Is Spravato Covered by UnitedHealthcare?
Yes! UnitedHealthcare covers Spravato for treatment-resistant depression. We handle UHC's authorization requirements.
UnitedHealthcare Plans We Work With
UnitedHealthcare Spravato Coverage Criteria
What UHC requires for Spravato approval
Clinical Diagnosis
Treatment-resistant depression (TRD) or MDD with acute suicidal ideation confirmed by psychiatric evaluation
Prior Medication Trials
Documentation of inadequate response to at least 2 antidepressants at therapeutic doses
REMS Certification
Administration at a certified healthcare setting (Next Step is fully REMS-certified)
Combination Therapy
Must be used in conjunction with an oral antidepressant medication
What You'll Pay with UnitedHealthcare
Your out-of-pocket cost depends on your UHC plan details. We help you understand your benefits and reduce costs where possible.
After meeting your deductible
Janssen manufacturer assistance
UHC/Optum Plans: If your mental health benefits are managed by Optum, we work directly with their authorization team for faster processing.
Our Process for UHC Members
- 1Verify your UnitedHealthcare benefits
- 2Complete psychiatric evaluation for eligibility
- 3Submit prior authorization to UHC/Optum
- 4Handle peer-to-peer reviews if required
- 5Enroll in Spravato Savings Program
- 6Begin treatment with clear cost expectations
UnitedHealthcare Spravato Coverage FAQs
Is Spravato covered by UnitedHealthcare?
Yes, UnitedHealthcare covers Spravato (esketamine) for treatment-resistant depression and MDD with suicidal ideation. Coverage requires prior authorization with documentation of treatment history. Next Step Psychiatry specializes in navigating UHC's authorization process.
What are UnitedHealthcare's requirements for Spravato coverage?
UnitedHealthcare requires: 1) Diagnosis of treatment-resistant depression or MDD with acute suicidal ideation, 2) Trial and failure of at least 2 antidepressants, 3) Treatment at a REMS-certified facility, 4) Use alongside an oral antidepressant, 5) Prior authorization approval.
How much does Spravato cost with UnitedHealthcare?
With UnitedHealthcare coverage, most patients pay a specialty medication copay of $50-150 per session after their deductible. The Spravato Savings Program can reduce costs to as low as $10 per session for eligible patients.
Does UHC Optum cover Spravato?
Yes, UHC plans that use Optum for behavioral health services cover Spravato for eligible patients. Next Step Psychiatry handles Optum's specific authorization requirements and can assist with their clinical review process.
How long does UnitedHealthcare prior authorization for Spravato take?
UnitedHealthcare prior authorization typically takes 3-5 business days for standard requests. Urgent requests can be expedited. Next Step Psychiatry manages the entire process and provides timely updates.
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 UnitedHealthcare Coverage?
Let us verify your UHC benefits and navigate the authorization process. We make accessing Spravato treatment simple.
4145 Lawrenceville Hwy STE 100, Lilburn, GA 30047