You have decided a patient might be a candidate for esketamine. The clinical reasoning took two minutes. The next part, the part about who pays and where they go, is where many of these referrals quietly fail. This is a script for that part.
It is written for referring clinicians and grounded in our summer poll of 443 Midwest adults. Two findings shape it. Coverage dominated: 85 percent of respondents named it as one of two things they most want in a provider. And coverage itself is split, 39 percent commercial against 37 percent Medicaid, Medicare at 23 percent, TRICARE at 5, and 9 percent uninsured. These are multi-select, whole-sample figures from the final validated data.
Why a script at all
Coverage talk feels like an administrative task, so it often gets handed to staff after the visit. The survey suggests that is too late. Patients listen to you most. A physician's recommendation would move 74 percent of respondents, far above friends and family at 18 percent. When the recommendation and the coverage question arrive together, from you, the plan holds together.
The lines below are suggestions. Adapt them to your voice and your patient.
Opening: name the option and the reason
"We have tried a few medications, and you are still not where either of us wants you to be. There is a treatment called esketamine, a nasal spray with the brand name Spravato. It is approved for people like you, whose depression held on after other antidepressants. I think it is worth considering for you."
Why it works: it links the option to the patient's own history, which is also what payers look for. And it gives the name, which most patients have never heard. In our survey, 73 percent had not.
If unsure, say so: "I want a specialist to evaluate whether it fits."
Ask about coverage early, and without apology
"Before we go further, I want to make sure we send you somewhere your insurance works. What plan are you on right now? If it is Medicaid, which company is on the card?"
Why it works: many patients feel awkward raising cost. Asking it yourself signals that coverage is a normal clinical consideration, which, for most of them, it is. Among our respondents, 65 percent said insurance would settle, or strongly shape, whether they try it.
Explain what happens at the site
"This is not a prescription you pick up. You use the spray in a certified clinic with a nurse watching, then remain for two hours or so afterward. Someone else has to drive you home, and the first few weeks mean several visits."
Why it works: logistics are where patients drop off. Being specific early lets them plan, or tell you now that transportation is a problem.
Address transportation for coverage-dependent patients
"If you are on Medicaid, your plan may cover rides to medical appointments. It is worth asking them when you call."
Why it works: many patients do not know the benefit exists, and the no-driving rule makes it directly relevant.
Set expectations about paperwork
"Your insurance will probably want to review this first. That is called prior authorization. I will send the clinic your medication history, which is usually the main thing they need. It can take a little time, and it is normal. It does not mean the answer is no."
Why it works: patients who expect a delay are less likely to read it as rejection. And most are willing to wait. In our survey, just over half preferred a covered route with more hoops to a simpler self-pay route. Self-pay drew 23 percent, and another 26 percent could not decide.
Name the site, and why you chose it
"I am referring you to [site]. They take your plan, and they are about [time] from here. Here is their number. If they tell you something different about your coverage, call us back and we will find another option."
Why it works: the patient leaves with a concrete next step and permission to return if it breaks. Proximity matters to them; 43 percent of our respondents put a nearby site in their top pair of priorities. A patient-facing page from Brain Recovery Centers on esketamine costs and coverage is a useful handout here.
Distinguish it from what they may have seen online
"You might see ads for ketamine clinics or at-home ketamine. That is a different thing. It is not the same FDA approval, and insurance often does not cover it. What I am recommending is the approved version given at a certified site."
Why it works: patients often conflate the two and may end up paying cash for a different treatment. It also speaks to a value many hold, since 59 percent of respondents rated FDA approval big or decisive.
Close with safety and follow-up
"While we are waiting on this, if things get worse, or if you have thoughts of not wanting to be here, call or text 988 any time. And let's set a follow-up so I can see how the referral is going."
Why it works: authorization and scheduling can take weeks. The patient needs a bridge.
For uninsured patients, a different opening
"You mentioned you do not have insurance right now. Before we look at specific treatments, it may be worth checking whether you qualify for Medicaid. Can we connect you with someone who can help with that?"
A successful coverage application may change every option that follows.
A note on the limits of this script
This script uses whole-sample figures only. It does not break any answer down by payer type, and nothing here should be read as describing how any particular group of patients feels. Read it as market research rather than clinical evidence. Esketamine's approval covers treatment-resistant depression, and whether it suits a given patient is your determination.
Crisis resources belong in every version of this conversation: the Suicide and Crisis Lifeline answers 988, voice or text, every hour, at no cost to the patient.
Methodology
Source: Pollfish survey 395586438, run with the Pollfish consumer panel through June 23, 2026; 443 completes, all working-age adults (18 through 64) from Wisconsin, Ohio, Minnesota, Illinois, Kansas, Iowa, Indiana, Missouri, Nebraska and Oklahoma. Coverage allowed several answers. Figures are whole-sample and final. The publisher sponsored and paid for the study.