hampshire Office of Professional Licensure and Certification — License Lookup
Vermont
Medicaid program: Green Mountain Care (Vermont's Medicaid programs)
Spravato: Listed as non-preferred, prior authorization required, on Vermont’s Preferred Drug List (updated October 2, 2026). The printed criteria require that both the treatment site and the patient be enrolled in the Spravato REMS program.
Compare Vermont with other states’ Medicaid rules for Spravato
Massachusetts
Medicaid program: MassHealth (Massachusetts combines Medicaid and CHIP into one program)
Spravato: Listed as esketamine (Spravato) on the MassHealth Drug List (Table 17, last revised July 2026), with prior authorization required. The criteria include that the prescriber be a specialist, such as a psychiatrist, or send consult notes from one.
Compare Massachusetts with other states’ Medicaid rules for Spravato
Rhode Island
Medicaid program: Rhode Island Medicaid, administered by the Executive Office of Health and Human Services
Spravato: In the non-preferred, prior-authorization-required column of the fee-for-service Preferred Drug List (effective October 1, 2026), marked “Manual PA.” If your Medicaid coverage comes through a health plan, ask the plan which drug list and criteria apply to you.
Compare Rhode Island with other states’ Medicaid rules for Spravato
Connecticut
Medicaid program: HUSKY Health
Spravato: Not listed on the Connecticut Medicaid Preferred Drug List (last updated September 16, 2026). The program’s posted prior authorization criteria, which carry no printed date, state that new prescriptions for Spravato require prior authorization.
Compare Connecticut with other states’ Medicaid rules for Spravato
- Connecticut Department of Social Services — HUSKY Health
- Connecticut Medicaid — Preferred Drug List, last updated September 16, 2026 (PDF)
- Connecticut Medical Assistance Program — Current PA Criteria, including Medically Necessary Spravato Prior Authorization (undated) (PDF)
- Connecticut eLicense — License Lookup
New York
Medicaid program: NYRx, the Medicaid Drug Program. Since April 1, 2023, it also covers prescriptions for members of mainstream Medicaid managed care plans.
Spravato: Not listed in NYRx’s preferred-drug tables. It appears in the Drug Utilization Review section of the NYRx list (revised September 14, 2026). For treatment-resistant depression, that section requires a trial of at least two oral antidepressants, and it requires the prescriber to attest to a baseline depression score before starting.
Compare New York with other states’ Medicaid rules for Spravato
New Jersey
Medicaid program: NJ FamilyCare
Spravato: We did not find a single statewide Medicaid drug list for New Jersey. The state’s 2024 parity evaluation says NJ FamilyCare managed care plans cover prescriptions and use a preferred drug formulary, and that some drugs require prior authorization. Ask your NJ FamilyCare plan how it covers Spravato.
Compare New Jersey with other states’ Medicaid rules for Spravato
Pennsylvania
Medicaid program: Medical Assistance (its managed care programs are called HealthChoices)
Spravato: Listed as non-preferred on the Statewide Preferred Drug List (effective January 2026), and non-preferred drugs require prior authorization. The list says its prior authorization guidelines apply to both fee-for-service and the Medical Assistance managed care plans. The state guideline effective January 5, 2026 requires Spravato to be prescribed by or in consultation with a psychiatrist.
Compare Pennsylvania with other states’ Medicaid rules for Spravato
- Pennsylvania Department of Human Services — Medicaid (Medical Assistance)
- Pennsylvania Department of Human Services — Statewide Preferred Drug List, effective January 2026 (v15) (PDF)
- Pennsylvania Medical Assistance Bulletin — Prior Authorization of Antidepressants, Other, effective January 5, 2026 (PDF)
- Pennsylvania Department of State — Verify a Professional or Occupational License (PALS)
Delaware
Medicaid program: Delaware Medical Assistance Program (DMAP)
Spravato: Listed in the “Antidepressants, Other” class of the Delaware Medicaid Preferred Drug List (version effective October 5, 2026), marked “clinical criteria applies.” The list says its prior authorization criteria are for fee-for-service members only; members of a managed care organization go through that plan’s criteria.
Compare Delaware with other states’ Medicaid rules for Spravato
Maryland
Medicaid program: Maryland Medicaid (also called Medical Assistance)
Spravato: In the “Non-Preferred / Requires Prior Authorization” column of the Preferred Drug List (updated August 6, 2026), with clinical criteria and quantity limits. Spravato is also on Maryland’s Mental Health Formulary, whose drugs are carved out of the managed care pharmacy benefit and paid as fee-for-service.
Compare Maryland with other states’ Medicaid rules for Spravato
Washington, DC
Medicaid program: DC Medicaid, run by the Department of Health Care Finance
Spravato: In the “Requires Prior Authorization” column of the fee-for-service Preferred Drug List (effective September 18, 2026). If your Medicaid coverage comes through a health plan, ask the plan which drug list and criteria apply to you.
