Drugs for the Nervous System
Drugs for Depression

BRAND NAME: Spravato 28 Mg Spry

GENERIC NAME: 
esketamine No Generic Available
  Status Notes or Restrictions
Anthem Blue Cross (HMO, PPO, EPO) priorauth.gif (816 bytes) NOTES_restrict.gif (377 bytes)
Cigna + Oscar notlisted.gif (324 bytes)  
Health Net priorauth.gif (816 bytes) NOTES_restrict.gif (377 bytes)
Kaiser Foundation Health Plan Northern California nonform.gif (625 bytes) NOTES_restrict.gif (377 bytes)
Kaiser Foundation Health Plan Southern California nonform.gif (625 bytes) NOTES_restrict.gif (377 bytes)
Oscar notreimb.gif (645 bytes)  
Sharp Health Plan notlisted.gif (324 bytes)  
Sutter Health Plus notlisted.gif (324 bytes)  
UnitedHealthcare priorauth.gif (816 bytes) NOTES_restrict.gif (377 bytes)
Western Health Advantage notlisted.gif (324 bytes)  


preferred.gif (540 bytes)  Preferred

approved.gif (510 bytes)   Approved

priorauth.gif (816 bytes)  Prior Auth.

nonform.gif (625 bytes)    Non-Formulary notreimb.gif (645 bytes)   Not Reimbursed notlisted.gif (324 bytes)   Not Listed
nonform.gif (625 bytes)    Benefits/Policies generic.gif (400 bytes) Generic Available, Brand Listed for reference only. Brand may not be covered.

NOTES.gif (377 bytes)NOTES_restrict.gif (372 bytes)

Notes or
Restrictions

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