Esketamine nasal spray (Spravato)

Coverage is limited to FDA‑approved uses of esketamine (Spravato) — adults with treatment‑resistant depression (TRD) and adults with major depressive disorder with acute suicidal ideation/behavior — used only with a concurrent oral antidepressant; patients <18 or non‑FDA indications are excluded. Approval requires age ≥18, psychiatrist prescribing, documentation of diagnosis and current oral antidepressant; for TRD documented nonresponse (≤25% improvement) to ≥2 antidepressants from different classes each used ≥6 weeks, PDMP review (unless unavailable), prescriber risk/benefit justification if psychosis history, adherence to specified induction/maintenance dosing, and time limits of up to 6 months for TRD and 2 months for acute suicidality.

"Treatment-resistant depression in adults (Spravato used in conjunction with an oral antidepressant)."

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