{ "meta": { "name": "European Esketamine Reimbursement Map", "version": "2026.09", "updated": "2026-09-04", "update_cadence": "quarterly", "next_verification": "2026-10", "license": "https://creativecommons.org/licenses/by/4.0/", "attribution": "PsyAccess: European Esketamine Reimbursement Map, psyaccess.health/reimbursement/ (CC BY 4.0)", "method": "One row per country: public funding status, the documented threshold (usually a number of failed treatments), and the practical detail patients most often miss. Every row cites the national regulator, payer or HTA body and carries a verification date. 'Being verified' is a publishable state; an empty cell is honest, a guessed one is not." }, "countries": [ { "country": "Germany", "country_code": "de", "funding": "Yes (GKV)", "threshold": "≥2 failed antidepressants in the current moderate-to-severe episode", "know": "A 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.", "guide": "/guides/reimbursement-germany/", "sources": [ { "label": "G-BA benefit assessment", "url": "https://www.g-ba.de/service/fachnews/84/", "checked": "2026-08-19" }, { "label": "Bundesweite Praxisbesonderheit für Esketamin", "url": "https://www.der-niedergelassene-arzt.de/medizin-und-forschung/details/depression-bundesweite-praxisbesonderheit-fuer-esketamin-nasenspray/1", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Netherlands", "country_code": "nl", "funding": "Yes (basispakket, since 09/2021)", "threshold": "2 antidepressants + 1 augmentation failed in the current episode", "know": "Only at specialized centers meeting the ENC-NL criteria; the center confirms coverage with your insurer before starting, and treatment counts toward the eigen risico.", "guide": "/guides/reimbursement-netherlands/", "sources": [ { "label": "Zorginstituut Nederland: package advice", "url": "https://www.zorginstituutnederland.nl/documenten/2020/09/30/pakketadvies-esketamine-neusspray-spravato", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Poland", "country_code": "pl", "funding": "Yes, fully free (NFZ programme B.147)", "threshold": "ages 18–75; at least two but no more than five failed antidepressants in the current episode", "know": "A live national waiting-time portal shows queues per center, and you may enroll at any contracted center nationwide (~64).", "guide": "/guides/reimbursement-poland/", "sources": [ { "label": "NFZ drug programme B.147", "url": "https://programylekowe.pl/program/leczenie-chorych-na-depresje-lekooporna/", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Switzerland", "country_code": "ch", "funding": "Yes (OKP, since 10/2025)", "threshold": "ages 18–74; 2 antidepressants + 1 augmentation failed; CGI-S ≥5", "know": "Only 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).", "guide": "/guides/reimbursement-switzerland/", "sources": [ { "label": "BAG: Spravato Limitatio and center list", "url": "https://www.bag.admin.ch/de/bag/de/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Arzneimittel/Referenzdokumente-zur-Spezialitaetenliste.html", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Czechia", "country_code": "cz", "funding": "Yes (since 02/2025)", "threshold": "under 65; ≥2 optimized antidepressants failed, non-psychotic episode", "know": "Insurers have a documented practice of exceptional individual reimbursement beyond the criteria (for example over 65) when options are exhausted.", "guide": "/guides/reimbursement-czechia/", "sources": [ { "label": "SÚKL reimbursement conditions (via PsyAccess Czechia guide)", "url": "https://psyaccess.health/guides/reimbursement-czechia/", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Portugal", "country_code": "pt", "funding": "Yes (hospital settings, since 05/2025)", "threshold": "≥3 strategies + psychotherapy, with ECT positioned in the pathway", "know": "The strictest published criteria in Europe: INFARMED's financing decision binds treatment to hospital administration.", "guide": "/guides/reimbursement-portugal/", "sources": [ { "label": "INFARMED financing decision (via PsyAccess Portugal guide)", "url": "https://psyaccess.health/guides/reimbursement-portugal/", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Finland", "country_code": "fi", "funding": "Yes (Kela, since 08/2023)", "threshold": "≥3 failed treatments incl. attached psychotherapy, one a combination; MADRS ≥31; psychiatrist's B-statement", "know": "Unique 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.", "guide": "/guides/reimbursement-finland/", "sources": [ { "label": "Kela: restricted reimbursement, code 3062", "url": "https://www.kela.fi/laake3062", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Denmark", "country_code": "dk", "funding": "Yes (recommended 19/11/2025)", "threshold": "≥3 failed antidepressant treatments in the current moderate-to-severe episode", "know": "A 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.", "guide": "/guides/reimbursement-denmark/", "sources": [ { "label": "Medicinrådet: recommendation of 19 Nov 