Is Spravato Covered by Cigna?
Yes! Cigna covers Spravato for treatment-resistant depression. We navigate Cigna's authorization process for you.
Cigna Spravato Coverage Criteria
Understanding what Cigna requires for Spravato approval
Clinical Diagnosis
Treatment-resistant depression (TRD) or MDD with acute suicidal ideation/behavior confirmed by evaluation
Failed Medication Trials
Documentation of inadequate response to 2+ antidepressants at adequate dose for adequate duration
REMS-Certified Facility
Must receive treatment at a certified healthcare setting (Next Step is fully REMS-certified)
Concurrent Treatment
Must be used alongside an oral antidepressant medication
What You'll Pay with Cigna
Your cost depends on your specific Cigna plan. We work to minimize your expenses through available assistance programs.
After meeting your deductible
Spravato manufacturer assistance
Cigna Plans Vary: Coverage details depend on your specific plan. We verify benefits before treatment to provide accurate cost estimates.
Our Process for Cigna Members
- 1Verify your Cigna benefits and coverage details
- 2Complete clinical evaluation for Spravato eligibility
- 3Submit prior authorization with comprehensive documentation
- 4Handle any denials through appeals process
- 5Enroll you in savings programs to reduce costs
- 6Begin treatment once approved
Cigna Spravato Coverage FAQs
Is Spravato covered by Cigna?
Yes, Cigna covers Spravato (esketamine) for treatment-resistant depression and major depressive disorder with suicidal ideation. Coverage requires prior authorization and meeting specific clinical criteria. Next Step Psychiatry works with Cigna to secure approvals for eligible patients.
What are Cigna's requirements for Spravato coverage?
Cigna requires: 1) Diagnosis of treatment-resistant depression or MDD with suicidal ideation, 2) Documentation of at least 2 failed antidepressant trials at adequate doses, 3) Treatment at a REMS-certified facility, 4) Concurrent oral antidepressant use, 5) Prior authorization approval.
How much does Spravato cost with Cigna insurance?
With Cigna coverage, most patients pay their specialty medication copay, typically $50-150 per session after meeting their deductible. The Spravato Savings Program can reduce out-of-pocket costs to as low as $10 per session for eligible commercially insured patients.
How long does Cigna prior authorization for Spravato take?
Standard Cigna prior authorization takes 3-5 business days. Urgent requests may be expedited. Next Step Psychiatry handles the entire Cigna authorization process and provides all necessary clinical documentation.
What if Cigna denies my Spravato prior authorization?
If Cigna denies authorization, Next Step Psychiatry files an appeal and can arrange peer-to-peer reviews with Cigna medical directors. Our expertise in navigating Cigna's requirements results in high approval rates even after initial denials.
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 Cigna Coverage for Spravato?
Let us verify your Cigna benefits and guide you through the authorization process. Most patients are approved within days.
4145 Lawrenceville Hwy STE 100, Lilburn, GA 30047