From our survey
Medicaid is not only for old cheap drugs, Spravato is not street ketamine, and cash is not always faster: confident claims, checked honestly.
When a treatment is new to you and your coverage comes through Medicaid, you tend to hear a lot of confident statements from people who have never actually checked. Some of them keep people from asking a question that could matter. Here are six beliefs we hear from Missourians on MO HealthNet about esketamine, sold as Spravato, set against what is actually known.
Any numbers here come from a June 2026 survey our publisher commissioned, answered by 443 Midwest adults. They are final, validated figures; most are whole-sample, and one is broken out for the 163 respondents on Medicaid.
What is closer to true: Medicaid programs do cover newer, brand-name medications, but they often put them behind prior authorization. That means your prescriber sends paperwork explaining why you need the drug, typically showing what you have already tried. It is a hurdle, not a wall.
The only way to know what your plan does is to ask. Call the member services number on your MO HealthNet health plan card and ask whether esketamine is covered, whether it needs prior authorization, and which certified treatment centers are in network. Five minutes on the phone replaces a lot of guessing.
What is closer to true: Maybe, and maybe not. Doctors are busy, appointments are short, and a primary care visit covers a lot of ground. Esketamine is not a first-line treatment. It is meant for depression that has not budged after two or more antidepressants, and certified centers alone can give it, so many general practices rarely deal with it.
Your doctor's view matters enormously, which is exactly why you should ask. Among our respondents, 74 percent said their own doctor's view would count for more than anyone else's in whether they tried this kind of treatment. If the most trusted voice in the decision has not raised it, you are allowed to raise it yourself.
What is closer to true: Esketamine is related to ketamine, but it is a specific FDA-approved medication with a specific approved use: adults with treatment-resistant depression, plus adults facing major depression together with acute suicidal thoughts or behavior. Every dose is taken inside a certified health care setting under observation, and at least two hours of monitoring follow. You never take it home.
That is a very different thing from recreational ketamine, and also different from the off-label IV ketamine or at-home ketamine products sold by some cash-pay clinics and online companies. Keeping those categories separate is not splitting hairs. It is the difference between a regulated treatment and something with far less oversight. A plain overview of Spravato describes the regulated version.
Plenty of people start out doubtful, and that is healthy. In our survey, 21 percent described their first reaction to ketamine therapy for depression as skeptical. Skepticism is a good reason to ask careful questions, not a reason to stop asking.
What is closer to true: Almost nobody does. Nearly three in four respondents, 73 percent, did not recognize Spravato. The one-in-five group that recognized it still could not say what it was, and just 6 percent actually understood it.
If you felt embarrassed reading about it for the first time, let that go. Being unfamiliar with this treatment puts you squarely in the majority. What moves someone from the majority to the informed minority is usually a single conversation.
What is closer to true: Paying cash may be faster for some off-label ketamine services, but it can also be very expensive, and those services are generally not esketamine. For most people on Medicaid, the covered route is the realistic one.
Survey respondents leaned the same way. Given a choice between insurance coverage with more hoops to jump through and paying yourself for a simpler start, 51 percent took the hoops, more than twice the 23 percent who would pay out of pocket. The remaining 26 percent were unsure. Medicaid respondents leaned further toward the covered route, at 57 percent. The hoops are real: documenting your history, waiting on approval, arranging rides. But a lot of people decide they are worth it.
What is closer to true: You can learn a lot online, but you cannot get this treatment without a clinician. Only 12 percent of respondents said they would start by researching on their own, while more than half, 56 percent, would go first to a primary care doctor.
There is another problem with searching. Asked for their likely Google search, they wrote things like "help with depression," "depression medicine alternatives," and "therapist near me." Nobody typed a drug name. Searches like those tend to return ads and directories, not a clear picture of what you might qualify for. Your doctor, with your history in front of them, is a much better filter.
Nothing here is medical advice. Esketamine is not right for everyone, and people with certain conditions, including some blood vessel problems and uncontrolled high blood pressure, may not be candidates. Whether it fits is for a clinician with your history in hand to judge.
If depression has you thinking about suicide, tell someone right away. The Suicide and Crisis Lifeline, staffed day and night, takes texts and calls at 988; veterans can press 1, and a trained person picks up.
The figures trace to a Pollfish consumer panel survey we ran until June 23, 2026, and 443 people ages 18 to 64 completed it in Iowa, Missouri, Kansas, Ohio, Nebraska, Illinois, Minnesota, Indiana, Wisconsin, and Oklahoma. Top-line results except the Medicaid breakdown noted above, all from the validated final data. Our publisher commissioned and financed the survey.