Clinical trials for the new drug Spravato have been very encouraging. If you’re considering getting Spravato treatment, one of your first questions is whether your insurance will cover it. One of the largest insurance companies in the United States, Blue Cross Blue Shield, insures tens of millions of Americans. Does the blue cross-blue shield cover Spravato?
Does the blue cross-blue shield cover Spravato?
Yes, Blue Cross Blue Shield (BCBS) insurance may cover Spravato (Esketamine), but it depends on your specific health plan and diagnosis status. For those under the Blue Cross Blue Shield Federal Employee Programme, here’s a friendly breakdown of what’s required for approval:
- Age Matters: You need to be 18 or older.
- Diagnosis Requirements: You should have either:
- Treatment-resistant depression, meaning you’ve tried at least two different types of antidepressants without enough improvement.
- Major depressive disorder (MDD) with acute suicidal ideation or behaviour.
- Additional Criteria for Spravato (Esketamine):
- Your depression diagnosis should be confirmed with an approved tool like the PHQ-9.
- Spravato should be used alongside an oral antidepressant.
- It must be administered under the watchful eye of a healthcare provider.
- Your blood pressure will be checked before and after each administration.
- The prescriber needs to monitor you for sedation and dissociation for at least two hours post-administration.
- Both the healthcare setting, pharmacy, and you must be registered with the Risk Evaluation and Mitigation Strategy (REMS) program.
- The prescriber should also keep an eye out for any clinical worsening or emergence of suicidal thoughts and behaviours.
- If you’re pregnant or of reproductive potential, the prescriber will advise on the potential risks to the foetus.
Remember, Spravato coverage through BCBS can differ from state to state and between different insurance providers. To get the most accurate and tailored information, it’s always best to reach out directly to your insurance company or healthcare provider. And don’t forget, the SPRAVATO with Me programme might be able to help reduce your out-of-pocket costs for this medication. Stay informed and take the steps needed to support your mental health journey!
When do Blue Cross and Blue Shield not provide coverage for Spravato?
Due to its experimental nature, esketamine nasal spray (Spravato) is not covered unless certain conditions are met.
Currently, using esketamine nasal spray for anaesthesia is still considered experimental.
How much does Spravato cost?
According to our estimates, the wholesale cost of a single Spravato injection is between $590 and $885. The recommended starting dose of Spravato is 8 mg once daily, spread over 30 days. Patients subsequently enter a maintenance phase, during which they must take the drug once a week. Is it true that Spravato requires a one-time payment of $5,600 and maintenance payments of almost $3,000 monthly? No. That’s not even the whole extent of the problem.
Does the blue cross-blue shield cover Spravato?
Blue Cross Blue Shield may pay for your Spravato treatment, depending on your specific policy and situation. Please check with your insurance company to ensure coverage before initiating any new treatment.
