Is Spravato Covered by Regence Insurance in Everett, WA?

Spravato is a breakthrough medication for treatment resistant depression. See how Regence coverage can work for you.

Discover how Regence BlueShield covers Spravato (esketamine) treatment for treatment-resistant depression in Everett, WA. Learn about medical vs pharmacy benefits, prior authorizations, and expected out-of-pocket costs.

Spravato® (esketamine) is an FDA-approved nasal spray for adults with treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal thoughts. If you live in Everett, WA and have Regence BlueShield insurance, you may be wondering if Spravato is covered and what steps are involved in getting it approved. Here’s a guide to help you understand how insurance coverage works, what you can expect during the prior authorization process, and how to estimate your out-of-pocket costs.

Is Spravato Covered by Regence BlueShield?

Yes, Regence BlueShield of Washington generally covers Spravato when medical necessity criteria are met.

Covered Conditions Include:

• Treatment-resistant major depressive disorder (TRD), defined as inadequate response to 2 or more antidepressants

• Major depressive disorder with acute suicidal ideation or behavior

Spravato is a Medical Benefit

Medical Benefit

• Spravato is billed as a procedure administered in the clinic

• Reimbursement typically includes both the medication and the monitoring time

• Your Provider knows the common billing codes: J3490 (Spravato), 96365 (administration), 99214 or 99417 (prolonged observation)

  
  

What Is the Prior Authorization Process Like?

Before starting Spravato, Regence requires a prior authorization (PA) to confirm medical necessity. Your provider submits clinical documentation showing:

• Diagnosis of MDD or TRD

• History of at least two failed antidepressants from different classes

• That the patient is concurrently taking an oral antidepressant

• Safety screening (e.g., no history of aneurysm, psychosis, pregnancy, uncontrolled hypertension)

PAs can take 5–10 business days, and decisions are often returned via fax or online portal. Appeals can be filed if initially denied.

What Will It Cost Me Out of Pocket?

Out-of-pocket costs depend on your specific Regence plan, deductible status, and whether your Spravato claim is processed under medical or pharmacy benefits.

Estimated Costs:

• Medical benefit: Often subject to deductible + coinsurance

Manufacturer Assistance

Janssen offers a Spravato Savings Program that may reduce costs to as low as $10 per treatment for eligible patients with commercial insurance. Visit Spravato.com to apply.

Final Thoughts

Spravato can be life-changing for those with treatment-resistant depression, but navigating insurance coverage can be complex. If you have Regence BlueShield in Everett, WA, your provider at Elevate Clinic will complete the prior authorization, insurance verification, and cost estimates on your behalf.

At the end of the day - know that at Elevate Clinic, we walk patients through every step—from verifying Regence coverage to securing approval and scheduling treatments.

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