Spravato (esketamine nasal spray – Janssen) — Cigna

Initial criteria

• Patient is ≥ 18 years of age; AND
• Patient has demonstrated nonresponse (≤ 25% improvement in depression symptoms or scores) to at least two different antidepressants, each from a different pharmacologic class, according to the prescriber; AND
• Each antidepressant was used at therapeutic dosages for at least 6 weeks in the current episode of depression, according to the prescriber; AND
• No history of psychosis OR history of psychosis and the prescriber believes that the benefits of Spravato outweigh the risks; AND
• The patient’s history of controlled substance prescriptions has been checked using the state prescription drug monitoring program (PDMP), according to the prescriber; AND
• The medication is prescribed by a psychiatrist.

Approval duration

6 months