High impact
Esketamine (Spravato) (CPB 0950, reviewed 2026-02-25)
Aetna·Effective Feb 25, 2026
Aetna updated its Esketamine (Spravato) coverage policy (CPB 0950) effective February 25, 2026, establishing new clinical criteria for coverage of this nasal spray for treatment-resistant depression (TRD) and major depressive disorder with acute suicidal ideation. The policy requires mandatory precertification for all administrations, specifies that treatment must be psychiatrist-prescribed and provider-supervised with 2-hour post-administration monitoring, and limits continuation therapy to 6 months for TRD and 4 weeks for acute suicidal ideation cases. Billing teams must implement prior authorization workflows and ensure proper documentation of clinical criteria at point of service.