Spravato Reimbursement in Germany: 2026 Coverage Guide

Yes. Esketamine nasal spray (Spravato) is reimbursed by German statutory health insurance (GKV) for treatment-resistant depression — no response to at least two antidepressants at adequate dose and duration in the current moderate-to-severe episode. For patients who meet those criteria, treatment is covered apart from standard co-payments, and since March 2023 it can be given in office-based psychiatric practices, not only hospitals. This page covers exactly who qualifies, how the prescribing 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

GKV coverage follows the EU label: esketamine nasal spray, taken alongside a continuing oral antidepressant, for adults with treatment-resistant major depression. Two decisions made the German route unusually solid. In 2023 the G-BA found a "considerable added benefit" for esketamine in severe treatment-resistant depression — reportedly a first for a psychiatric drug in Germany. And a nationwide Praxisbesonderheit agreement excludes Spravato prescriptions from the doctor's normal budget, so "we can't afford to prescribe it" is not a valid answer. Coverage includes the supervised administration and the roughly two-hour observation period, which office-based practices bill through a dedicated code, GOP 01549.

Who qualifies

The criteria are the label criteria, and GKV coverage tracks them directly:

An adult with a moderate-to-severe depressive episode;
No response to at least two different antidepressants at adequate dose and duration in the current episode — "adequate" means sufficient dose for sufficient duration, so a week on a starting dose usually does not count;
Esketamine is always combined with a continuing oral antidepressant.

The practical currency is a written treatment history: every antidepressant tried in the current episode, with substance, dose, duration and outcome. Assemble it before any appointment — it decides more cases than anything else.

Who decides and how to apply

The decision sits with a psychiatrist, not an insurer. There is no formal insurer pre-authorization for on-label outpatient use — Germany is a label-following system, where the psychiatrist prescribes within the criteria and the funding is built into how the treatment is billed. A GP cannot prescribe Spravato, but can do two useful things: refer you and print out your medication history.

The real hurdle is capacity, not paperwork. Since March 2023 treatment is possible in office-based psychiatric practices as well as hospital outpatient departments, but the observation requirement demands space and staff, so finding a practice that offers the treatment is the practical task. To see who is listed near you, browse providers in Germany; for the full picture of every legal route in the country, see our Germany access guide.

What it costs you

For patients who meet the criteria, treatment is covered apart from standard co-payments. The comparison with self-pay is stark: the list price is around €345 per 28 mg device, so a four-week induction can reach roughly €8,000 before clinic fees. Privately insured patients (PKV) are covered under their own policies — request written confirmation before starting.

If you do not qualify

Three honest fallbacks exist, in rough order of practicality:

Private ketamine clinics. Off-label ketamine infusions apply broader criteria after their own screening, at roughly €200–400 per infusion (a course of six typically €1,500–2,500), entirely self-pay. Screening quality varies — see our clinic-choice guide.
Clinical trials are free by definition; see the trials guide for how to search.
§2 Abs. 1a SGB V is Germany's statutory route to individual coverage for life-threatening or gravely disabling illness with no standard alternative. No documented psychedelic case exists yet — a mechanism to know about, not to count on.

Separately, Germany's psilocybin compassionate use program (ZI Mannheim and OVID Berlin, treatment-resistant depression only) provides the drug free by law, with surrounding care billed as normal hospital treatment — the initial BfArM listing runs to 11 July 2026, so confirm current status with the sites.

Frequently asked questions

Is Spravato reimbursed in Germany?

Yes — statutory insurance (GKV) covers it for treatment-resistant depression, defined as no response to at least two antidepressants at adequate dose and duration in the current moderate-to-severe episode, with only standard co-payments for the patient.

Do I need my insurer's approval before starting?

No. For on-label outpatient use there is no formal insurer pre-authorization; the psychiatrist prescribes within the label criteria. This is different from pre-approval systems such as Switzerland or Belgium — see the Europe-wide reimbursement map for the comparison.

Why is it still hard to get if it is covered?

Reimbursement is a funding decision, not a capacity decision. The observation requirement demands space and staff, so relatively few practices offer the treatment — the search for a prescribing practice is usually the slowest step.

Is ketamine (the infusion) covered too?

Not routinely. Racemic ketamine for depression is off-label and self-pay in the private clinic market; Germany's national depression guideline places off-label ketamine in inpatient psychiatric settings.

Sources

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.

Is Esketamine (Spravato) Reimbursed in Germany? 2026 Coverage Guide

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