Spravato™ (esketamine nasal spray)

Spravato is covered for adults (≥18 years) only for the FDA‑approved uses — treatment‑resistant depression (as adjunct to an oral antidepressant) and depressive symptoms in major depressive disorder with acute suicidal ideation/behavior (also adjunctive); use in patients <18 years is excluded. Coverage requires documented nonresponse to ≥2 antidepressants from different classes (≤25% improvement) each at therapeutic doses for ≥6 weeks, current use of at least one oral antidepressant, prescription by a psychiatrist, PDMP review, adherence to the specified induction/maintenance dosing regimens (TRD approvals up to 6 months; acute suicidal ideation/behavior up to 2 months with 84 mg twice weekly ×4 weeks — reducible to 56 mg for tolerability), and if there is a history of psychosis, documentation that benefits outweigh risks.

"Treatment-resistant depression in adults (Spravato is indicated, in conjunction with an oral antidepressant, for the treatment of treatment-resistant depression in adults)."