Spravato (esketamine) Nasal Spray — Coverage Criteria
Clinical medical policy governing prior authorization, coverage criteria, and coding for Spravato (esketamine) nasal spray for treatment-resistant depression and depressive symptoms with acute suicidal ideation or behavior for Anthem members.
Updated clinical criteria for treatment resistant depression to allow for monotherapy use.
Added HCPCS/HCPCS drug coding change to use J0013 for the drug effective 1/1/26 and removed S0013 effective 12/31/25.
Quantity limit: 4 kits per 28 days with allowance for additional kits in first month of therapy.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.