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Does Medicare Cover Spravato (Esketamine) Treatment?

Does Medicare Cover Spravato (Esketamine) Treatment?

Does Medicare Cover Spravato (Esketamine) Treatments?

Yes, Medicare will cover Spravato treatments if your doctor has recommended it. Medicare Part B coverage is crucial for beneficiaries who require Medicare Spravato coverage because of the medication’s high cost.1

MEDICARE INSURANCE ELIGIBILITY

  • United States citizen
  • 65 or older
  • Or younger, if you have a disability or End Stage Renal Disease

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How to Verify Medicare 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 easiest and quickest method of determining your Medicare Spravato benefits.

Allow our highly skilled care coordinators to handle the challenges of contacting your insurance company for more information about Medicare esketamine nasal spray coverage. A care coordinator will review your Medicare insurance coverage and thoroughly explain your options after you’ve submitted the form. Rest assured that all information shared or discussed is kept entirely private.

What is Spravato?

Spravato, or Esketamine, is a nasal spray used to treat treatment resistant depression (TRD). Approved by the Food and Drug Administration (FDA) in March of 2019, Spravato is used in conjunction with an oral antidepressant to treat individuals with TRD and adults with major depressive disorder (MDD).2 TRD encompasses patients with MDD with acute suicidal ideation or behaviors. These individuals have not responded to psychotherapy and at least two antidepressant drugs administered at acceptable doses for an adequate time.3

Although the impact rate varies, randomized trials have demonstrated that Spravato can effectively treat TRD. Depending on the length of Spravato treatment, studies suggest 40-60% efficacy.4

The efficacy of Spravato was evaluated in three four-week clinical trials and one longer-term maintenance-of-effect experiment. In the three short-term studies, patients were randomized to receive Spravato or a placebo nasal spray. All of the patients started a new oral antidepressant at the same time. They continued it throughout the trials due to the seriousness of TRD.

Spravato had a statistically significant effect on the severity of depression in one of the short-term studies, and some of those effects were apparent within two days. However, the two other short-term trials did not pass the statistical tests necessary to demonstrate 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

The following are the most common side effects patients who have undergone Spravato treatment have experienced:

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

Esketamine packaging warns about potential abuse, misuse, and 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. Additionally, patients with aneurysmal vascular disorders or uncontrolled hypertension may be more vulnerable to complications.

Furthermore, Spravato may impair one’s motor, thinking, judgment, and response time skills.

After taking the medication, you shouldn’t drive or use machinery until the following day. Women who are pregnant or intend to become pregnant should take precautions because Spravato also has the potential to harm a fetus. While receiving treatment, women shouldn’t breastfeed.

These side effects could persist anywhere from a few days to several weeks. If the side effects persist, worry you, or become severe, talk to your Spravato doctor.6 Keep in mind that the oral antidepressant could be what is causing side effects instead of Spravato.

Spravato treatments are only available in licensed healthcare settings, with trained medical personnel authorized to prescribe and dispense the medication.7 Therefore, Spravato is not available at your local pharmacy.

The Food and Drug Administration (FDA) launched the Risk Evaluation and Mitigation Strategy (REMS) program8 to lower the dangers of giving certain medications with severe adverse effects. REMS programs also assist customers in medication management, and they instruct healthcare providers on how to closely monitor and prescribe these medications.9 This allows a Spravato clinician to determine whether the drug is safe and effective.

How Much Does Spravato Cost Without Insurance?

Without Medicare Spravato coverage, the following are average costs for the treatment. These costs will differ by location and other variables. Therefore, they may not reflect the actual cost of what you’ll pay for this treatment in Tennessee.

You’ll most likely pay more at the beginning of treatment and less in the long run. Depending on whether you’re receiving Spravato doses weekly or bi-weekly, costs can range from $5,664 to $8,142 in the first month of treatment, $2,832 to $4,248 in the second month, and possibly $1,416 to $4,248 each following month.

Sources

  1. Moody, Colleen. “Does Medicare Cover Esketamine?” Medicare & Medicare Advantage Info, Help and Enrollment, Medicare.org, 18 Mar. 2021, www.medicare.org/articles/does-medicare-cover-esketamine.
  2. “SPRAVATO® (Esketamine) | SPRAVATO®.” SPRAVATO® (Esketamine), Janssen Pharmaceuticals, Inc, 23 Feb. 2022, www.spravato.com/trd.
  3. 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
  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