Kaiser Foundation Health Plan Southern California |
Spravato 28 Mg Spry (esketamine) |
Drugs for the Nervous System : Drugs for Depression |
- Step Therapy: Major Depressive Disorder:
Step Applies
Major Depressive Disorder with Suicidal Ideation : Step Therapy Applies
- Prior Authorization: Major Depressive Disorder:
PA Applies
Major Depressive Disorder with Suicidal Ideation : PA Applies
- Major Depressive Disorder:
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Documented Diagnosis: No
Major Depressive Disorder with Suicidal Ideation : Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
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