Who pays for esketamine in Europe: payer criteria in 17 countries

Name: Who pays for esketamine in Europe: payer criteria in 17 countries
Creator: PsyAccess
License: https://creativecommons.org/licenses/by/4.0/

12 / 17 countries with public or insurer funding for esketamine among the 17 we document, each with its own threshold

One EU label, seventeen different answers. This dataset records, country by country, whether esketamine (Spravato) is publicly funded, under what threshold, and the one practical fact patients and referring clinicians most often miss. Every row carries primary payer sources and the date we last verified it.

Updated 2026-10-20 · With payer-policy changes; fully re-verified at least quarterly · Download CSV (open, CC BY 4.0) · Press & media

Row-level CSV is open, including per-row primary source URLs.

Payer criteria by country (full dataset; also available as CSV)

Country	Public funding	Threshold	Worth knowing
Germany	Yes (GKV)	≥2 failed antidepressants in the current moderate-to-severe episode	A nationwide Praxisbesonderheit keeps Spravato prescriptions out of the doctor's budget: 'we can't afford to prescribe it' is not a valid answer; office-based practices bill via GOP 01549 since 10/2023.
Netherlands	Yes (basispakket, since 09/2021)	2 antidepressants + 1 augmentation failed in the current episode	Only at specialized centers meeting the ENC-NL criteria; the center confirms coverage with your insurer before starting, and treatment counts toward the eigen risico.
Poland	Yes, fully free (NFZ programme B.147)	ages 18–75; at least two but no more than five failed antidepressants in the current episode	A live national waiting-time portal shows queues per center, and you may enroll at any contracted center nationwide (~64).
Switzerland	Yes (OKP, since 10/2025)	ages 18–74; 2 antidepressants + 1 augmentation failed; CGI-S ≥5	Only at the 52 BAG-designated centers, only after the insurer's trust doctor approves a cost request, and for a maximum of 10 months (extendable twice by 3 months).
Czechia	Yes (since 02/2025)	under 65; ≥2 optimized antidepressants failed, non-psychotic episode	Insurers have a documented practice of exceptional individual reimbursement beyond the criteria (for example over 65) when options are exhausted.
Portugal	Yes (hospital settings, since 05/2025)	≥3 strategies + psychotherapy, with ECT positioned in the pathway	The strictest published criteria in Europe: INFARMED's financing decision binds treatment to hospital administration.
Finland	Yes (Kela, since 08/2023)	≥3 failed treatments incl. attached psychotherapy, one a combination; MADRS ≥31; psychiatrist's B-statement	Unique pharmacy-dispensing model under restricted entitlements 3062 (40%) and 1539 (100%); the entitlement is limited to one year, continued only if your MADRS score has at least halved.
Denmark	Yes (recommended 19/11/2025)	≥3 failed antidepressant treatments in the current moderate-to-severe episode	A reversal of the council's cautious 2020 assessment after 32-week data and a lower price; Medicinrådet estimates roughly 40–60 candidate patients per year, so capacity builds slowly. A separate track since 01/2023 covers acute use for admitted patients with acutely increased suicide risk.
Belgium	Yes (since 06/2021)	moderate-severe episode; ≥2 failed antidepressants; per-patient prior authorization	Hospital-administered under INAMI/RIZIV Chapter IV, the insurer's advising physician approves each patient before the first dose.
Italy	Yes (hospital medicine, Classe H, since 05/2022)	≥2 failed antidepressants; AIFA monitoring registry	Delivery runs through regionally authorized psychiatric centers, availability varies by region.
Ireland	Yes (HSE, since 01/2022)	documented TRD; psychiatrist-initiated	Access runs via specialist psychiatric services rather than a designated-center list.
Spain	Yes (hospital medicine, since 11/2022)	ages 18–74; ≥3 failed strategies incl. augmentation	The hospital psychiatry and pharmacy commission is the gatekeeper, and practice varies noticeably by region.
United Kingdom	Scotland only (SMC2258); England & Wales: NICE declined	Scotland: documented TRD, no response to ≥2 antidepressants in the current episode	The Norway/England paradox in miniature: the same approved medicine is funded north of the border and private-only south of it. First NHS racemic-ketamine pilots exist in England.
Sweden	'Strongly restrained' (NT Council; regions decide)	in practice roughly 4 failed alternatives (antidepressants, augmentation and, where appropriate, ECT) documented in writing	Sweden never said no; it told its 21 regions to hold back (recommendation of 30/06/2021, revised 06/11/2024), which produces a real but deliberately narrow route.
France	Hospital-only	under 65; ≥2 antidepressants of 2 classes failed; ECT not an option	No private ketamine market at all; since 03/2026 a ketamine compassionate framework exists for suicidal crisis.
Norway	NO: Spravato rejected three times (2021–2022); 2025 reassessment declined		Instead, Norway publicly funds generic IV ketamine for TRD since 25/08/2025, a world first, with registry follow-up and a re-evaluation due by end of 2028. Separately, on 24/08/2026 Beslutningsforum approved ketamine (not esketamine) for acute suicidal crisis in hospitals and DPS (sak 097-2026, ID2025_034).
Austria	Inpatient only (hospital financing); not in the outpatient reimbursement code (EKO)	outpatient: case-by-case chief-physician approval	In the private Wahlarzt market the sickness fund refunds part of each invoice, typically €80–110 per session; the partial refund is a legal entitlement. Published private ketamine sessions run EUR 350-450 (our prices dataset).

Methodology

One row per country among the 17 with a documented esketamine pathway (or a documented refusal, e.g. NICE TA854 in England).
Funding and threshold statements are transcribed from primary payer sources (G-BA, SMC, NFZ, BAG, NT Council and peers), linked per row in the CSV and on the reimbursement map.
The 'worth knowing' column records the one operational fact that most changes outcomes (e.g. Germany's Praxisbesonderheit removing the budget objection).
Rows are re-verified on payer updates and at least quarterly; the CSV carries per-row source URLs.
New in Oct 2026: an rtms_public_funding column in the CSV, filled only where verified (PL yes per Dz.U. 2025 poz. 1212; NL yes for TRD with CBT per the ZN circular of 29.01.2025; DE/BE/FR no; UK partial per NICE IPG542 trust-by-trust); other countries are left empty, not marked no.

Sources

How to cite

PsyAccess (2026). Who pays for esketamine in Europe: payer criteria in 17 countries. https://psyaccess.health/data/who-pays-esketamine-ketamine-europe/ (updated 2026-10-20). Licensed CC BY 4.0.

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<p>12 / 17 countries with public or insurer funding for esketamine among the 17 we document, each with its own threshold. Source: <a href="https://psyaccess.health/data/who-pays-esketamine-ketamine-europe/">PsyAccess: Who pays for esketamine in Europe: payer criteria in 17 countries</a> (CC BY 4.0, updated 2026-10-20).</p>

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