Esketamine nasal spray (Spravato)

Evicore covers Spravato (esketamine nasal spray) only for FDA‑approved adult uses—treatment‑resistant depression (TRD) and major depressive disorder with acute suicidal ideation/behavior—and excludes non‑FDA indications. Approval requires age ≥18, a psychiatrist prescriber, concurrent oral antidepressant, PDMP check unless unavailable, and for TRD documented nonresponse (≤25% improvement) to ≥2 antidepressants from different classes each used ≥6 weeks (patients with psychosis may be treated only if the prescriber documents that benefits outweigh risks); approvals are limited to 6 months for TRD and 2 months for acute suicidality with dosing limits up to 84 mg twice weekly and specified induction/maintenance schedules.

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

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