Medicaid Coverage of Esketamine and Ketamine Therapies: Cross-Sectional Policy Analysis Across 51 Jurisdictions and 165 Coverage Entities (August 2025)

Abstract

We reviewed official Medicaid coverage documents from 165 policy-making entities across 51 U.S. jurisdictions (state agencies, MCOs, and PBM carve-outs) captured in August 2025. Esketamine (Spravato) is covered by 75/165 entities (45.5%; 72/75 with prior authorization), while 90/165 (54.5%) are Not Stated; alternative ketamine routes are effectively unavailable (IV 1/165 [0.6%], IM 0, oral largely Not Stated), and six jurisdictions have no covering entities. All underlying data are publicly available on Zenodo: Medicaid coverage database (https://doi.org/10.5281/zenodo.17041139), Medicaid MCO enrollment (https://doi.org/10.5281/zenodo.17041210), Medicaid managed-care penetration (https://doi.org/10.5281/zenodo.17041502).

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