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Does Cigna Cover Spravato (Esketamine) Treatment?

Does Cigna Cover Spravato (Esketamine) Treatment?

Does Cigna Cover Spravato (Esketamine) Treatments?

Yes, Cigna health insurance covers Spravato as medically necessary when certain criteria meet Food and Drug Administration (FDA) indications or other uses with supportive evidence.1

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

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How to Verify Cigna Coverage for Spravato

Athena Care and its multiple Spravato treatment clinics in Tennessee are in-network with most major insurance plans. Filling out our free and confidential online insurance verification form is the most reliable method to determine your Cigna Spravato coverage in Tennessee.

Let our highly skilled care coordinators handle the challenges of contacting your insurance company for more information about Cigna 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 remains confidential.

What is Spravato?

Spravato or Esketamine is a nasal spray used to treat Treatment Resistant Depression (TRD). Patients with Major Depressive Disorder (MDD) with acute suicidal thoughts or actions who have not improved after taking at least two antidepressants at suitable doses for a sufficient time are considered to have TRD.2

Esketamine is a new type of ketamine, an anesthetic that was extensively used as a veterinary medication or on battlefields, that can be taken intranasally and provides immediate and practical benefits.3 The effect rate varies, but randomized trials have shown that Spravato can rapidly relieve TRD. Depending on the length of your Cigna ketamine treatment, studies suggest 40-60% efficacy.4

Three four-week clinical trials and one longer-term maintenance-of-effect trial were used to judge Spravato’s efficacy. In the three short-term studies, patients were randomized to receive Spravato or a placebo nasal spray. All of the patients began a required new oral antidepressant at the same time. They continued it throughout the trials due to the seriousness of TRD.

In one of the short-term experiments, Spravato had a statistically significant impact on the degree of depression, some of which became visible after just 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 to take Spravato combined with an oral antidepressant experienced significantly fewer relapses of depressive symptoms than those on placebo nasal spray.

Risks & Side Effects of Spravato

Spravato users most frequently reported the following side effects during clinical trials:

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

Esketamine is packaged with warnings concerning potential abuse and misuse as well as the risk of sleepiness and dissociation. Additionally, there is a chance that suicidal thoughts and actions will be more prevalent in children and young people.5 For this reason, Spravato is not approved for use in children. In addition, patients with uncontrolled or poorly managed hypertension or pre-existing aneurysmal vascular diseases may be more susceptible to complications.

Additionally, Spravato may impair one’s motor, thinking, judgment, and response time skills. After taking the medication, patients shouldn’t drive or use machinery until the next day. Spravato may also harm a fetus. Thus, expectant mothers and those planning pregnancies should exercise caution. While receiving treatment, women shouldn’t breastfeed.

Side effects could persist anywhere from a few days to several weeks. Consult your doctor if they linger, concern you, or become severe.6 Also, keep in mind that the oral antidepressant and not Spravato could cause some side effects.

Spravato can only be administered in a licensed healthcare setting with medical professionals trained to prescribe and distribute it.7 The Risk Evaluation and Mitigation Strategy (REMS) program for Spravato mandates that healthcare facilities that administer the medicine be certified.8 Therefore, Spravato is not available at your local pharmacy.

The 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.9 This allows Spravato doctors to determine whether the drug’s health benefit outweighs its danger.

How Much Does Spravato Cost Without Insurance?

Without Cigna esketamine nasal spray coverage, the following are average costs for the treatment. These costs will vary by location and other factors. Therefore, they may not reflect the actual price of what you’ll pay for Spravato treatment in Tennessee.

Most likely, the initial cost of Spravato will be higher, and the overall cost will be lower. 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 subsequent month, depending on whether dosing is weekly or biweekly.

Sources

  1. “Prior Authorization Psychiatry – Spravato TM (Esketamine Nasal Spray).” Cigna, https://static.cigna.com/assets/chcp/pdf/coveragePolicies/cnf/cnf_606_coveragepositioncriteria_psychiatry_spravato_pa.pdf. Accessed 9 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. 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/
  6. 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
  7. “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
  8. 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
  9. 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