Does United Healthcare Provide Coverage for Spravato Treatment in Tempe Arizona?
- Topher Bradshaw
- 16 hours ago
- 4 min read
Spravato has emerged as a promising treatment for individuals facing severe depression that has not responded to traditional therapies. If you or a loved one are considering Spravato, understanding whether your insurance covers this treatment is crucial. United Healthcare, one of the largest health insurers in the Arizona, does provide coverage for Spravato, but this depends on meeting specific clinical criteria and obtaining prior authorization. This post breaks down what Spravato is, how it works, and the details of United Healthcare’s coverage to help you navigate your treatment options here at Alevea Mental Health in Tempe Arizona. Let's get to answering, does United Healthcare Provide Coverage for Spravato Treatment in Tempe Arizona?
What Is Spravato and How Is It Used?
Spravato is a nasal spray medication containing esketamine, a derivative of ketamine. The U.S. Food and Drug Administration (FDA) approved Spravato in 2019 for treatment-resistant depression (TRD) and major depressive disorder (MDD) with acute suicidal thoughts. Unlike traditional antidepressants, which often take weeks to show results, Spravato can provide relief within hours. Compared to traditional anti-depressant medications, Spravato may provide relief much faster, especially when combined with anti-depressants.
Treatment-Resistant Depression and Major Depressive Disorder
Treatment-Resistant Depression (TRD): This refers to depression that has not improved after trying at least two different antidepressant treatments.
Major Depressive Disorder (MDD) with Acute Suicidal Ideation: This is a severe form of depression where the patient experiences thoughts of suicide.
Spravato is intended for patients who have not found relief from other medications. It is administered under medical supervision in Tempe at Alevea Mental Health, combined with an oral antidepressant to increase effectiveness.
How Spravato Works
Spravato targets NMDA receptors in the brain, which play a role in mood regulation and cognition. By blocking these receptors, esketamine helps restore communication between brain cells, potentially reversing symptoms of depression quickly.
This mechanism differs from standard antidepressants that primarily affect serotonin or norepinephrine and usually require weeks to take effect. Spravato’s rapid action makes it a valuable option for patients needing urgent symptom relief.
Does United Healthcare Provide Coverage for Spravato Treatment in Tempe Arizona?
Alevea Mental Health is considered In-Network with United Healthcare which covers Spravato treatment, but coverage is not automatic. Patients at Alevea that are considered for Spravato Treatment must meet specific clinical criteria and obtain prior authorization before treatment begins. Here are the key points to understand:
Clinical Criteria for Coverage
The patient must have a diagnosis of treatment-resistant depression or major depressive disorder with suicidal ideation.
Documentation of failure to respond to at least two other antidepressant treatments is typically required.
The treatment must be administered in a certified healthcare setting, like Alevea Mental Health, under supervision.
The patient must be enrolled in a Risk Evaluation and Mitigation Strategy (REMS) program, which ensures safe use of Spravato.
Prior Authorization Process
United Healthcare requires prior authorization to confirm that the patient meets the clinical criteria. This process involves:
Alevea's Psychiatric Providers conduct a comprehensive psychiatric evaluation either Telemedicine or In-Office in Tempe, documenting all necessary information and initiate the Prior Authorization for you.
You would need to complete a PHQ9 and GAD7 screening form online.
Most Prior Authorizations are done electronically which can speed up the process however, typically takes 1-2 weeks from United Healthcare to receive a response.
Once approved, our staff will enroll you in the required REMS program sponsored by Spravato, order the Spravato to the required pharmacy, and schedule your first treatment at the Tempe office.
Coverage Limits and Costs
Coverage may vary depending on the specific United Healthcare plan.
Patients may be responsible for copayments, coinsurance, or deductibles according to their plan.
Spravato Offers Patient Cost Support options: https://www.spravato.com/patient-support-program/
It is essential to check with United Healthcare directly or through your healthcare provider to understand your out-of-pocket costs.
Practical Tips for Patients Considering Spravato
Consult an Alevea Provider: Discuss whether Spravato is appropriate for your condition and treatment history.
Contact United Healthcare: Verify your specific plan’s coverage and understand the prior authorization requirements.
Prepare Documentation: Work with your provider to gather necessary medical records and treatment history.
Understand the Treatment Setting: Spravato must be administered at the Alevea Tempe Arizona location which is a certified REMS location.
Ask About Financial Assistance: Spravato Offers Cost Savings Options, please read more on their website: https://www.spravato.com/patient-support-program/
Why Spravato Is a Significant Option
For many patients with severe depression, traditional treatments may not provide relief while Ketamine Infusions (FDA off-label and not covered by insurance) might not be financially feasible without insurance coverage. Spravato at Alevea Mental Health offers a new approach with rapid effects, which can be life-changing. Its approval and coverage by major insurers like United Healthcare reflect its growing role in mental health care.
Patients who meet the criteria and receive coverage can access this treatment in Arizona at Alevea Mental Health in Tempe, improving safety and outcomes.
You can schedule a Spravato Consult with one of our amazing psychiatric providers today, text or call our office 480-923-6200 or Book Online
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