Spravato Shortage Update: What Patients Need to Know in 2026

If you've been prescribed Spravato (esketamine nasal spray) for treatment-resistant depression (TRD) and you're struggling to access treatment, you may be wondering: is there a shortage? The short answer is no — but access challenges remain very real for patients in 2026. Here's the full update.

Is Spravato in a Shortage in 2026?

As of 2026, Spravato is NOT on the FDA's official drug shortage list. Janssen Pharmaceuticals (a Johnson & Johnson company) continues to manufacture and distribute esketamine nasal spray without reported supply interruptions. The product is available in both 56 mg and 84 mg dose kits.

However, "no FDA shortage" does not mean "easy to access." Spravato's access problems are structural — built into the drug's REMS (Risk Evaluation and Mitigation Strategy) program requirements, geographic distribution of certified treatment centers, insurance coverage barriers, and cost.

Why Patients Still Struggle to Access Spravato

The barriers to accessing Spravato come in several distinct forms:

REMS program restrictions: Spravato must be administered at a certified healthcare facility. It cannot be dispensed to patients to take home. Every session requires at least 2 hours of monitoring on-site.

Geographic gaps: Certified Spravato treatment centers are concentrated in urban and suburban areas. Patients in rural or lower-density regions may face 50+ mile drives for twice-weekly sessions during the 4-week induction phase.

Insurance prior authorization: Nearly every insurance plan requires prior authorization for Spravato. The approval process can take 1–4 weeks and often requires detailed documentation of failed antidepressant trials.

High cost: Without insurance, Spravato costs $600–$1,200 per session. The first month of treatment can cost over $8,200.

Limited appointment availability: Even in cities with certified centers, appointment slots can be difficult to get. Some centers have waitlists of weeks or months.

Spravato's History: From Restricted Access to Expanded Approval

Spravato was first approved by the FDA on March 5, 2019 for treatment-resistant depression in adults — used alongside an oral antidepressant. In 2020, the FDA expanded approval to include depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior, again in conjunction with an oral antidepressant.

On January 21, 2025, the FDA granted Janssen a supplemental NDA approval making Spravato the first and only monotherapy for adults with TRD — meaning it can now be prescribed alone, without requiring a concurrent oral antidepressant. This expanded the potential patient population and gave prescribers more flexibility.

Despite these approvals, Spravato's REMS program and access barriers have persisted. The drug is on track to exceed $1 billion in annual sales, reflecting growing demand — but real-world access variability remains a critical challenge for patients across the U.S.

What About the Ketamine Shortage That Affects Some Patients?

Racemic ketamine (Ketalar) — a different product from Spravato — has experienced periodic shortage-like situations due to demand surges for off-label depression infusions, surgical use, and other indications. Importantly, this does NOT affect Spravato supply, as esketamine is a separate, branded formulation manufactured and distributed separately by Janssen.

If your clinic uses IV racemic ketamine (not Spravato) and has faced supply issues, speak with your provider about whether Spravato is an appropriate alternative for your situation.

What Patients Can Do If They Can't Access Spravato

If you're facing access barriers to Spravato in 2026, here are practical steps:

Use the official SPRAVATO treatment center locator at spravato.com to find certified facilities near you, expanding your search radius if needed.

Contact the SPRAVATO REMS support line at 1-855-382-6022 for help locating certified centers.

Ask your psychiatrist to start the insurance prior authorization process immediately — it can take up to 4 weeks.

Apply for the Spravato withMe Savings Program to reduce medication costs to as little as $10/session if you have commercial insurance.

Discuss alternative treatments with your doctor — TMS, IV ketamine, ECT, and Auvelity are all viable options if Spravato access remains blocked.

Finding Other Medications You Need

If you're managing treatment-resistant depression, you may also be taking oral medications — antidepressants, mood stabilizers, or other psychiatric medications — that can themselves be hard to find at local pharmacies. medfinder calls pharmacies near you to find which ones can fill your prescriptions, saving you the time and frustration of calling around on your own.

For a full breakdown of what to try if Spravato remains inaccessible, see our guide: Alternatives to Spravato If You Can't Fill Your Prescription.