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Am I eligible?
Am I eligible?

Who Pays for Esketamine in Europe: The Reimbursement Map (2026)

Esketamine (Spravato) is formally approved across the EU/EEA — but whether anyone pays for it depends entirely on where you live: 13 countries fund it, each behind different criteria; several approved it and then declined to pay. This map shows, country by country, who pays, what you must document, and where the real threshold lies — usually in the phrase “failed treatments”.

Dataset updated · next verification pass 2026-10 · JSON · CSV (CC BY 4.0)

CountryPublic fundingThe thresholdThe one thing to knowLast verified
Germany #
access guide		Yes (GKV)≥2 failed antidepressants in the current moderate-to-severe episodeA nationwide Praxisbesonderheit keeps Spravato prescriptions out of the doctor's budget: 'we can't afford to prescribe it' is not a valid answer; office-based practices bill via GOP 01549 since 10/2023.
Netherlands #
access guide		Yes (basispakket, since 09/2021)2 antidepressants + 1 augmentation failed in the current episodeOnly at specialized centers meeting the ENC-NL criteria; the center confirms coverage with your insurer before starting, and treatment counts toward the eigen risico.
Poland #
access guide		Yes, fully free (NFZ programme B.147)ages 18–75; at least two but no more than five failed antidepressants in the current episodeA live national waiting-time portal shows queues per center, and you may enroll at any contracted center nationwide (~64).
Switzerland #
access guide		Yes (OKP, since 10/2025)ages 18–74; 2 antidepressants + 1 augmentation failed; CGI-S ≥5Only at the 52 BAG-designated centers, only after the insurer's trust doctor approves a cost request, and for a maximum of 10 months (extendable twice by 3 months).
Czechia #
access guide		Yes (since 02/2025)under 65; ≥2 optimized antidepressants failed, non-psychotic episodeInsurers have a documented practice of exceptional individual reimbursement beyond the criteria (for example over 65) when options are exhausted.
Portugal #
access guide		Yes (hospital settings, since 05/2025)≥3 strategies + psychotherapy, with ECT positioned in the pathwayThe strictest published criteria in Europe: INFARMED's financing decision binds treatment to hospital administration.
Finland #
access guide		Yes (Kela, since 08/2023)≥3 failed treatments incl. attached psychotherapy, one a combination; MADRS ≥31; psychiatrist's B-statementUnique pharmacy-dispensing model under restricted entitlements 3062 (40%) and 1539 (100%); the entitlement is limited to one year, continued only if your MADRS score has at least halved.
Denmark #
access guide		Yes (recommended 19/11/2025)≥3 failed antidepressant treatments in the current moderate-to-severe episodeA reversal of the council's cautious 2020 assessment after 32-week data and a lower price; Medicinrådet estimates roughly 40–60 candidate patients per year, so capacity builds slowly. A separate track since 01/2023 covers acute use for admitted patients with acutely increased suicide risk.
Belgium #
access guide		Yes (since 06/2021)moderate-severe episode; ≥2 failed antidepressants; per-patient prior authorizationHospital-administered under INAMI/RIZIV Chapter IV, the insurer's advising physician approves each patient before the first dose.
Italy #
access guide		Yes (hospital medicine, Classe H, since 05/2022)≥2 failed antidepressants; AIFA monitoring registryDelivery runs through regionally authorized psychiatric centers, availability varies by region.
Ireland #
access guide		Yes (HSE, since 01/2022)documented TRD; psychiatrist-initiatedAccess runs via specialist psychiatric services rather than a designated-center list.
Spain #
access guide		Yes (hospital medicine, since 11/2022)ages 18–74; ≥3 failed strategies incl. augmentationThe hospital psychiatry and pharmacy commission is the gatekeeper, and practice varies noticeably by region.
United Kingdom #
access guide		Scotland only (SMC2258); England & Wales: NICE declinedScotland: documented TRD, no response to ≥2 antidepressants in the current episodeThe Norway/England paradox in miniature: the same approved medicine is funded north of the border and private-only south of it. First NHS racemic-ketamine pilots exist in England.
Sweden #
access guide		'Strongly restrained' (NT Council; regions decide)in practice roughly 4 failed alternatives (antidepressants, augmentation and, where appropriate, ECT) documented in writingSweden never said no; it told its 21 regions to hold back (recommendation of 30/06/2021, revised 06/11/2024), which produces a real but deliberately narrow route.
France #
access guide		Hospital-onlyunder 65; ≥2 antidepressants of 2 classes failed; ECT not an optionNo private ketamine market at all; since 03/2026 a ketamine compassionate framework exists for suicidal crisis.
Norway #
access guide		NO: Spravato rejected three times (2021–2022); 2025 reassessment declined—Instead, Norway publicly funds generic IV ketamine for TRD since 25/08/2025, a world first, with registry follow-up and a re-evaluation due by end of 2028.
Austria #
access guide		Inpatient only (hospital financing); not in the outpatient reimbursement code (EKO)outpatient: case-by-case chief-physician approvalIn the private Wahlarzt market the sickness fund refunds part of each invoice, typically €80–110 per session; the partial refund is a legal entitlement.

