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Does TRICARE Cover Spravato (Esketamine) Treatments?

Does TRICARE Cover Spravato (Esketamine) Treatments?

Does TRICARE Cover Spravato (Esketamine) Treatments?

TRICARE covers mental health inpatient and outpatient care.1 Patients with treatment resistant depression (TRD) or major depressive disorder (MDD), who acquire prior authorization from TRICARE, can access Spravato. Your TRICARE Spravato benefits are dependent upon your specific TRICARE insurance plan.

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How to Verify TRICARE Spravato Coverage

Athena Care and its 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 best method to determine your TRICARE Spravato coverage in Tennessee.

Allow our highly trained care coordinators to handle the inconveniences of contacting your insurance company to learn more about TRICARE esketamine nasal spray coverage. After you’ve submitted the form, a care coordinator will review your TRICARE insurance and clearly explain your options. Rest assured that all information exchanged or discussed will remain completely private.

What is Spravato?

Spravato, also known as esketamine, is the brand name of a prescription nasal spray medication that the (Food and Drug Administration) FDA approved in March of 2019. Esketamine is a new type of ketamine, an anesthetic that was extensively used as a veterinary medication or on battlefields. Esketamine can be taken intranasally and provides quick and effective benefits.2

Spravato is used with an antidepressant to treat individuals with treatment-resistant depression (TRD) and adults with major depressive disorder (MDD).3 TRD encompasses patients with MDD with acute suicide ideation or behaviors who have not responded to at least two antidepressant medications administered at acceptable doses for an adequate time.4

The effect rate varies by research, but randomized trials have shown that Spravato can relieve TRD quickly. Depending on the length of Spravato treatment therapy, studies suggest 40-60% efficacy.5

In the United States, three four-week clinical trials and one longer-term maintenance-of-effect trial were used to assess Spravato’s efficacy. Patients were randomly assigned to receive Spravato or a placebo nasal spray in the three short-term experiments. Because of the serious nature of TRD and the requirement for patients to get therapy, all of the patients started a new oral antidepressant at the same time and continued it throughout the trials.

Spravato had a statistically significant effect on the severity of depression in one of the short-term studies, and some were apparent within two days. However, the two other short-term trials failed to pass the statistical tests required to demonstrate effectiveness.

Patients in stable remission who continued to receive Spravato alongside an oral antidepressant had a significantly longer time before relapsing with depressive symptoms than patients on placebo nasal spray plus in the longer-term maintenance-of-effect trial.

Risks & Side Effects of Spravato

The most common side effects patients who have undergone Spravato treatment experienced in clinical trials included:

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

Esketamine is labeled with warnings concerning the risks of drowsiness and dissociation and the possibility of addiction and misuse. In children and young adults, there is also the potential of an increased risk of suicidal thoughts and behaviors.6 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 attention, thinking, response time, and motor skills. Patients should wait until the next day after obtaining the medication before driving or operating machines. Spravato has the potential to harm a fetus, so pregnant women or planning to become pregnant women should exercise caution. While being treated, women should not breastfeed.

These side effects may last anywhere from a few days to several weeks. If the side effects persist, bother you, or become severe, talk to your doctor.7 It’s important to remember that the oral antidepressant, not Spravato, may induce side effects.

Spravato can only be administered in a licensed healthcare setting with medical professionals trained to prescribe and distribute it.8 Healthcare facilities that provide Spravato must be certified under the Risk Evaluation and Mitigation Strategy (REMS) program.9 As a result, Spravato isn’t available at your neighborhood pharmacy.

The Food and Drug Administration (FDA) launched the REMS program to lower the dangers of giving certain medications with severe adverse effects. REMS programs assist customers in medication management services. They also teach healthcare providers how to monitor and provide these drugs.10 This allows a Spravato provider to determine whether the drug’s benefit outweighs its danger.

How Much Does Spravato Cost Without Insurance?

The following are the average prices for Spravato without insurance coverage. The pricing will vary depending on the area and other factors. As a result, they may not accurately reflect the cost of Spravato treatment in Tennessee.

You’ll probably pay more at the start of your Spravato treatment and less in the end. Costs can range from $5,664 to $8,142 in the first month of therapy, $2,832 to $4,248 in the second month, and possibly $1,416 to $4,248 each month after that, depending on whether dosing is weekly or bi-weekly.

Sources

  1. TRICARE. “Mental Health Therapeutic Services.” TRICARE, Department of Defense (DOD), 20 Mar. 2022, www.tricare.mil/CoveredServices/IsItCovered/MentalHealthTherapeuticServices.
  2. 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
  3. “SPRAVATO® (Esketamine) | SPRAVATO®.” SPRAVATO® (Esketamine), Janssen Pharmaceuticals, Inc., 23 Feb. 2022, www.spravato.com/trd
  4. 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
  5. 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
  6. 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/
  7. 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
  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