Western Health Advantage
Spravato (56 MG Dose) (esketamine)
Drugs for the Nervous System : Drugs for Depression
  • Preventive health - zero copay may apply.

  • For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on drug coverage click  HERE;
  • Prior Authorization: Ankylosing Spondylitis (AS), Nonradiographic Axial Spondyloarthritis:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Psoriasis (PsO):
    Documented Diagnosis: Yes
    Age Requirement: >= 6
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Psoriatic Arthritis (PsA):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 plan year
    Reauthorization Required: Yes

  • Step Therapy: ST_APPLIES