Spravato (esketamine nasal spray – Janssen) — Cigna

Initial criteria

• Patient is ≥ 18 years of age; AND
• Diagnosis of major depressive disorder with acute suicidal ideation or behavior; AND
• No history of psychosis OR history of psychosis and the prescriber believes that the benefits of Spravato outweigh the risks; AND
• The medication is prescribed by a psychiatrist.

Reauthorization criteria

• After completing a 4-week course of therapy for MDD with acute suicidal ideation or behavior, subsequent 4-week courses can be approved if patient continues to have MDD with acute suicidal ideation/behavior and continues to meet criteria.

Approval duration

2 months