Yes, under some of the narrowest criteria in Europe. Esketamine nasal spray (Spravato) has been publicly financed in Spain as a hospital medicine since November 2022 — for adults aged 18 to 74 whose current moderate-to-severe episode has failed at least three treatment strategies, including an augmentation strategy. For patients who meet those criteria, treatment is financed within hospital care; the practical variable is your region, because implementation differs across the seventeen autonomous communities. 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
Esketamine nasal spray is classified for hospital dispensing (diagnóstico hospitalario / uso hospitalario) and financed by the national health system since November 2022, under criteria narrower than the EU label. The prescribing decision sits with hospital psychiatry; the drug is dispensed and administered in the hospital, with post-dose observation, always alongside a continuing oral antidepressant. Formal financing criteria are national — but each autonomous community, and often each hospital pharmacy commission, decides how actively to run an esketamine program and how many patients to take.
Who qualifies
The national financing criteria:
- Adults aged 18 to 74;
- A current moderate-to-severe depressive episode;
- At least three failed treatment strategies, including an augmentation strategy — for example lithium or an atypical antipsychotic added to an antidepressant — each at adequate dose and duration.
Because the criteria count strategies rather than simply antidepressants, the documentation you bring matters even more than elsewhere: a written history that shows each strategy — including the augmentation attempt — with substance, dose, duration and outcome is what turns a referral into a scheduled assessment. Assemble it with your psychiatrist before any referral.
Who decides and how to apply
Two gatekeepers share the decision. Your psychiatrist documents the failed strategies and refers you; the hospital team — often with its pharmacy commission — applies the financing criteria and its internal protocol before treatment starts. Some hospitals require their own case review board sign-off on each patient, and internal protocols can interpret "three failed strategies" differently. The regional variation is real: two patients with identical histories can face completely different waits depending on region. If your local hospital has no program, ask your psychiatrist about referral to a reference hospital elsewhere in your community — or in another one. For the full picture of every legal route in the country, see our Spain access guide; to see who is listed near you, browse providers in Spain.
What it costs you
For patients who meet the criteria, treatment is publicly financed within hospital care — the medicine is dispensed inside the hospital, not at a pharmacy, and administration and observation happen there too. The self-pay comparison is the private ketamine market: prices vary widely with the level of psychotherapy included, and full ketamine-assisted psychotherapy programs cost thousands of euros.
If you do not qualify
Spain has no named exceptional or individual-case reimbursement mechanism for esketamine — the standard financing criteria govern. Before treating a "no" as final, remember that a refusal at one hospital is not a final answer for all of Spain. Beyond that, the honest fallbacks are:
- Private ketamine clinics. Off-label ketamine from licensed physicians is legal, with clinics operating mainly in Barcelona, Madrid and Mallorca — self-pay, with full KAP programs running to thousands of euros. Verify the physician's college registration and the facility's healthcare authorization, and use our clinic-choice guide before paying.
- Clinical trials are free by definition, and Spain is a serious research jurisdiction — 24 psychedelic trials are tracked in connection with Spain, 4 of them active. See the trials guide for how to search.
Frequently asked questions
Is Spravato reimbursed in Spain?
Yes — it is publicly financed as a hospital-dispensed medicine since November 2022 for adults aged 18 to 74 with treatment-resistant depression, where the current moderate-to-severe episode has failed at least three treatment strategies including augmentation. Treatment runs through hospital psychiatry.
What counts as a treatment strategy?
More than a simple antidepressant switch: the criteria require three failed strategies at adequate dose and duration, one of them an augmentation strategy — for example lithium or an atypical antipsychotic added to an antidepressant. Documenting each strategy with dose, duration and outcome is the core of your case.
Does it matter which autonomous community I live in?
Yes, more than it should. Programs, waits and internal rules differ by region and hospital, even though the financing criteria are national. If your region has no active program, ask explicitly about referral to a reference hospital.
I am over 74 — is that final in Spain?
Within the standard criteria, yes: the financing window is 18 to 74, and Spain has no documented exceptional-approval route for esketamine. Some other countries do have individual-case mechanisms — the Europe-wide reimbursement map shows where they exist and how they work.
Sources
- CIMA — AEMPS medicines information center
- Ministerio de Sanidad
- EMA: Spravato (esketamine) EPAR
- Blossom: Spain country report
- 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.