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Does United Healthcare Cover Spravato (Esketamine) Treatment?

Does United Healthcare Cover Spravato (Esketamine) Treatment?

Does United Healthcare Cover Spravato (Esketamine) Treatments?

United Healthcare Spravato coverage depends on the patient’s ability to meet all of the requirements listed below:1

  • Diagnosis of treatment resistant major depressive disorder (MDD) by a mental health professional
  • The medication is psychiatrist-prescribed or in consultation with one.
  • Submission of medical records that include at least one of three specific assessments
  • In the present depressive episode, there’s a history of a trial, failure, or contraindication of three different antidepressant medications or treatment regimens at the maximum tolerable dose(s) for at least eight weeks.
  • Spravato will begin at the same time as a new daily oral antidepressant for the member.
  • The Spravato provider and/or the provider’s healthcare setting is certified in the Spravato REMS program.

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How to Verify United Healthcare 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 United Healthcare Spravato benefits in Tennessee.

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

What is Spravato?

Spravato, commonly known as esketamine, is a brand name for an FDA approved prescription nasal spray drug. Esketamine is a brand-new form of ketamine, a common anesthetic used in veterinary medicine and on battlefields. Esketamine is an intranasal drug that gives immediate and effective results.2

Treatment resistant depression (TRD) and adults with major depressive disorder (MDD) are treated with Spravato in combination with an antidepressant.3 TRD refers to MDD patients who have experienced acute suicidal thoughts or behaviors and have not responded to at least two antidepressant drugs given at adequate doses for a sufficient 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, studies suggest 40-60% efficacy.5

Three four-week clinical trials and one longer-term maintenance-of-effect trial were utilized to evaluate Spravato’s efficacy in the United States. Patients were randomized to receive Spravato or a placebo nasal spray in the three short-term studies. The seriousness of TRD and the need for treatment required all of the patients to begin taking a new oral antidepressant simultaneously and throughout the trials.

In one of the short-term studies, Spravato had a statistically significant effect on the severity of depression, with some impact visible within two days. The two other short-term trials, on the other hand, failed to pass the statistical tests required to show effectiveness.

In the longer-term maintenance-of-effect trial, individuals in stable remission who continued to take Spravato alongside an oral antidepressant had a considerably longer time before relapsing with symptoms of depression than patients on placebo nasal spray plus.

Risks & Side Effects of Spravato

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

  • Dissociation
  • 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. There is also the possibility of an elevated risk of suicidal thoughts and behaviors in children.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.

Spravato can also affect your attention, reasoning, response time, and motor abilities. Patients should not drive or operate equipment until the next day after receiving their prescription. Additionally, because Spravato has the potential to harm a fetus, pregnant women and women who are hoping to get pregnant should be cautious. Women should not breastfeed while undergoing treatment.

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 average prices for Spravato without insurance coverage. The cost will vary based on the location and other considerations. As a result, the cost of Spravato treatment in Tennessee may be underestimated.

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. “UnitedHealthcare Pharmacy Clinical Pharmacy Programs.” UnitedHealthcare®, UnitedHealthcare Services, Inc., 2021, https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/drugs-pharmacy/commercial/r-z/PA-Med-Nec-Spravato.pdf
  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