Spravato™ (esketamine nasal spray)

Spravato (esketamine nasal spray) is covered only for adults (≥18) with FDA‑approved indications—treatment‑resistant depression (as adjunct to an oral antidepressant) or major depressive disorder with acute suicidal ideation/behavior (also as adjunct)—and is not covered outside these indications. Coverage requires documentation of nonresponse (≤25% improvement) to ≥2 different antidepressants from different pharmacologic classes each used at therapeutic doses for ≥6 weeks, current use of an oral antidepressant, prescription by a psychiatrist, PDMP review, and prescriber justification if history of psychosis; approvals are time‑limited (6 months for TRD, 2 months for acute suicidal ideation/behavior) with specified induction and maintenance dosing schedules.

"Is currently receiving at least one oral antidepressant (required for both covered indications)."

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