The appointment is fifteen minutes long. You have been rehearsing what to say in the car, and the moment the doctor says "What brings you in today?" all of it evaporates. You say "I'm fine, just tired," and you leave with a refill of the same pill that has not been working.
This article is here so that does not happen. It is a script, written for Missourians covered by MO HealthNet, for asking a doctor about esketamine, the depression treatment sold as Spravato. If you want background first, a patient guide to Spravato is short.
Why a script helps
Most people cannot bring this treatment up because they do not know it exists. In a survey our publisher paid for, covering 443 Midwest adults, the name Spravato was entirely new to 73 percent. One in five more had heard it somewhere but could not have explained it. Understanding stood at 6 percent. These figures are final.
Meanwhile, the doctor is the person who carries the most weight. For 74 percent of respondents, their own doctor would be the most convincing advocate for a treatment like this, with friends and family far behind at 18 percent. Of the 163 respondents on Medicaid, 75 percent felt that way. So you are walking into a room with the single most influential person in this decision, and you are the one who has to raise the topic. Having words ready makes that possible.
Before you go
- Book the right visit. When you call, say the appointment is to talk about depression that is not improving. That gives the office a chance to schedule enough time.
- Bring your medicine list. Write out every antidepressant with its dose, its duration, and the reason you quit it. Esketamine's approval targets depression that has outlasted two or more antidepressants, and MO HealthNet plans often want that history for prior authorization.
- Call your plan first if you can. Your plan's member line, printed on the card, can confirm any prior authorization rule for esketamine and name in-network certified centers. Knowing that turns an abstract question into a concrete one.
- Write your script on paper or in your phone. Reading from notes is completely normal. Doctors see it all the time.
The script
Adapt this to your own words. The structure matters more than the exact phrasing.
1. Name the problem plainly
"I want to talk about my depression. I've tried [number] antidepressants and I'm still struggling. Here's my list."
Hand over the list. This one sentence does a lot of work. It tells the doctor the visit is serious, and it puts the treatment history, which is the heart of any eligibility question, on the table right away.
2. Describe the impact, not just the feeling
"It's affecting my work, my sleep, and how I am with my family. Some days I can't get out of bed."
Concrete effects help a clinician judge severity. Be honest, including about anything that scares you.
3. Ask about esketamine by name
"There's a nasal spray called Spravato, esketamine, meant for depression that other medicines haven't helped. Could I be a candidate? If not, can you tell me why?"
Asking for the reason matters. A good answer might be that you have not yet tried enough medications at full dose, or that a health condition like uncontrolled high blood pressure makes it a poor fit. Both are useful to know.
4. Ask the coverage question out loud
"I'm on MO HealthNet. If this makes sense for me, would you be able to request prior authorization, or refer me to someone who can?"
You are not being pushy. Coverage was the defining concern in our survey: 85 percent ranked it among their top two priorities when choosing where to get care. Your doctor knows it is on your mind. Saying it saves time.
5. Ask who takes the next step
"What happens next, and who does it? Do I call someone, or will your office?"
Plenty of good plans die in the gap between offices. Leave knowing who is responsible for the referral, the prior authorization, and the first appointment.
6. Ask about logistics
"If I start, how often would I need to go, and how long does each visit take?"
Expect an answer along these lines: twice a week for roughly the first month, then weekly, then weekly or every other week. Every session adds two or more hours of observation, and you cannot drive afterward until you have slept. If you do not have a ride, ask whether your plan provides rides to medical appointments.
If the doctor is unfamiliar
Not every primary care doctor in Missouri has referred someone for esketamine. If yours seems unsure, you can ask:
"Would you be willing to refer me to a psychiatrist who can evaluate me for it?"
Psychiatrists were the second most common first stop in our survey, chosen by 23 percent. A referral is a perfectly reasonable ask.
If the answer is "not yet"
Sometimes the honest clinical answer is that another step comes first, such as a medication adjustment, therapy, or checking for another cause. Ask what would need to happen for esketamine to come back into the conversation, and when you should follow up. Suitability is a medical judgment, and the clinician who knows your full history should make it.
What not to worry about
You do not need to sound like an expert. You do not need to have read the research. You only need to say the medicines are not working, show what you have tried, and ask. In our survey, 5 percent of people said they would have no starting point at all. Having this script means you are already past that point.
If what you are carrying includes thoughts of ending your life, say so at the appointment, and do not wait for it if the thoughts are strong. The Suicide and Crisis Lifeline answers 988 texts and calls at any hour, veterans can press 1, and a real person picks up.
Methodology
Pollfish's consumer panel hosted the survey, which 443 people ages 18 to 64 completed from Minnesota, Illinois, Oklahoma, Iowa, Missouri, Nebraska, Kansas, Indiana, Ohio, and Wisconsin before it closed on June 23, 2026. The figures are whole-sample except the Medicaid breakdown. All figures reflect Pollfish's final validation. Our publisher asked for this research and paid for it.