Ketalar® (Ketamine) and Spravato® (Esketamine) – Commercial Medical Benefit Drug Policyopen_in_new

Spravato (esketamine) nasal spray is covered for treatment‑resistant depression and for depressive symptoms in adults with MDD with acute suicidal ideation/behavior when prescribed per FDA labeling by or in consultation with a psychiatrist, the provider/setting is REMS‑certified with observed administration and ≥2‑hour monitoring, baseline and ongoing measurement‑based assessments are documented and (for TRD) there is documented failure of ≥2 antidepressant trials of ≥8 weeks (for acute suicidality, used with a newly initiated or optimized oral antidepressant); authorizations are limited to ≤12 months. Ketalar (ketamine) injection is covered only for specific anesthesia indications (procedures not requiring skeletal muscle relaxation, induction, or as supplemental anesthesia) and is investigational/not medically necessary for psychiatric disorders, chronic pain, and migraine.

"Spravato (esketamine) nasal spray — Treatment-Resistant Depression (TRD): Spravato is proven for the treatment of treatment-resistant depression (TRD) when all of the following criteria are met: In..."