Yes. Esketamine nasal spray (Spravato) has been reimbursed in Belgium since June 2021 under INAMI/RIZIV Chapter IV — hospital-administered, with your health insurer's advising physician approving each patient in advance. The criteria are a moderate-to-severe depressive episode and at least two failed antidepressants; the per-patient prior authorization is what makes the Belgian route distinctive, and it runs on your documented treatment history. This page covers who qualifies, how the approval works, what you pay, and what to do if you fall outside the criteria; the eligibility decision itself always sits with a clinician, and you can begin orienting yourself with our eligibility check.
What is covered
Since June 2021, esketamine nasal spray is reimbursed under Chapter IV of the INAMI/RIZIV medicines rules — the chapter for medicines that need prior authorization. Spravato is classified as a hospital-use medicine in Belgium, so administration and the roughly two-hour observation period happen in a hospital psychiatric service, not at a pharmacy or private office. Esketamine is given in combination with an SSRI or SNRI, and once your file is approved, the medicine is covered within normal hospital billing.
Who qualifies
The Chapter IV criteria are:
- A moderate-to-severe depressive episode;
- No response to at least two antidepressants taken at adequate dose and duration — "adequate" means sufficient dose for sufficient duration, so a week on a starting dose usually does not count;
- Esketamine given in combination with an SSRI or SNRI.
In a pre-approval system like Belgium's, the practical currency is a written treatment history: every antidepressant tried in the current episode, with substance, dose, duration and outcome. The advising physician reads exactly this record against the criteria, so assemble it — with your GP or psychiatrist — before any referral. It usually decides both the outcome and the speed.
Who decides and how to apply
Reimbursement is approved per patient, in advance, by the advising physician (médecin-conseil / adviserend arts) of your health insurance fund (mutualité / ziekenfonds). The hospital submits your file — diagnosis plus the documented failed treatments — and the advising physician approves or refuses reimbursement before the first dose is scheduled.
Begin with your GP or treating psychiatrist and ask for a referral to a hospital psychiatric department that runs an esketamine program — Belgian university hospitals took part in the international esketamine development trials, so the infrastructure is established. Ask the hospital to file the prior-authorization request early: the step can add several weeks. Do not start treatment on a promise that paperwork will follow — without prior authorization there is no reimbursement. To see what is listed near you, browse providers in Belgium; for the full picture of every legal route in the country, see our Belgium access guide.
What it costs you
Once the advising physician approves, the medicine is covered and treatment happens within normal hospital billing — expect standard co-payments and possibly facility or consultation charges, and ask the service up front for the full picture. Our sources do not document a fixed patient amount, so the honest advice is to get the hospital's own figures before the first session. Plan the practical side too: sessions are more frequent during induction and you must not drive for the rest of the day, so arrange a ride home for every visit.
If you do not qualify
Belgium has no documented individual-case or exceptional funding route for esketamine in our sources, so the honest fallbacks are:
- Hospital off-label ketamine. The national medicines reference CBIP documents off-label intravenous ketamine in resistant depression and acute severe suicidal distress as an existing hospital practice under prescriber responsibility. There is no dedicated reimbursement for it as an antidepressant — where it happens, it happens inside hospital care and hospital budgets, so the conversation belongs with a hospital psychiatrist.
- No private clinic shortcut. Belgium has effectively no private ketamine clinic market; be wary of anyone selling ketamine therapy privately. If you consider any private offer, apply the checks in our clinic-choice guide first.
- Clinical trials are free by definition — Belgium currently has two recruiting hospital-run psilocybin studies, in Ghent for treatment-resistant depression and in Brussels for severe alcohol use disorder; see the trials guide for how participation works.
Frequently asked questions
Is Spravato reimbursed in Belgium?
Yes — since June 2021, under INAMI/RIZIV Chapter IV, for a moderate-to-severe depressive episode after at least two failed antidepressants. Treatment is hospital-administered, and your insurance fund's advising physician must approve your file before you start.
How long does the Chapter IV approval take?
Budget several weeks and ask the hospital to file early. The quality of your treatment documentation is usually what decides both the outcome and the speed. Belgium is one of Europe's per-patient pre-approval systems, alongside Switzerland — see the Europe-wide reimbursement map for the comparison.
Do I pay anything once I am approved?
The medicine is reimbursed and treatment runs within normal hospital billing — expect standard co-payments and possibly facility charges, and ask the hospital service for the full picture up front.
Can I get ketamine infusions at a private clinic instead?
Effectively no — Belgium has no meaningful private ketamine market. Off-label ketamine for resistant depression or acute suicidal distress is an established but hospital-based practice under prescriber responsibility, with no dedicated reimbursement as an antidepressant.
Sources
- CBIP/BCFI — Spravato Chapter IV reimbursement, Belgium (June 2021)
- CBIP — intranasal esketamine: hospital-use medicine entry
- CBIP — ketamine medicines information, including off-label psychiatric use
- Blossom: Medical access in Belgium
- Reimbursement Pathways for Psychedelic Therapies in Europe — Magnetar Access × Blossom (2025)
This guide is for general information only and is not medical advice, a diagnosis, or a recommendation of any treatment. Regulations and reimbursement rules change; always verify current requirements with your insurer and discuss your options with a licensed clinician who knows your history. If you are in crisis, contact your local emergency number or a crisis line immediately.
This guide awaits review by a licensed medical professional.