Esketamine nasal spray (Spravato)

Covered: Spravato (esketamine nasal spray) is authorized only for adults (≥18) with FDA‑approved treatment‑resistant depression and must be used in conjunction with an oral antidepressant; uses for other indications are not supported. Key requirements: documented nonresponse (≤25% improvement) to ≥2 antidepressants from different classes each used ≥6 weeks, current use of an oral antidepressant, prescription by a psychiatrist, supervised intranasal administration per specified induction/maintenance dosing with benefit assessed at end of induction, PDMP check, and approvals limited to 6 months.

"Has no history of psychosis OR has a history of psychosis and the prescriber believes that the benefits of Spravato outweigh the risks"

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