Who Qualifies for SPRAVATO Treatment?

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Spravato® was approved for use in addressing treatment-resistant depression in adults several years ago. Since then, many patients with major depressive disorder have questioned whether Spravato® may be a viable option. This article discusses the basics of Spravato® treatment and identifies who qualifies for Spravato® treatment.

What is Spravato®?

Spravato® is a nasal spray that delivers a derivative of ketamine, esketamine. Ketamine is an anesthetic that has been used for decades that has recently gained attention for its beneficial effects in treating depression. Esketamine has been highly successful at addressing treatment-resistant depression. One study found that 70% of patients with treatment-resistant depression who added esketamine to an oral antidepressant showed symptom improvement.

The positive results with esketamine show incredible promise, with some experts calling it a ‘miracle drug.’ Like ketamine, esketamine can help the brain form new neural connections, allowing patients to develop more positive thoughts and behaviors. Additionally, as esketamine is fast-acting, patients can find relief from their depression symptoms in hours rather than weeks, as most oral antidepressants take.

Who Qualifies for Spravato®?

Patients with major depressive disorder that has not responded to traditional forms of treatment also called treatment-resistant depression (TRD), are eligible for Spravato® treatment. And esketamine is covered by most insurance carriers, including Medicare and Medicaid. However, it has a very narrow set of approved conditions, which limits treatment for TRD or major depressive disorder with suicidal ideation.

For Medicaid or Medicare coverage, the patient must meet the following criteria:

Treatment-Resistant Depression

  • Must be 18 years of age or older.
  • Have a documented diagnosis of treatment-resistant major depressive disorder.
  • The patient must have tried and failed at least two different oral antidepressants. The prescriptions must also be from different drug classes, such as one being an SSRI and one an SNRI, at optimized doses for at least eight weeks.
  • Spravato® must be prescribed by a psychiatrist in a certified Spravato® treatment center.
  • Spravato® must be taken in conjunction with an oral antidepressant.
  • The patient’s baseline depression status must be documented using an appropriate clinical rating scale.

Major Depressive Disorder with Suicidal Ideation

  • Must be 18 years of age or older.
  • Must have a documented diagnosis of major depressive disorder with acute suicidal ideation or behaviors that require immediate medical intervention.
  • Spravato® must be prescribed by a psychiatrist in a certified Spravato® treatment center.
  • Spravato® must be taken in conjunction with an oral antidepressant.
  • The allowable dosage is limited to 84 mg twice weekly.

Who Should Not Take Spravato®?

Spravato® can be life-changing for many patients with TRD or those with major depressive disorder accompanied by acute suicidal ideation. However, it also can have serious side effects for some patients.

Additionally, taking Spravato® should be avoided by any patients with the following conditions:

  • Blood vessel diseases, including those in the brain, chest, abdominal aorta, and arms and legs.
  • Those with an abnormal connection between veins and arteries.
  • Individuals with a history of bleeding in the brain.
  • Those allergic to esketamine, ketamine, or any ingredients found in Spravato®.

You will also want to consult with a healthcare provider if you have any of the following conditions:

  • Heart or brain problems, including high blood pressure, fast or slow heartbeats that also cause shortness of breath, chest pain, lightheadedness, fainting, history of heart attack, stroke, heart valve disease, heart failure, or brain injury that results in increased brain pressure
  • Liver problems
  • Psychosis
  • Pregnancy or currently breastfeeding

Some medications may interact with Spravato®. Therefore, discussing this treatment option with a qualified healthcare professional is essential. They can provide important safety information and conduct a Spravato® risk evaluation to help you determine if it’s the right treatment for you.

What if My Insurance Doesn’t Cover Spravato®?

If you believe you may benefit from Spravato®, you may seek out a Spravato® treatment center. The professionals there may discuss insurance questions and provide information about patient support programs.

If your insurance doesn’t cover Spravato® or you are uninsured and unqualified for Medicare and Medicaid, Janssen Pharmaceuticals has an option called Spravato® withMe. It’s a patient support program that can lower your out-of-pocket costs associated with taking Spravato®.

Spravato® withMe can also help lower your out-of-pocket expenses even if you are insured through private or government insurance. This patient support program can dramatically reduce the patient’s liability for treatment center costs.

Therefore, if you are medically qualified to receive Spravato® treatment, you have options to ensure it is affordable, which removes cost as a barrier to treatment. If you would like additional information about Spravato® treatment, Spravato® withMe patient support, insurance education, or full prescribing information, you can visit a local Spravato® treatment center.

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