Esketamine nasal spray (Spravato)

Covered only for the FDA‑approved indication—treatment‑resistant depression in adults—as adjunctive therapy with an oral antidepressant; use for non‑FDA indications or without an oral antidepressant is not covered. Approval requires documented nonresponse (≤25% improvement) to ≥2 antidepressants from different classes each used at therapeutic dose ≥6 weeks in the current episode, current oral antidepressant use, psychiatrist prescriber, PDMP check if available, age ≥18, supervised intranasal administration with induction/maintenance dosing per policy, documented benefit after the induction phase, and authorization is limited to 6 months.

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

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