Does Cigna Cover Spravato (Esketamine) Treatment?

Does Cigna Cover Spravato (Esketamine) Treatments?

Yes, Cigna health insurance covers Spravato as medically necessary when certain criteria meet Food and Drug Administration (FDA) indications or other uses with supportive evidence.¹

Prior authorization may be required because a doctor specializing in the treated condition must prescribe Spravato. This is due to the specific knowledge needed for evaluating and diagnosing patients treated with Spravato treatment therapy and the necessary monitoring post-treatment.

Jump to Section

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

How to Verify Cigna Coverage for Spravato

Athena Care and its multiple Spravato treatment clinics in Tennessee are in-network with most major insurance plans. To determine your Cigna Spravato coverage in Tennessee, call your insurance company or contact us below. One of our care coordinators can help you navigate your insurance coverage and help you get the care you need..

What is Spravato?

Spravato or Esketamine is a nasal spray used to treat Treatment Resistant Depression (TRD). Patients with Major Depressive Disorder (MDD) with acute suicidal thoughts or actions who have not improved after taking at least two antidepressants at suitable doses for a sufficient time are considered to have TRD.²

Esketamine is a new type of ketamine, an anesthetic that was extensively used as a veterinary medication or on battlefields, that can be taken intranasally and provides immediate and practical benefits.³ The effect rate varies, but randomized trials have shown that Spravato can rapidly relieve TRD. Depending on the length of your Cigna ketamine treatment, studies suggest 40-60% efficacy.⁴

Three four-week clinical trials and one longer-term maintenance-of-effect trial were used to judge Spravato’s efficacy. In the three short-term studies, patients were randomized to receive Spravato or a placebo nasal spray. All of the patients began a required new oral antidepressant at the same time. They continued it throughout the trials due to the seriousness of TRD.

In one of the short-term experiments, Spravato had a statistically significant impact on the degree of depression, some of which became visible after just two days. However, the two further short-term trials did not succeed in the statistical tests required to show efficacy.

In the longer-term maintenance-of-effect trial, individuals in stable remission who continued to take Spravato combined with an oral antidepressant experienced significantly fewer relapses of depressive symptoms than those on placebo nasal spray.

Risks & Side Effects of Spravato

Spravato users most frequently reported the following side effects during clinical trials:

• Disassociation
• Dizziness
• Nausea
• Drowsiness
• Vertigo
• Decreased feeling or sensitivity (hypoesthesia)
• Anxiety
• Lethargy
• Elevated blood pressure
• Vomiting
• Feeling inebriated

Esketamine is packaged with warnings concerning potential abuse and misuse as well as the risk of sleepiness and dissociation. Additionally, there is a chance that suicidal thoughts and actions will be more prevalent in children and young people.⁵ 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 one’s motor, thinking, judgment, and response time skills. After taking the medication, patients shouldn’t drive or use machinery until the next day. Spravato may also harm a fetus. Thus, expectant mothers and those planning pregnancies should exercise caution. While receiving treatment, women shouldn’t breastfeed.

Side effects could persist anywhere from a few days to several weeks. Consult your doctor if they linger, concern you, or become severe.⁶ Also, keep in mind that the oral antidepressant and not Spravato could cause some side effects.

Spravato can only be administered in a licensed healthcare setting with medical professionals trained to prescribe and distribute it.⁷ The Risk Evaluation and Mitigation Strategy (REMS) program for Spravato mandates that healthcare facilities that administer the medicine be certified.⁸ Therefore, Spravato is not available at your local pharmacy.

The Food and Drug Administration (FDA) launched the REMS program to lower the dangers of administering certain medications with severe adverse effects. REMS programs assist customers with medication management services. In addition, they instruct healthcare providers on how to closely monitor and prescribe these medications.⁹ This allows Spravato doctors to determine whether the drug’s health benefit outweighs its danger.

Average Cost of Spravato With Cigna Insurance

Understanding the financial aspects of mental health treatment is crucial. When it comes to Spravato (Esketamine), several factors influence its cost. The average price per treatment session can vary from $590 to $885. It’s important to note that many insurance providers, including Cigna, may cover Spravato treatment, which can significantly reduce out-of-pocket expenses for patients.

To further assist with managing Spravato expenses, there is a SPRAVATO® withMe program. Eligible patients using commercial or private health insurance can pay $10 per treatment for SPRAVATO® medication costs, with a maximum program benefit of $8,150 per calendar year. This assistance can make a significant difference in the affordability of this treatment. Remember, the cost-effectiveness of Spravato is not solely about the price but its potential to provide relief from treatment-resistant depression. Always reach out to your healthcare provider or insurance company for personalized information on insurance reimbursement and financial planning for mental health treatment.

How Much Does Spravato (Esketamine) Cost Without Cigna Insurance?

Without Cigna esketamine nasal spray coverage, the following are average costs for the treatment. Most likely, the initial cost of Spravato will be higher, and the overall cost will be lower. Prices can vary from $5,664 to $8,142 in the first month of therapy, $2,832 to $4,248 in the second, and possibly $1,416 to $4,248 each subsequent month, depending on whether dosing is weekly or biweekly.

These costs will vary by location and other factors. Therefore, they may not reflect the actual price of what you’ll pay for Spravato treatment in Tennessee.

Spravato Treatment Center Near Me That Accept Cigna Insurance

Navigating the road to mental health recovery can feel daunting, but finding the right treatment center shouldn’t be. If you’re in Tennessee and seeking “Spravato treatments near me” or “Esketamine treatment near me,” Athena Care is a trusted and reliable option. We proudly offer Spravato (Esketamine) treatments, and we accept Cigna insurance, which can significantly alleviate financial concerns and make this innovative treatment more accessible.

Athena Care has multiple treatment centers located across Tennessee. Whether you are in bustling Nashville or Memphis, or quieter towns like Franklin, Murfreesboro, Hendersonville, Clarksville, or Knoxville, there’s an Athena Care center ready to support you on your mental health journey. Our local centers aim to make mental health treatment accessible and convenient for all Tennesseans.

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