Legal status per country (the legality map): access by country.

How to read “failed treatments”

Dose + duration + documentation. Assemble — ideally with your GP or psychiatrist — a written record of every antidepressant and augmentation tried in the current episode: substance, dose, duration, outcome, side effects, plus any psychotherapy. An “adequate trial” means a sufficient dose for a sufficient duration; a week on a starting dose usually does not count. In pre-approval systems (Switzerland, Belgium, Finland, Czechia beyond the criteria) this record is literally what the insurer's physician reads — your written medication history is the most valuable document you own.

Approved is not funded: the Norway/England paradox

Approval is European; payment is national. Norway rejected Spravato three times (2021–2022) — and then did what no other country has done: since 25 August 2025 it publicly funds generic IV ketamine for the same patient group, with registry follow-up and a re-evaluation due by end of 2028. England shows the same paradox in miniature: NICE said no while Scotland's SMC said yes — the same approved medicine is funded north of the border and private-only south of it. The rule of thumb: never ask whether a medicine is “approved”; ask who pays for the treatment.

The practical playbook

  1. In label-following systems (Germany, Scotland) the psychiatrist prescribes within the criteria; funding is built into the billing.
  2. In pre-approval systems (Switzerland, Belgium, Finland, Czechia beyond criteria) the center files a written request with your insurer before the first dose — that can add weeks, so ask them to start early.
  3. In hospital-financed systems (France, Spain, Italy, Portugal) the hospital's own protocol or pharmacy commission is the real gatekeeper.
  4. Two habits smooth all three routes: let the center manage the insurer paperwork, and ask up front how long approval typically takes in your region.
  5. Where the public route is closed: self-pay at a vetted clinic (prices in the cost index) — or a clinical trial, which costs participants nothing.

Frequently asked questions

Is esketamine (Spravato) reimbursed in Europe?

In most of continental Europe, yes — Germany, the Netherlands, Poland, Switzerland, Belgium, Italy, Ireland, Spain, Finland, Czechia, Portugal and Denmark fund it publicly, nearly always under strict treatment-resistance criteria. England is the big exception (NICE declined; Scotland accepted), and Norway rejected Spravato but funds generic IV ketamine instead.

What counts as a “failed treatment”?

Dose + duration + documentation: an adequate trial means a sufficient dose for a sufficient time, recorded in writing with substance, dose, duration, outcome and side effects. A week on a starting dose usually does not count. Your written medication history is the most valuable document you own.

My country reimburses — why is access still hard?

Reimbursement is a funding decision, not a capacity decision. The bottleneck is the small number of sites (the observation requirement demands space and staff) and psychiatrists who know the pathway.

What if I fall outside the criteria?

Most systems have individual-case mechanisms (e.g. Switzerland's Art. 71a–d KVV, Czech exceptional approvals, Germany's §2 Abs. 1a SGB V). Beyond those, clinical trials are free by definition and often the strongest option where reimbursement is closed.

Sources and verification

Every number carries its primary source and the date it was last checked against that source.

See also: the European price index · the editorial reimbursement guide · legal status by country · eligibility check