You live in St. Peters, your coverage is MO HealthNet, and the antidepressants have not done what anyone hoped. Somebody mentioned a nasal spray for depression that is given in a clinic, and you want to know whether it is even possible for you. This guide walks the route from that first question to a real answer, one step at a time.
First, you are not behind
If you had to look up the word "esketamine," you have plenty of company. In a survey we commissioned this summer, 443 adults from ten Midwest states were asked about Spravato, the brand name for esketamine. The "never heard of it" group was the largest by far at 73 percent. Roughly one person in five, 21 percent, recognized the name while drawing a blank on what it does. The group that genuinely understood it was a small sliver: 6 percent.
The numbers are final, and they do not mean you missed something obvious; the treatment rarely appears in ads and is given only in certified settings.
Step 1: Know what you are asking about
Esketamine is a nasal spray the FDA approved for two groups of adults: those with treatment-resistant depression, where two or more antidepressants have not worked well enough, and those whose major depression includes acute suicidal thinking or actions. You use it yourself at a certified center while staff watch, remain at least two hours, and skip driving until the next day.
It is not the same thing as IV ketamine at a cash-only clinic or ketamine lozenges shipped by an online company. Those use a related drug off-label and are generally outside what Medicaid pays for. When you call your plan or talk to your doctor, say "esketamine" or "Spravato" so there is no confusion. A short guide to the Spravato treatment can help you describe it.
Step 2: Call the number on your card
Most MO HealthNet members belong to a managed care plan, and that plan's member services line is printed on your ID card. Before you make any appointment, call and ask:
- Is esketamine on the plan's list of covered drugs, and does it need prior authorization?
- Which certified esketamine treatment centers are in network for someone in St. Peters?
- Can I book a psychiatrist directly, or is a referral required?
- Does my plan offer non-emergency medical transportation, and can a ride cover a visit lasting three hours or more?
Jot down the date, who you spoke with, and what they told you.
Why start with coverage? Because that is what almost everyone in our survey said matters most: insurance was in the top two provider factors for 85 percent, and for 65 percent coverage would settle the matter or weigh on it heavily. Of the 163 respondents on Medicaid, 68 percent said the same.
Step 3: Gather your history
Prior authorization for esketamine usually depends on documenting what you have already tried. Make a simple list:
- Each antidepressant you have taken, with the dose and roughly how many weeks or months
- Why you stopped: not working, side effects, or both
- Any therapy you have done, and for how long
- Other conditions and current medicines, especially anything for blood pressure
Your pharmacy in St. Peters can print your fill history if you have lost track. Bring the list to every appointment.
Step 4: Pick your door
In our survey, a primary care doctor was the most popular first stop, at 56 percent, followed by psychiatrists at 23 percent. Twelve percent would search online alone, and for 5 percent there was no obvious starting point.
For a MO HealthNet member, the primary care door is usually the easiest to open. You already have an assigned provider, visits cost little or nothing, and your doctor can make the referral your plan may require. If you already see a psychiatrist through a community mental health center or another clinic, that is an equally good place to ask.
Step 5: Ask the question directly
Doctors heavily influence this decision. Their own doctor's recommendation would be the push for three in four respondents, 74 percent to be exact. Say that the medicines have not worked, bring your list, and ask whether you should be evaluated for esketamine. Then ask what the next step is and who takes it.
Step 6: Plan the calendar and the ride
The first month usually means two visits a week. After that, weekly for about a month, then weekly or every two weeks. Every visit ends with you needing someone else to drive.
From St. Peters, a certified center could be a short hop down I-70 or a longer trip into St. Louis County. When you compare centers your plan offers, ask about parking, appointment times that work around a job, and whether they have experience getting prior authorizations approved for Medicaid patients. Nearness came second in our survey's priority list, picked by 43 percent, and twice-weekly visits make it easy to see why.
Step 7: If the answer is no
A denial from your plan, or a doctor who does not think esketamine fits you, is not the end of the road. Ask your doctor what the reason was. Plans have an appeal process, and your prescriber can often supply more documentation. Ask about other options too, including different medications, therapy approaches, and treatments like transcranial magnetic stimulation. The right treatment for you is a clinical judgment, and it may not be this one.
Keep your coverage steady
Missouri Medicaid coverage has to be renewed periodically. Answer renewal letters promptly and keep your address current with the state. Losing coverage mid-course is one of the most avoidable ways for treatment to stall.
Please do not wait on paperwork if you are in danger. If suicide is on your mind, or you feel unable to keep yourself safe, 988, by phone or text, reaches a trained Suicide and Crisis Lifeline counselor, day or night, for free, and veterans can press 1.
Methodology
This guide's figures trace to a survey on Pollfish's consumer panel, answered through June 23, 2026, by 443 respondents, ages 18 through 64, from Illinois, Missouri, Nebraska, Kansas, Iowa, Ohio, Indiana, Wisconsin, Minnesota, and Oklahoma. Results are whole-sample figures apart from the Medicaid breakdown, and every one was checked in the panel's final validation. The research was ordered and paid for by our publisher.