2025", "url": "https://medicinraadet.dk/nyheder/2025/efter-nye-data-og-lavere-pris-nu-anbefaler-medicinradet-esketamin-til-svaer-behandlingsresistent-depression", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Belgium", "country_code": "be", "funding": "Yes (since 06/2021)", "threshold": "moderate-severe episode; ≥2 failed antidepressants; per-patient prior authorization", "know": "Hospital-administered under INAMI/RIZIV Chapter IV, the insurer's advising physician approves each patient before the first dose.", "guide": "/guides/reimbursement-belgium/", "sources": [ { "label": "BCFI: reimbursement listing 06/2021", "url": "https://www.bcfi.be/nl/recente-informatie-juni-2021-nieuwigheden-schrappingen-andere-wijzigingen/", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Italy", "country_code": "it", "funding": "Yes (hospital medicine, Classe H, since 05/2022)", "threshold": "≥2 failed antidepressants; AIFA monitoring registry", "know": "Delivery runs through regionally authorized psychiatric centers, availability varies by region.", "guide": "/guides/reimbursement-italy/", "sources": [ { "label": "AIFA Classe H listing (via PsyAccess Italy guide)", "url": "https://psyaccess.health/guides/reimbursement-italy/", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Ireland", "country_code": "ie", "funding": "Yes (HSE, since 01/2022)", "threshold": "documented TRD; psychiatrist-initiated", "know": "Access runs via specialist psychiatric services rather than a designated-center list.", "guide": "/guides/reimbursement-ireland/", "sources": [ { "label": "HSE reimbursement (via PsyAccess Ireland guide)", "url": "https://psyaccess.health/guides/reimbursement-ireland/", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Spain", "country_code": "es", "funding": "Yes (hospital medicine, since 11/2022)", "threshold": "ages 18–74; ≥3 failed strategies incl. augmentation", "know": "The hospital psychiatry and pharmacy commission is the gatekeeper, and practice varies noticeably by region.", "guide": "/guides/reimbursement-spain/", "sources": [ { "label": "Hospital medicine status (via PsyAccess Spain guide)", "url": "https://psyaccess.health/guides/reimbursement-spain/", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "United Kingdom", "country_code": "gb", "funding": "Scotland only (SMC2258); England & Wales: NICE declined", "threshold": "Scotland: documented TRD, no response to ≥2 antidepressants in the current episode", "know": "The 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.", "guide": "/guides/reimbursement-uk/", "sources": [ { "label": "SMC2258: esketamine accepted, restricted", "url": "https://www.scottishmedicines.org.uk/medicines-advice/esketamine-spravato-full-smc2258/", "checked": "2026-08-19" }, { "label": "NICE TA854", "url": "https://www.nice.org.uk/guidance/ta854", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Sweden", "country_code": "se", "funding": "'Strongly restrained' (NT Council; regions decide)", "threshold": "in practice roughly 4 failed alternatives (antidepressants, augmentation and, where appropriate, ECT) documented in writing", "know": "Sweden 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.", "guide": "/guides/reimbursement-sweden/", "sources": [ { "label": "NT Council recommendation (via Läkartidningen)", "url": "https://lakartidningen.se/opinion/debatt/2021/11/nt-radet-rekommenderar-kraftigt-aterhallsam-anvandning-av-spravato/", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "France", "country_code": "fr", "funding": "Hospital-only", "threshold": "under 65; ≥2 antidepressants of 2 classes failed; ECT not an option", "know": "No private ketamine market at all; since 03/2026 a ketamine compassionate framework exists for suicidal crisis.", "guide": "/guides/reimbursement-france/", "sources": [ { "label": "ANSM/HAS framework (via PsyAccess France guide)", "url": "https://psyaccess.health/guides/reimbursement-france/", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Norway", "country_code": "no", "funding": "NO: Spravato rejected three times (2021–2022); 2025 reassessment declined", "threshold": null, "know": "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.", "guide": "/guides/reimbursement-norway/", "sources": [ { "label": "Nye Metoder: esketamine ID2019_116", "url": "https://www.nyemetoder.no/metoder/esketamin-spravato/", "checked": "2026-08-19" }, { "label": "Nye Metoder: ketamine ID2022_018", "url": "https://www.nyemetoder.no/metoder/ketamin/", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" }, { "country": "Austria", "country_code": "at", "funding": "Inpatient only (hospital financing); not in the outpatient reimbursement code (EKO)", "threshold": "outpatient: case-by-case chief-physician approval", "know": "In the private Wahlarzt market the sickness fund refunds part of each invoice, typically €80–110 per session; the partial refund is a legal entitlement.", "guide": "/guides/reimbursement-austria/", "sources": [ { "label": "EKO status and Wahlarzt refunds (via PsyAccess Austria guide)", "url": "https://psyaccess.health/guides/reimbursement-austria/", "checked": "2026-08-19" } ], "verified_at": "2026-09-04" } ] }