insurance for spravato esketamine
Insurance for SPRAVATO can be complex. Let the staff at Libertas Mind make treatment easy, comfortable and reliable.
1. Your insurance and SPRAVATO™ - is it covered?
Many insurances cover Spravato because of how effective it is in helping treat resistant depression.
2. Is SPRAVATO expensive?
Most of our patients only pay a COPAY that is listed on their insurance card. Spravato is unique because it can be covered under your medical or pharmacy benefit, so you can check with your insurance company or ask us about insurance coverage and any related out-of-pocket costs.
Without insurance, SPRAVATO is very expensive.
The out-of-pocket cost for Spravato 56 mg is $1,025 for a 2, 28 mg/device therapy pack. Each pack provides one dose of 56 mg.
The out-of-pocket cost for Spravato 84 mg is $1,589 for a 3, 28 mg/device therapy pack. Each pack provides one dose of 84 mg.
3. What determines if you qualify for SPRAVATO treatment?
In order to qualify for SPRAVATO treatment, the medical policies for nearly all carriers require:
(a) A diagnosis of treatment-resistant depression (TRD) or major depressive disorder (MDD) with acute suicidal ideation.
(b) Evidence that previous treatments didn’t help. This includes evidence that you have tried two different classes of oral antidepressants for 6-8 weeks, and at least 2 augmentive medications.
For your first meeting with one of our providers, brings your prescription history over the last 2-5 years so we can review it. Most pharmacies can supply this on demand.
4. Does your insurance require a Preauthorization?
Prior authorization is a process where we submit documentation to your insurance and Spravato to prove medical necessity. Libertas Mind has experience with all the major carriers and is successful in getting preauthorization’s approved. The review process can take 1-2 weeks.
Aetna and Spravato – requires prior authorization.
Anthem and Spravato – covers Spravato BUT requires prior authorization.
Blue Cross and Blue Shield and Spravato – covers Spravato BUT requires prior authorization.
Cigna and Spravato – covers Spravato BUT requires prior authorization.
CDPHP and Spravato – covers Spravato BUT requires prior authorization. CDPHP has the most strict criteria for intiation and continuation compared to other carriers.
Highmark and Spravato – covers Spravato. Their requirement for authorization is mixed. Some of their policies do require and some policies do not require prior authorization. Please check with us and we can call on your behalf.
MVP and Spravato – covers Spravato AND requires prior authorization.
Medicaid covers Spravato BUT requires prior authorization.
Medicare covers Spravato BUT requires prior authorization. If you have straight Medicare that covers Part D, then no prior authorization is needed. Most patients have a managed Medicare policy, or Medicare advantage where a prior authorization is needed.
NYSHIPP and Spravato – NY State Health Insurance policy or Empire plan covers Spravato BUT does not require prior authorization.
5. Are there savings programs for your Copays and drug costs? YES
We can help guide you through these programs.
The manufacturer of the medication offers a SPRAVATO withMe Savings Program which can help you save money while paying down your deductible. Spravato WithMe is split into 2 separate programs:
SPRAVATO withMe Savings Program can provide savings on their out-of-pocket medication costs for SPRAVATO®. Eligible commercially-insured patients pay $10 per treatment for SPRAVATO® medication costs, with an $8,150 maximum program benefit per calendar year.
You can submit your expenses or the portion of the bill that is your responsibility to this program. They will pay up to $500 a year.
We are the largest provider of SPRAVATO™ in the Capital district and take the most insurances.
At Libertas Mind we are committed to providing accessible and high-quality mental health services to all. For those struggling with treatment-resistant depression, we are in-network with a wide range of insurance plans. This ensures that our patients can access this potentially life-changing treatment without financial concerns being a primary obstacle.
If you’re located in the Capital area, our team is ready to assist you on your journey towards wellness. We encourage you to contact us directly if you are considering this treatment or need more information. Our team can provide detailed information about treatment availability.
With nearly 30% of all patients with depression considered treatment resistant – SPRAVATO treatment has become a revolutionary treatment. If you or a loved one continue to suffer from major depression, SPRAVATO™ (esketamine) should be considered.
If you’re interested in more information about why SPRAVATO™ is so effective click below to learn more.
