Yes. Since 7 May 2025, esketamine nasal spray (Spravato) is publicly financed in Portugal for use in hospital settings in adults with treatment-resistant major depression — under some of Europe's strictest criteria. INFARMED — Portugal's medicines authority — requires at least three failed antidepressant strategies in the current episode, prior psychotherapy, and a documented position on electroconvulsive therapy before financing applies. 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
On 7 May 2025, INFARMED approved public financing of esketamine nasal spray for use in hospital settings in adults with treatment-resistant major depressive disorder. Portuguese media called it the first psychedelic-class medicine financed for severe depression. Coverage is hospital-shaped: the drug is dispensed, administered and observed within hospital psychiatry, not prescribed for a pharmacy or a private clinic, and the financing follows the hospital's own protocol as much as the national rule.
Who qualifies
The criteria are stricter than in most European countries, and each element is load-bearing:
- At least three failed antidepressant treatments — different antidepressants, with combination or oral augmentation strategies, in the current moderate-to-severe depressive episode. Most of Europe requires two; Portugal requires three.
- Prior psychotherapy — you must have previously undergone psychotherapy.
- A documented position on electroconvulsive therapy (ECT) — resistance to ECT, a contraindication, lack of access, or a documented refusal.
- Esketamine is used in combination with an oral antidepressant (SSRI or SNRI), per the EU label.
The practical currency is a written treatment history: every antidepressant and augmentation tried in the current episode (substance, dose, duration, outcome), your psychotherapy record, and — a step unique to Portugal's criteria — a documented discussion of ECT. Assembling that record before the first appointment does more work than anything you say in the room.
Who decides and how to apply
The route runs through hospital psychiatry: your psychiatrist — or your GP via a psychiatric referral — refers you to a hospital psychiatric service, whose team applies the financing criteria before scheduling treatment. There is no insurer application: as in other hospital-financed systems, the hospital's own protocol and pharmacy commission are the gatekeeper as much as the national decision.
Waiting depends on which hospitals in your region run an esketamine programme and how quickly your documentation comes together; the three-strategies-plus-psychotherapy record is often the slower part. To see what is listed, browse providers in Portugal; for the full picture of every legal route in the country, see our Portugal access guide.
What it costs you
For patients who meet the criteria, treatment is financed within hospital care — administration and the roughly two-hour observation period included.
The private comparison is Lisbon's small ketamine-assisted psychotherapy market. The Clinic of Change publishes an initial evaluation consultation at 120 euro and a KAP programme at 3,900 euro for patients with insurance or 5,500 euro without, payable in four instalments; it also lists private Spravato treatment. Liminal Minds (Miraflores, Algés) offers KAP and antidepressant infusion therapy without published prices. No Portuguese insurer routinely covers the ketamine-assisted component itself — the insurance-linked price difference reflects what a policy can absorb of the surrounding consultations, so ask for a written breakdown for your specific insurer before committing.
If you do not qualify
Three honest fallbacks exist:
- Private ketamine-assisted psychotherapy in Lisbon, at the published prices above. Both clinics screen across more than one appointment before any treatment decision — ask what happens if screening rules you out after the paid evaluation, and see our clinic-choice guide for the full checklist.
- Clinical trials are free by definition. The one recruiting Portuguese psilocybin study is PsyPal at the Champalimaud Foundation in Lisbon, for psychological distress in palliative care; see the trials guide for how participation works.
- No decriminalisation shortcut. Portugal's Law 30/2000 removes criminal penalties for personal possession; it licenses no therapy, clinic or retreat, and creates no treatment route.
Frequently asked questions
Is Spravato reimbursed in Portugal?
Yes — since 7 May 2025 INFARMED finances it for hospital use in treatment-resistant depression, provided you have at least three failed antidepressant strategies in the current episode, prior psychotherapy, and a documented position on ECT. Treatment and financing both run through the hospital psychiatric service.
Do I really need prior psychotherapy and an ECT step?
Under the May 2025 financing criteria, yes: prior psychotherapy and a documented position on ECT (resistance, contraindication, lack of access or refusal) sit alongside the three failed antidepressant strategies. Your psychiatrist documents these; raise them early so the record is complete.
Why three failed treatments when most of Europe requires two?
Reimbursement is a national decision, and Portugal set stricter national criteria than the EU label minimum. See the Europe-wide reimbursement map for how Portugal's bar compares with its neighbours.
Is private ketamine-assisted psychotherapy covered by insurance?
Not the ketamine-assisted component itself — no Portuguese insurer routinely covers it. Parts of the surrounding care, such as psychiatric and psychology consultations, can fall under a health policy, which is why The Clinic of Change publishes 3,900 euro with insurance versus 5,500 euro without. Get a written breakdown before starting.
Sources
- INFARMED — Spravato (esketamine) public financing decision notice, 7 May 2025
- Público: Infarmed aprova primeiro psicadélico para depressão grave a usar em meio hospitalar (12 May 2025)
- Blossom: Medical access in Portugal
- EMA: Spravato (esketamine) EPAR
- The Clinic of Change — Lisbon: programmes and published prices
- 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.