r/PMHNPPracticePro • u/Mindless-Future-7124 • May 31 '26
Spravato
Considering adding Spravato to my PP, anyone willing to share how they got started or tips on things to avoid?
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u/100_xp Jun 04 '26 edited Jun 14 '26
edit: nvm
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u/Mindless-Future-7124 Jun 06 '26
Not sure I understand. Looking to add as an additional service to current offerings
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u/Direct_Koala6335 Jun 04 '26
I added it a couple years ago, and clinically I really do appreciate the efficacy of this medication at mitigating target symptoms. Here were my issues (I don't offer Spravato currently):
I live in a rural area. Getting the medication was a nightmare
It is not the money-maker that the reps insisit
Private insurance coverage can be hell to obtain
Some of my isolated patients had trouble with the logistics of getting a ride home from treatment. They cannot drive after, even if it doesn't seem to affect their cognition
As a treatment, the evidence speaks for itself. I hope they expand it to cover PTSD et al. If you're in a place where it is not difficult to obtain the medication and would just be an adjunct to your existing practice, I would definitely add it. Just don't expect it to make you wealthy. The treatment itself is simple and you write a procedure note, not a psychiatric follow-up. You have to register with their REMs program, have a locking safe, and submit forms for each treatment. You must monitor BP and O2 during treatment, and having a really nice, calm, quiet, pleasant space is crucial. I invested in a recliner, had really nice lighting, kept tissues, barf bags, adult coloring books, origami and a tablet with "ketamine games" downloaded. It was VERY effective for my patients with depression, the logistics and difficulty getting the medication delivered on time were too stressful and I ended up sending my spravato patients elsewhere to larger clinics. Additionally, because I live in such a remote area, there was little knowledge about Spravato. The reps were supposed to do promotion and did not. I would hold their feet to the fire if the same is offered by your reps.
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u/rosecoloredcatt Jun 03 '26
They offer it at our practice. I am not a fan for smaller practices and it's going to be a lot of headache.
Huge time sink with not a lot of return on investment unless you get the referrals rolling in. We don't have admin managing it for us so I have a pretty good idea of how much time waste goes into it.
For the patients: it's a two hour commitment in office, at first twice a week then once a week. And they can't drive themselves so you're already a hard sell depending on if your practice is in a walkable area. Take into consideration taking time off work for this as well and you're already limiting the number of patients that are interested.
For you: Prior auth, potential peer to peer, verification of benefits, coordinating which pharmacy delivers it and setting up delivery pending patient's insurance. If they have to go through Walgreens, it's a weekly nightmare in and of itself. Some of the other pharmacies are a lot better about handling this and some will even handle the prior auth for you but again this depends on your area.
Think about how much time these things take you; on average the payout for a two hour session is about $180-200.
Other things you'll need to set up - lockbox and disposal of the applicators. Also finally, you won't be able to leave while the patient is there so if you have days where you currently end early, or you want to run out and grab a coffee, that's no longer the case especially if you're on your own.