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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• Does TRICARE Cover Spravato (Esketamine) Treatments?
• How to Verify TRICARE Coverage for Spravato
• What is Spravato?
• How Much Does Spravato Cost Without Insurance?

How to Verify TRICARE Spravato Coverage

Athena Care and its Spravato treatment clinics in Tennessee are in-network with most major insurance plans. Find out about specific TRICARE esketamine nasal spray coverage by calling your insurance company or by contacting us below. One of our care coordinators can help you navigate your insurance coverage and get the care you need.

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.

Average Cost of Spravato Treatment With TRICARE Insurance

The average cost of mental health treatment can be a significant factor in the decision-making process for many individuals. When it comes to the average cost of Spravato with TRICARE insurance, several factors come into play. While specific costs can vary based on your unique TRICARE plan and the frequency and dosage of treatments, TRICARE generally follows Centers for Medicare & Medicaid (CMS) billing guidelines for Spravato. It’s important to remember that pre-authorization or medical necessity may be required for coverage.

Out-of-pocket expenses can be considerably reduced with TRICARE insurance, making the cost of esketamine therapy more manageable. Financial assistance for Spravato is also available, potentially reducing the cost to as low as $10 per treatment for eligible and commercially insured patients. When budgeting for Spravato, it’s crucial to consider all these factors and consult with your provider and insurance company for accurate pricing information for Spravato. Remember, investing in mental health is a worthy expense, and there are resources available to make this investment more feasible.

How Much Does Spravato Cost Without TRICARE Insurance?

The following are the average prices for Spravato without insurance coverage. 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.

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.

Spravato Treatment Center Near Me That Accept TRICARE Insurance

If you’re seeking “Spravato treatments near me” or “Esketamine treatment near me,” and you’re a TRICARE insurance holder, Athena Care is a viable option. Athena Care is a leading provider of mental health services with multiple locations across Tennessee and proudly accepts TRICARE insurance. Our mission is to make innovative treatments such as Spravato (Esketamine) accessible and financially manageable for our patients.

Our presence in Tennessee is robust, with treatment centers situated in major cities such as Nashville and Memphis, and also in Franklin, Murfreesboro, Hendersonville, Clarksville, and Knoxville. These local centers ensure that wherever you are in the state, quality mental health care is within your reach.

To find the nearest Athena Care center offering Spravato treatments, we recommend reaching out to us directly or using resources such as the SPRAVATO® treatment center locator or the TRICARE Health Care Provider Directory. Every step towards seeking help is a step towards wellness and recovery. Your mental health matters, and finding the right treatment in your area is a crucial part of this journey.