Kaiser Foundation Health Plan Northern California
Spravato 28 Mg Spry (esketamine)
Drugs for the Nervous System : Drugs for Depression
  • 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

  • Step Therapy: Major Depressive Disorder:
    Step Applies Major Depressive Disorder with Suicidal Ideation :
    Step Therapy Applies