Yes — esketamine nasal spray (Spravato) is reimbursed in France, but only within hospital psychiatric care, and under criteria narrower than the EU label: adults under 65 whose current episode has failed at least two antidepressants from two different pharmacological classes, with ECT not an option. Assessment, initiation and every supervised dosing session happen inside a hospital psychiatric service, where treatment is covered by public insurance. This page covers exactly who qualifies, how the hospital route 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
France treats esketamine as hospital medicine, full stop. Spravato is dispensed and administered within hospital psychiatric services — French health authorities, the HAS for reimbursement assessment and the ANSM for safety framing, have kept the drug inside that perimeter, and there is no retail pharmacy reimbursement route. Within hospital care, the treatment is covered by public insurance.
Ketamine for depression is likewise hospital-only. In March 2026 the ANSM created a compassionate prescribing framework (cadre de prescription compassionnelle, CPC) covering IV ketamine for severe suicidal ideation in adults — a defined protocol for what specialized hospital units were already doing during a crisis. It is an acute-care tool used by hospital teams, not something you can request at a private practice.
Who qualifies
The French coverage framework is narrower than the EU label. You qualify when:
- You are an adult under 65;
- Your current depressive episode has resisted at least two antidepressants from two different pharmacological classes, taken at adequate dose and duration;
- ECT is not an option in your case.
Note the class of each drug you have tried in your written medication history — the two-classes criterion makes it load-bearing. "Adequate" means sufficient dose for sufficient duration; a week on a starting dose usually does not count.
Who decides and how to apply
Eligibility is decided twice. First, your treating psychiatrist documents your treatment history and decides whether to refer — nothing moves without a specialist who supports it, though a GP can start things with a psychiatric referral. Second, the hospital psychiatric department applies its internal protocol before scheduling treatment. Neither step can be skipped, and both run on documentation.
Ask specifically which regional hospital runs an esketamine program and how long the assessment queue is; university hospital centers (CHU) are the usual anchors, and several months between referral and treatment is common. The full picture of every legal route is in our France access guide; to see what is listed, browse providers in France.
What it costs you
For patients who meet the criteria, esketamine treatment is covered by public insurance within hospital care, as is hospital ketamine under the compassionate framework. There is no private market to price-compare against: private ketamine clinics as seen in Germany or the UK effectively do not exist in France, and any private offer should be treated with extreme caution.
If you do not qualify
- Over 65? The French framework targets adults under 65. Discuss alternatives with your psychiatrist: hospital ketamine protocols, ECT, other augmentation strategies, or trials without the same age cutoff.
- In a suicidal crisis, the March 2026 CPC framework means hospital teams have a defined protocol for IV ketamine — this runs through emergency and hospital psychiatry, not appointments.
- Clinical trials are free by definition and can be screened for in parallel with a hospital referral. Recruiting French studies in mid-2026 include the CHU Nîmes psilocybin Phase 3 (alcohol use disorder with depressive symptoms) and MOODBOOSTER, an AP-HP ketamine trial in severe depression — see the trials guide.
- Do not substitute a private "ketamine therapy" offer — the legitimate route in France runs through hospital psychiatry. Our clinic-choice guide explains what legitimate screening looks like anywhere in Europe.
Frequently asked questions
Is Spravato reimbursed in France?
Yes, within hospital psychiatric care only — covered by public insurance for adults under 65 whose current episode failed at least two antidepressants from two different pharmacological classes, with ECT not an option.
Can I get Spravato from a private psychiatrist in France?
No. Initiation and administration happen in hospital psychiatric services. A private psychiatrist's role is to document your history and refer you.
How long does the hospital route take?
It varies by region and program; between the psychiatric referral, the hospital's own assessment and scheduling, several months is common. Asking about the queue up front helps you plan, and trial screening can run in parallel.
Why is France stricter than its neighbours?
France runs a hospital-financed system: the hospital's own protocol is the gatekeeper as much as the national rule, and the criteria add an age cutoff and a two-classes requirement that label-following systems such as Germany do not have. See the Europe-wide reimbursement map for the comparison.
Sources
- HAS — Haute Autorité de Santé
- ANSM — Agence nationale de sécurité du médicament
- EMA: Spravato product information
- Blossom: Medical access in France
- 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.