Compare Washington, DC with other states’ Medicaid rules for Spravato
Virginia
Medicaid program: Cardinal Care, which includes all managed care and fee-for-service Medicaid members
Spravato: Not listed on the Preferred Drug List / Common Core Formulary (October 1, 2026 version; the July 1, 2026 version did not list it either). The state publishes Spravato criteria in its Physician Administered Drug criteria (Appendix B, effective July 23, 2026). For treatment-resistant depression, they include a failed trial of at least two antidepressants of different classes, each for at least six weeks.
Compare Virginia with other states’ Medicaid rules for Spravato
- Virginia Department of Medical Assistance Services — Cardinal Care
- Virginia Medicaid — Preferred Drug List / Common Core Formulary (checked July 1 and October 1, 2026 versions)
- Virginia DMAS — Appendix B: Physician Administered Drug (PAD) Criteria, effective July 23, 2026 (PDF)
- Virginia Department of Health Professions — License Lookup
North Carolina
Medicaid program: NC Medicaid
Spravato: Not listed on the NC Medicaid Preferred Drug List (effective October 1, 2026). It is listed in NC Medicaid’s Physician Administered Drug Program catalog (September 17, 2026 version) under billing code J0013, with a minimum age of 18. If your Medicaid coverage comes through a health plan, ask the plan which drug list and criteria apply to you.
Compare North Carolina with other states’ Medicaid rules for Spravato
South Carolina
Medicaid program: Healthy Connections Medicaid
Spravato: Not listed on the single Preferred Drug List (effective October 1, 2026), which fee-for-service and every managed care plan use for the drug classes it lists. We found no official South Carolina document on Spravato coverage, so ask your plan or the state Medicaid agency.
Compare South Carolina with other states’ Medicaid rules for Spravato
Georgia
Medicaid program: Georgia Medicaid and PeachCare for Kids®
Spravato: Listed as non-preferred, prior authorization required, on the Preferred Drug List (effective October 1, 2026). The fee-for-service criteria (revised January 1, 2026) include that it be prescribed by or in consultation with a psychiatrist. If you are in a Georgia Families managed care plan, ask the plan which criteria apply.
Compare Georgia with other states’ Medicaid rules for Spravato
- Georgia Department of Community Health — Georgia Medicaid and PeachCare for Kids®
- Georgia Medicaid/PeachCare Preferred Drug List, effective October 1, 2026 (PDF)
- Georgia Medicaid Fee-for-Service — Antidepressants PA Summary, revised January 1, 2026 (PDF)
- Georgia Composite Medical Board — Verify a Licensee
Florida
Medicaid program: Florida Medicaid; most members are in Statewide Medicaid Managed Care
Spravato: Not listed on the Florida Medicaid Preferred Drug List (effective October 1, 2026). The state posts separate Spravato prior authorization criteria (revised September 16, 2026). They require documented trial and failure of preferred oral antidepressants from different classes, each for at least four weeks, and approve three months at a time. If your Medicaid coverage comes through a health plan, ask the plan which drug list and criteria apply to you.
Compare Florida with other states’ Medicaid rules for Spravato
- Florida Agency for Health Care Administration — Statewide Medicaid Managed Care
- Florida Medicaid Preferred Drug List, effective October 1, 2026 (PDF)
- Florida Medicaid — Spravato™ (esketamine) Prior Authorization Criteria, revised September 16, 2026 (PDF)
- Florida Department of Health, Medical Quality Assurance — License Verification
At a glance
- Spravato is given only at REMS-certified healthcare settings; the manufacturer’s Find a Center tool lists them.
- Medicaid rules for Spravato differ by state. Most of the state documents we found require prior authorization or set clinical criteria, and some states handle it outside the main drug list.
- Check your prescriber’s license with the state board that issued it before you book.
- ClinicalTrials.gov lists ketamine and esketamine studies; many studies pay for the study treatment and research visits, and some participants receive placebo.
- Drug lists are revised often. Use the dated state documents above, not this summary, when you talk to your plan.
Sources
- U.S. Drug Enforcement Administration — Ketamine Drug Fact Sheet (Schedule III; misuse-related health effects) — Schedule III status (PDF)
- FDA — Understanding Unapproved Use of Approved Drugs "Off Label" — off-label prescribing
- 21 CFR 1306.03 — Persons entitled to issue prescriptions (eCFR) — who may prescribe controlled substances
- U.S. FDA — Original approval letter for esketamine (Spravato®) nasal spray, March 5, 2019 — FDA approval of Spravato (PDF)
- SPRAVATO® REMS Program Overview — REMS program and certified treatment center requirements — certified settings and two-hour monitoring (PDF)
- Johnson & Johnson (manufacturer) — SPRAVATO® Treatment Center Locator (Find a Center)
- ClinicalTrials.gov — active and completed ketamine studies in depression
- ClinicalTrials.gov — esketamine studies in depression
- ClinicalTrials.gov (NIH) — Learn About Studies: costs, payment, and placebo — study costs and placebo
- SAMHSA — FindTreatment.gov, treatment facility locator
- U.S. FDA — Compounding Risk Alerts, including the October 2023 warning on compounded ketamine products for psychiatric use