Spravato for treatment-resistant depression

The indication

Treatment-resistant depression is exactly what Spravato was approved for: adults with major depressive disorder who have not responded to at least two antidepressants at adequate dose and duration in the current episode. It is taken with an oral antidepressant, which you continue throughout. See the coverage hub, the Spravato hub, and the coverage checker.

What the trials showed

In the pivotal four-week trial, about half of patients on esketamine plus an oral antidepressant responded versus about a third on placebo spray plus antidepressant. In the maintenance trial, continuing esketamine after remission cut relapse roughly in half compared with stopping.

Meeting the criteria

Approval turns on documentation: two adequate trials in the current episode with doses and dates, a current oral antidepressant, a baseline rating scale score, and treatment at a certified center. See treatment-resistant depression criteria explained and how prior authorization works.

Coverage and cost

Covered by most commercial plans, Medicare and Medicaid with prior authorization. Insured cost is typically $10 to $250 per session; Medicare coinsurance about $220 unless a supplement pays it. See Spravato coverage by insurer.