VA coverage of Spravato for treatment-resistant depression can require up to 50 supervised visits and difficult travel

Esketamine, sold as Spravato, is the only FDA-approved and VA-covered pharmacological option beyond standard antidepressants for adults with treatment-resistant depression, but access is demanding. Veterans generally need documented nonresponse to at least two adequate antidepressant trials and an approved formulary exception. The nasal spray requires twice-weekly visits for four weeks, followed by less frequent dosing, with at least two hours of supervised observation and a ride home after each appointment. Veterans whose VA facility does not offer Spravato may need a case-by-case Community Care referral to a civilian clinic, creating additional travel and scheduling barriers, especially in rural areas. The article cites estimates of 25 to 50 treatments annually and discusses investigational psilocybin approaches intended to provide longer-lasting effects with fewer sessions, while noting that these treatments are not yet available clinical alternatives.