Most discussion of esketamine and primary care focuses on what patients believe. This piece turns the lens around. It tests five beliefs referrers sometimes hold about their own role, checking each against our own poll data, 443 adults in ten Midwest states, and against how the treatment actually runs.
The survey was fielded in June 2026 on a general population panel. Its figures are final and validated, and they describe care-seeking preferences, not clinical outcomes.
Myth one: "Once I send the referral, my part is done."
The reality: The referral is where many patients get lost. Our respondents overwhelmingly planned to start with primary care: 56 percent named it as where they would begin with ketamine or esketamine, and 5 percent admitted they would be stuck without help. Patients who choose you as their entry point are, by definition, relying on you to route them.
A depressed patient is poorly positioned to chase an unscheduled referral, return voicemails, or navigate a prior authorization. Small follow-through steps make a large difference:
- A staff check at two to three weeks to confirm the appointment was scheduled.
- A clear instruction to the patient about who will call them and what to do if no one does.
- A return note from the receiving clinician so you know the outcome.
None of this is extensive. It is the difference between a referral and a result.
Myth two: "Documentation for prior authorization is the specialist's job."
The reality: The specialist submits it, but the evidence usually lives in your chart. Payers commonly want each prior antidepressant trial documented with drug, dose, duration, and response, often along with serial symptom scores. The receiving clinician can only submit what you recorded.
That matters to patients more than almost anything else. In our poll, coverage appeared on 85 percent of respondents' two-item provider lists, and 65 percent said it could make or break their willingness to try esketamine. A thin medication history in the referral can mean a denial, an appeal, and weeks of delay for someone who is already struggling.
Myth three: "If I bring up esketamine, patients will expect it."
The reality: Patients in our survey were more measured than eager. Shown the idea of ketamine treatment for depression or PTSD, the biggest share of respondents, 34 percent, were wary yet willing to hear more. Next came doubters at 21 percent, then two groups at 18 percent each (the hopeful or curious, and those new to the idea), with opponents at 9 percent.
That profile suggests most patients want information and a trusted opinion, not a prescription on demand. They also defer strongly to physicians: for 74 percent, the doctor's view would settle it. Mentioning esketamine as one of several options, with a clear explanation of who is and is not a candidate, positions you as the guide rather than the gatekeeper. The eligibility decision still rests with the treating clinician.
Raising it also lets you correct a common confusion. Most patients cannot tell approved esketamine from IV infusions used off-label or from home-use ketamine sold online. Brain Recovery Centers' page on how Spravato treatment works is one clear reference you can hand them. If you do not draw that line, the internet will draw it for them, badly.
Myth four: "My Medicaid patients will not be able to access it."
The reality: Access varies, and assuming the answer can close a door that is actually open. In our sample, Medicaid covered 37 percent of respondents, nearly matching the 39 percent on commercial plans, and 23 percent reported Medicare, with multiple answers allowed. Plenty of patients prefer the covered route, too: half would put up with extra insurance steps sooner than pay cash.
State Medicaid programs and their managed care plans set their own criteria for esketamine, and certified sites differ in which plans they accept. The practical steps:
- Check your state's and plans' current criteria rather than relying on an old denial.
- Identify at least one certified site near you that accepts Medicaid.
- Note that Medicaid typically includes non-emergency medical transportation, which can address the requirement that patients not drive after treatment. Confirm the site's discharge policy.
Myth five: "Patients who want to avoid more drugs are not candidates for anything new."
The reality: Many patients want non-medication options and do not know they exist. Among our respondents, 64 percent wanted to avoid drugs where possible, yet TMS was familiar to only 25 percent, and just over half the whole sample landed in the group unaware of TMS but keen on avoiding drugs.
A patient who hesitates at "another medication" may be very receptive to TMS, a structured psychotherapy, or both. Esketamine is itself a medication, so for these patients it may not be the first thing to mention. Listening for the drug-free preference helps you offer the option most likely to be accepted.
What these myths share
Each one underestimates how much of the path runs through primary care. The survey data points one way: patients start with their primary doctor, trust that doctor's recommendation above every other source, and depend on that office for the records that unlock coverage. A few habits turn that responsibility into something manageable:
- Document medication trials completely, as you go.
- Know two or three local destinations, including one that accepts Medicaid.
- Name the full range of options, including drug-free ones.
- Follow up on referrals rather than assuming they landed.
Limits
This is survey research on care-seeking attitudes, not clinical evidence or prescribing guidance. Esketamine's approved uses include adult treatment-resistant depression; certified sites give it under a REMS and watch the patient after every dose. Candidacy is a clinical judgment.
A patient in crisis can reach 988 by voice or by text, and Suicide and Crisis Lifeline counselors stay on duty whatever the hour. Mentioning it at the moment of referral, while the patient waits for the next appointment, is a small act that can matter a great deal.
Methodology
Survey 395586438 went out through Pollfish's consumer panel, gathered 443 completes, and closed June 23, 2026. Everyone answering was 18 to 64 and lived in Nebraska, Iowa, Ohio, Missouri, Kansas, Minnesota, Indiana, Oklahoma, Illinois or Wisconsin. Payer items allowed multiple answers. We report validated, final whole-sample numbers. The publisher commissioned the poll and covered the bill.