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Does Ambetter Cover Spravato (Esketamine) Treatment?

Does Ambetter Cover Spravato (Esketamine) Treatment?

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Does Ambetter Cover Spravato (Esketamine) Treatments?

Yes, Ambetter health insurance covers Spravato (Esketamine) treatments according to their prescription drug benefits.1 It may be necessary to impose requirements, such as referrals, before approving the use of Ambetter ketamine treatment coverage.

Prior authorization may also be required because a doctor specializing in treating the condition must prescribe Spravato. This is due to the specific knowledge needed for evaluating and diagnosing patients undergoing Spravato treatment therapy and the required post-treatment monitoring.

How to Verify Ambetter Coverage for Spravato

Athena Care and its multiple Spravato treatment clinics in Tennessee are in-network with most major insurance companies, including Ambetter plans. Please visit our free, no-obligation online insurance verification form to determine the specifics of your Ambetter Spravato coverage in Tennessee.

Our expert care coordinators can quickly and efficiently handle the challenges of contacting your insurance company for more information about Ambetter Spravato benefits. A care coordinator will review your insurance and thoroughly explain your options after you’ve submitted the form. Rest assured that all information shared or discussed is confidential.

What is Spravato?

Spravato or Esketamine is a nasal spray used to care for Treatment Resistant Depression (TRD). TRD is deemed to exist in patients with Major Depressive Disorder (MDD). They have experienced acute suicidal thoughts or behaviors and have not improved after taking at least two antidepressants at recommended dosages for a considerable period.2

Esketamine is a brand-new variety of ketamine, an anesthetic widely used in veterinary medicine and battlefields. It can be administered intranasally and offers instant and efficient advantages.3 Randomized trials have demonstrated that Spravato can effectively treat TRD despite varying efficacy rates. Depending on the length of your Ambetter ketamine treatment, studies estimate a 40–60% efficacy rate.4

In addition, Spravato’s efficacy was assessed in three four-week clinical trials and one longer-term maintenance-of-effect trial. Patients were randomly assigned to receive Spravato or a placebo nasal spray in the three short-term experiments. At the same time, each patient started taking the necessary new oral antidepressant throughout the trial due to the severity of TRD.

In one of the short-term experiments, Spravato demonstrated a statistically significant impact on the degree of depression, some of which became noticeable after only two days. However, the two further short-term trials did not succeed in the statistical tests required to show efficacy.

In the longer-term maintenance-of-effect trial, individuals in stable remission who continued taking Spravato combined with an oral antidepressant experienced substantially fewer relapses of depressive symptoms than those on placebo nasal spray.

Risks & Side Effects of Spravato

During clinical studies, users of Spravato most frequently reported the following side effects:

  • Disassociation
  • Dizziness
  • Nausea
  • Drowsiness
  • Vertigo
  • Decreased feeling or sensitivity (hypoesthesia)
  • Anxiety
  • Lethargy
  • Elevated blood pressure
  • Vomiting
  • Feeling inebriated

Side effects could persist anywhere from a few days to several weeks. Consult your doctor if they linger, concern you, or become severe.5 Also, keep in mind that the oral antidepressant and not Spravato could cause some side effects.

Spravato may impair one’s motor, thinking, judgment, and response time skills. Therefore, patients should wait until the following day to use machinery or drive after taking the drug. In addition, Spravato could harm a fetus, so pregnant women and those considering becoming pregnant should use caution. Furthermore, it’s important to inform your doctor if you have ever experienced a stroke, heart attack, blood vessel disease, or the related, if you are going to have any surgeries, including dental, and if you are taking any other medications.6

Esketamine comes with labels alerting users to the possibility of abuse and misuse and the possibility of tiredness and dissociation. Additionally, Spravato is not approved nor recommended for the following groups of people:

  • Children and adolescents7
  • People with uncontrolled or poorly managed hypertension
  • People with pre-existing aneurysmal vascular diseases
  • Women who are breastfeeding

Spravato can only be administered in a licensed healthcare setting with medical professionals trained to prescribe and distribute it.8 The Risk Evaluation and Mitigation Strategy (REMS) program for Spravato mandates that healthcare facilities that administer the medicine be certified.9 Therefore, Spravato is not available at your local pharmacy.

