Why Delivery Method Matters in Ketamine Therapy
In mental health care, how a medication is delivered matters almost as much as what it is. For people exploring ketamine-based treatments, one common question is:
Why is Spravato a nasal spray, rather than a pill, IV, or injection?
Spravato (a brand name of esketamine) is the only FDA-approved ketamine-based medication for treatment-resistant depression, and its intranasal form is no accident. The choice reflects careful balancing of absorption, how strongly it binds to its target receptors, and insurance coverage — all key to making this treatment both effective and accessible.
In this article, Lumin Health explores the science behind Spravato’s nasal formulation and why it is growing as a reliable option in clinical practice of mental health treatment.
Mucous Membranes and Ready Absorption of Spravato
The inside of your nose is lined with mucous membranes — specialized tissue rich with blood vessels and ideal for rapid drug absorption. This makes the intranasal route a powerful way to deliver medications that need to:
- Act quickly
- Bypass liver metabolism (known as “first-pass” metabolism) long enough to be effective
With Spravato, the active ingredient is S-ketamine — a one of the two mirror-images of ketamine — that is absorbed efficiently through these membranes, entering the bloodstream and reaching the brain in minutes.
“The nasal route is predictable. We know how much is being absorbed, and it avoids a lot of the variability we see with other non-injected forms.” — Dr. Ben Yudkoff
This route allows for relatively fast onset, without the invasiveness of IV infusions — especially helpful in outpatient psychiatric settings.
Lower Drug Volume = Less Leakage, Higher Fidelity
One challenge with intranasal medications is loss of drug — through leakage or swallowing Spravato addresses this by using a low-volume, high-concentration spray, which reduces:
- Drip-back into the throat with unintentional swallowing (which can decrease effectiveness)
- Dripping out of the nose
- Dosing inconsistencies
“It’s not just that it’s nasal — it’s that it’s engineered for nasal use.” — Dr. Ben Yudkoff
This attention to volume and delivery fidelity means clinicians can feel more confident about what dose is actually being absorbed — crucial in a treatment where both effectiveness and side effects are dose-sensitive.
How This Ties to Spravato FDA Approval and Insurance Coverage
Spravato’s pharmacology and nasal format is central to its regulatory and insurance status.
The nasal form of esketamine, Spravato, was patented by Janssen and received FDA approval for treatment-resistant depression due to its demonstrated safety and efficacy. Because of this, Spravato meets criteria for coverage by many insurers.
In contrast, IV ketamine and other formats are typically not covered as they are used “off-label” — meaning mental health treatment is not in the approved use cases for ‘generic’ ketamine, which is typically only in anesthetic contexts. This is the case even though IV ketamine infusions or intramuscular ketamine injections may be appropriate in some cases.
“We’ve had patients choose Spravato because it’s covered, reliable, and supervised in a way that makes them feel safe.” — Dr. Ben Yudkoff
This makes the nasal spray format a practical bridge between effective neuroscience and real-world accessibility.
Frequently Asked Questions
Q: Is intranasal esketamine (Spravato) better than IV?
A: Not necessarily. IV ketamine offers precise dosing and rapid onset, but requires clinical infrastructure and is often used off-label, which means the drug incurs an out-of-pocket expense to patients. Spravato’s nasal route was chosen for reliable absorption of esketamine, combined with ease of use and insurance accessibility.
Q: Will insurance cover it?
A: Spravato is FDA-approved for treatment-resistant depression and is often covered by insurance when prescribed by a REMS-certified provider and administered in a certified clinic. IV ketamine and compounded nasal sprays typically fall under off-label use, which are not always reimbursed.
Spravato (esketamine) as a Nasal Spray
Spravato’s nasal spray formulation isn’t meant to be a convenience — it’s a carefully chosen strategy. It leverages the body’s natural absorption pathways to deliver fast, robust relief in a format that fits both clinical safety protocols and insurance frameworks.
Whether nasal, IV, or otherwise, the route of ketamine administration should match the patient’s needs, diagnosis, and life context. At Lumin Health, we help patients understand these options so they can make informed decisions grounded in clarity, not hype.
