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For clinicians

How to become a Spravato provider: certification, step by step.

Spravato can only be given in a healthcare setting certified under the SPRAVATO REMS. Certification itself is mostly paperwork. Running a program well is the harder part. Here’s both, from a practice that has given more than 30,000 treatments.

Medically reviewed by David Boguslavsky, MD on · Published · 2 min read

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Spravato (esketamine) is only available through a federal safety program, the SPRAVATO REMS (Risk Evaluation and Mitigation Strategy). Every dose is given in a certified healthcare setting, under supervision, followed by monitoring.1 If you’re a psychiatrist, nurse practitioner or practice leader thinking about offering it, this is what certification involves and what running the program day to day takes.

The official forms, training and login are all on the SPRAVATO REMS website. Requirements change from time to time, so treat that site as the final word on the current versions.

The certification steps

  1. Choose an authorized representative. Each healthcare setting designates one person who is accountable for the setting’s compliance with the program.2
  2. Enroll the setting in the SPRAVATO REMS. Outpatient and inpatient settings enroll separately, through the REMS website.
  3. Train the relevant staff, and keep the records. Training covers the risks the program exists to manage: sedation, dissociation, respiratory depression, and abuse and misuse. Training records are checked in audits.2
  4. Equip the monitoring space. Patients are monitored for at least two hours after every dose, with blood pressure checks, and the setting must have a pulse oximeter to monitor patients onsite.13
  5. Set up supply. Spravato reaches certified settings only through certified pharmacies or contracted distributors, and the setting keeps records of every shipment received and every dose given. It is never sent home with a patient.2
  6. Enroll each patient, and document each session. Outpatients are enrolled in the program, and a Patient Monitoring Form is completed for treatment sessions and submitted to the REMS.2

Certified settings are audited, and a setting that doesn’t follow the requirements can be suspended or de-certified.2

What running a program actually takes

Getting certified is the easy part. What decides whether a Spravato program helps patients, and stays viable, is operations:

  • Chair time. Every session takes a little over two hours, and new patients come twice a week for the first month.1 That’s a lot of room and staff time per patient.
  • Clinical coverage. Someone qualified watches every patient for the full monitoring period, and responds to blood pressure rises, sedation or distress.
  • Insurance. Prior authorizations, renewals and appeals are constant. A program that can’t get approvals quickly loses patients before their first dose.
  • Transport. Patients can’t drive until the next day, so every visit needs a ride home. Some patients drop out over this alone.
For clinicians

Have a patient who needs Spravato now? Refer them to us.

While you get set up, we can evaluate your patient, usually within one business day, handle the insurance, and keep you informed.

Refer a patient
Call (908) 450-7002
Prefer to fax?

Get our one-page referral form by email. Fill it in and fax it back; the fax number is on the form.

Questions clinicians ask us

Where do I log in to the REMS? On the SPRAVATO REMS website, which also has the current enrollment and monitoring forms.

Do I need to be a psychiatrist? The program certifies healthcare settings rather than individual specialties. Check the current eligibility details on the REMS website.

Can I refer instead of certifying? Yes, and many clinicians do. We handle the evaluation, the REMS requirements and the insurance approval, and keep you informed about your patient’s progress. Call (908) 450-7002, or get our referral form by email and fax it back to us.

Sources

  1. SPRAVATO® (esketamine) nasal spray, Prescribing Information: boxed warning, dosing, and REMS. Janssen Pharmaceuticals.
  2. U.S. Food and Drug Administration. NDA 211243/S-027 supplement approval letter, SPRAVATO REMS modification. January 23, 2026.
  3. U.S. Food and Drug Administration. NDA 211243/S-013 supplement approval letter, SPRAVATO REMS modification (respiratory depression; pulse oximetry). December 31, 2024.
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