Is Spravato Covered by Aetna?
Yes! Aetna covers Spravato for treatment-resistant depression. We handle prior authorization and help maximize your benefits.
Aetna Spravato Coverage Criteria
Understanding what Aetna requires for Spravato approval
Diagnosis Requirement
Treatment-resistant depression (TRD) or major depressive disorder (MDD) with acute suicidal ideation or behavior
Prior Medication Trials
Documentation of inadequate response to at least 2 antidepressants at adequate dose and duration
REMS Certification
Must receive treatment at a REMS-certified healthcare setting (Next Step is fully certified)
Concurrent Antidepressant
Must be used in conjunction with an oral antidepressant medication
What You'll Pay with Aetna
Your out-of-pocket cost depends on your specific Aetna plan, but we work to minimize your expenses with available assistance programs.
After meeting your deductible
Spravato manufacturer assistance
Note: Facility fees and provider fees may apply separately from medication costs. We'll provide a complete cost estimate before treatment begins.
Our Process for Aetna Members
- 1Verify your Aetna benefits and explain coverage
- 2Complete clinical evaluation for Spravato eligibility
- 3Submit prior authorization with full documentation
- 4Handle any denials through appeals process
- 5Enroll you in savings programs to reduce costs
- 6Begin treatment once approved
Aetna Spravato Coverage FAQs
Is Spravato covered by Aetna?
Yes, Aetna covers Spravato (esketamine) for treatment-resistant depression and major depressive disorder with suicidal ideation. Coverage requires prior authorization, documentation of failed antidepressant trials, and treatment at a REMS-certified facility like Next Step Psychiatry.
What are Aetna's requirements for Spravato coverage?
Aetna requires: 1) Diagnosis of treatment-resistant depression or MDD with suicidal ideation, 2) Documentation of at least 2 failed antidepressant trials, 3) Treatment at a REMS-certified healthcare setting, 4) Use alongside an oral antidepressant, 5) Prior authorization approval.
How much does Spravato cost with Aetna insurance?
With Aetna coverage, most patients pay their standard specialty medication copay, typically $50-150 per session after meeting their deductible. The Spravato Savings Program can reduce costs to as low as $10 per session for eligible patients.
How long does Aetna prior authorization for Spravato take?
Standard Aetna prior authorization for Spravato takes 3-5 business days. Urgent requests may be processed in 24-72 hours. Next Step Psychiatry handles the entire authorization process and can expedite when clinically necessary.
What if Aetna denies my Spravato prior authorization?
If Aetna denies authorization, Next Step Psychiatry files an appeal on your behalf. We provide additional clinical documentation and can arrange peer-to-peer reviews with Aetna medical directors. Our high success rate means most denials are overturned.
Told Spravato Isn't Covered? Give Us a Chance.
Many patients come to us after being told by other clinics that Spravato isn't covered by their insurance, that the cost is too high, or that their coverage is "too complicated" to figure out. We specialize in solving these exact problems.
Other Clinic Said No?
We've helped countless patients get approved after being denied elsewhere.
Cost Too High?
Our team navigates complex coverage to minimize your out-of-pocket costs.
Complicated Coverage?
We're experts at working with prior authorizations and appeals.
Ready to Use Your Aetna Coverage for Spravato?
Let us verify your Aetna benefits and start the prior authorization process. Most patients are approved within days.
4145 Lawrenceville Hwy STE 100, Lilburn, GA 30047