The United States Food and Drug Administration (FDA) launched the REMS program to lower the dangers of administering certain medications with severe adverse effects. REMS programs assist customers with medication management services. In addition, they instruct healthcare providers on how to closely monitor and prescribe these medications.10 This allows Spravato doctors to determine whether the drug’s benefits outweigh its dangers.

How Much Does Spravato Cost Without Insurance?

Without Ambetter esketamine nasal spray coverage, the following are average costs for the treatment. These prices will differ based on location and other variables. As a result, they might not accurately represent the cost of Spravato treatment in Tennessee.

The initial cost of Spravato will probably be higher, and the overall cost will decrease. Prices can vary from $5,664 to $8,142 in the first month of therapy, $2,832 to $4,248 in the second, and possibly $1,416 to $4,248 each month after that, depending on whether dosing is weekly or biweekly.

Sources

  1. “2022 Prescription Drug Benefits.” Ambetter of Tennessee, Celtic Insurance Company, www.ambetteroftennessee.com/content/dam/centene/ambettertn/pdfs/2021_tn_formulary.pdf. Accessed 29 July 2022.
  2. Office of the Commissioner. “FDA Approves New Nasal Spray Medication for Treatment-Resistant Depression; Available Only at a Certified Doctor’s Office or Clinic.” U.S. Food and Drug Administration, U.S. Food and Drug Administration, 6 Mar. 2019, www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified
  3. Bruno, Bryan Medical Director. “The Difference Between Ketamine and Esketamine (Spravato) for Depression Treatment.” Mid City TMS, Mid City TMS, 15 Apr. 2021, www.midcitytms.com/the-difference-between-ketamine-and-esketamine-spravato-for-depression-treatment
  4. Anca. “What Is the Success Rate of Spravato for Treatment-Resistant Depression?” Ketamine Clinic of Pennsylvania, Ketamine Clinic of Pennsylvania, 8 July 2019, kcofp.com/ufaqs/what-is-the-success-rate-of-spravato-for-treatment-resistant-depression
  5. Seabright, Jen PharmD. “Spravato Side Effects: What You Should Know.” Medical News Today, Healthline Media UK Ltd, 21 Mar. 2022, www.medicalnewstoday.com/articles/drugs-spravato-side-effects#fa-qs
  6. “Esketamine Nasal Spray: MedlinePlus Drug Information.” National Library of Medicine, American Society of Health-System Pharmacists, Inc, medlineplus.gov/druginfo/meds/a619017.html. Accessed 29 July 2022.
  7. Bahr, Rebecca et al. “Intranasal Esketamine (SpravatoTM) for Use in Treatment-Resistant Depression In Conjunction With an Oral Antidepressant.” P & T : a peer-reviewed journal for formulary management vol. 44,6 (2019): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534172/
  8. “What Are the Success Rates of Esketamine?” Mindful Health Solutions, Mindful Health Solutions, 22 Feb. 2022, mindfulhealthsolutions.com/treatment-faqs/esketamine/what-are-the-success-rates-of-esketamine
  9. Center for Drug Evaluation and Research. “Risk Evaluation and Mitigation Strategies | REMS.” U.S. Food and Drug Administration, U.S. Food and Drug Administration, 17 Dec. 2021, www.fda.gov/drugs/drug-safety-and-availability/risk-evaluation-and-mitigation-strategies-rems
  10. Slowiczek, Lindsay PharmD. “Spravato (Esketamine).” Medical News Today, Healthline Media UK Ltd, 11 Dec. 2021, www.medicalnewstoday.com/articles/326038#_noHeaderPrefixedContent

If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.

One of our friendly associates will help you get the help you need. Take this first step to feel better and take control. 

(615) 320-1155