Where is SPRAVATO® Administered?

SPRAVATO® is self-administered at REMS-certified SPRAVATO® treatment centers under the supervision of a health care provider. REMS stands for Risk Evaluation and Mitigation Strategy.

SPRAVATO® is a brand name for esketamine nasal spray, a Schedule III controlled substance derived from ketamine. This medication can cause brief sedation and dissociation in people who take it, and it has the potential to be abused. That’s why the esketamine nasal spray is only distributed to providers under the REMS program.

The FDA requires that all providers, pharmacies, and health care centers that want to provide SPRAVATO® earn REMS certification.

To understand REMS, it’s helpful to know how these providers and health care clinics become certified treatment centers. For either an outpatient or inpatient clinic to gain the status of a REMS-certified treatment center, they must go through many steps before they can begin treating patients with nasal esketamine for depression.

If you’re a patient at a certified inpatient health care setting, you won’t need to enroll in the SPRAVATO® REMS program when your provider prescribes SPRAVATO®. However, if you’re going to an outpatient center, like Greenbrook, you’ll need to enroll.

How to Discuss SPRAVATO® With Your Health Care Provider?

At this point, you might be wondering ‘is Spravato covered by insurance?’ The answer is “probably yes.” At Greenbrook, our care team can help you figure out the insurance side of things. The easiest way to bring nasal esketamine up with your primary care provider is to ask if they believe you’re a candidate for it.

While you can seek out nasal esketamine without a referral, any doctor, therapist, psychologist, or social worker can refer you to a certified nasal esketamine treatment center. The medication is FDA-approved for treatment-resistant depression (TRD) and major depressive disorder with suicidal ideation or behavior (MDSI).

To qualify for treatment, you’ll need to have tried at least two oral antidepressants for six weeks each without significant improvement.

After you’ve talked through your medical history with your PCP and any other health care providers you want to loop in, schedule an nasal esketamine spray consultation with a certified provider. Your treatment provider will conduct an assessment of your symptoms and study your medical history before giving their approval for nasal esketamine treatment. The next step is to enroll you in the REMS program. Your treatment provider will make sure you understand the risks and benefits of treating depression with nasal esketamine spray. They’ll also make sure you agree to these requirements.

Each time you receive treatment, you’ll need to:-Administer the nasal spray yourself—at Greenbrook, we give you the opportunity to practice with trainer sprayers that look and act just like the real thing but do not dispense medication

-Stay at the healthcare setting for at least two hours after treatment, after which your provider will tell you if you’re cleared to go home

-Arrange a ride home, as you will not be able to drive or operate heavy machinery until the following day after treatment

You and your provider will fill out the form and sign it. Your provider will then send the form to SPRAVATO® REMS. Once you’re enrolled, you and your provider can figure out the best treatment plan to fit your needs. A typical round of nasal esketamine spray treatment consists of 24-26 sessions in four phases.

Schedule a Consultation With Greenbrook

At Greenbrook, our Care Team will communicate with your other providers — with your permission — to ensure that they stay up-to-date on your treatment and your progress. If you're struggling with treatment resistant depression and nasal esketamine spray isn’t an option, Greenbrook also provides transcranial magnetic stimulation. Learn more about how TMS works.