Does Ambetter Cover Spravato (Esketamine) Treatment?

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Does Ambetter Cover Spravato (Esketamine) Treatments?

Yes, Ambetter health insurance covers Spravato (Esketamine) treatments according to their prescription drug benefits.¹ It may be necessary to impose requirements, such as referrals, before approving the use of Ambetter ketamine treatment coverage.

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

How to Verify Ambetter Coverage for Spravato

Athena Care and its multiple Spravato treatment clinics in Tennessee are in-network with most major insurance companies, including Ambetter plans. Find out if your insurance provider can help with the costs by calling your insurance company or by contacting 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 care for Treatment Resistant Depression (TRD). TRD is deemed to exist in patients with Major Depressive Disorder (MDD). They have experienced acute suicidal thoughts or behaviors and have not improved after taking at least two antidepressants at recommended dosages for a considerable period.²

Esketamine is a brand-new variety of ketamine, an anesthetic widely used in veterinary medicine and battlefields. It can be administered intranasally and offers instant and efficient advantages.³ Randomized trials have demonstrated that Spravato can effectively treat TRD despite varying efficacy rates. Depending on the length of your Ambetter ketamine treatment, studies estimate a 40–60% efficacy rate.⁴

In addition, Spravato’s efficacy was assessed in three four-week clinical trials and one longer-term maintenance-of-effect trial. Patients were randomly assigned to receive Spravato or a placebo nasal spray in the three short-term experiments. At the same time, each patient started taking the necessary new oral antidepressant throughout the trial due to the severity of TRD.

In one of the short-term experiments, Spravato demonstrated a statistically significant impact on the degree of depression, some of which became noticeable after only 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 taking Spravato combined with an oral antidepressant experienced substantially fewer relapses of depressive symptoms than those on placebo nasal spray.

Risks & Side Effects of Spravato

During clinical studies, users of Spravato most frequently reported the following side effects:

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

Side effects could persist anywhere from a few days to several weeks. Consult your doctor if they linger, concern you, or become severe.⁵ Also, keep in mind that the oral antidepressant and not Spravato could cause some side effects.

Spravato may impair one’s motor, thinking, judgment, and response time skills. Therefore, patients should wait until the following day to use machinery or drive after taking the drug. In addition, Spravato could harm a fetus, so pregnant women and those considering becoming pregnant should use caution. Furthermore, it’s important to inform your doctor if you have ever experienced a stroke, heart attack, blood vessel disease, or the related, if you are going to have any surgeries, including dental, and if you are taking any other medications.⁶

Esketamine comes with labels alerting users to the possibility of abuse and misuse and the possibility of tiredness and dissociation. Additionally, Spravato is not approved nor recommended for the following groups of people:

• Children and adolescents⁷
• People with uncontrolled or poorly managed hypertension
• People with pre-existing aneurysmal vascular diseases
• Women who are breastfeeding

Spravato can only be administered in a licensed healthcare setting with medical professionals trained to prescribe and distribute it.⁸ The Risk Evaluation and Mitigation Strategy (REMS) program for Spravato mandates that healthcare facilities that administer the medicine be certified.⁹ Therefore, Spravato is not available at your local pharmacy.

The United States 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.¹⁰ This allows Spravato doctors to determine whether the drug’s benefits outweigh its dangers.

How Much Does Spravato (Esketamine) Cost Without Insurance?

Without Ambetter esketamine nasal spray coverage, the following are average costs for the Spravato medication treatment. These prices will differ based on location and other variables. As a result, they might not accurately represent the cost of Spravato treatment in Tennessee.

The initial cost of Spravato will probably be higher, and the overall cost will decrease. 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 month after that, depending on whether dosing is weekly or biweekly.

Spravato Treatment Center Near Me That Accept Ambetter Insurance

At Athena Care, our mission is to provide accessible and high-quality mental health services to all. We’re proud to be in-network with a broad range of insurance plans, including Ambetter. This partnership allows you to access our wide array of services and expertise without financial concerns being a barrier. Our goal is to ensure continuity of care and a diverse selection of healthcare professionals to meet your individual needs.

In addition to accepting Ambetter insurance, we offer innovative treatments such as Spravato (Esketamine). This FDA-approved medication, used in conjunction with an oral antidepressant, can be a vital resource for those dealing with treatment-resistant depression. If you’re considering this treatment or need more information, we encourage you to contact us directly. Our team can provide detailed information about treatment availability and guide you to the nearest facility offering this service. Remember, every step towards seeking help is a step towards wellness and recovery.