Does Anthem Blue Cross Cover Spravato in California?

Anthem Blue Cross plans in California generally cover Spravato (esketamine) for treatment-resistant depression when medical necessity criteria are met, and prior authorization is required in essentially all cases. Approval turns on three things: documented treatment-resistant depression, meaning an inadequate response to at least two adequate antidepressant trials; administration at a REMS-certified clinic; and use alongside an oral antidepressant, which is how the medication is FDA-approved.

On this page: Is Spravato covered? · What Anthem generally requires · The REMS requirement · If you are denied · Checking your plan

Does Anthem Blue Cross cover Spravato?

In most California Anthem plans, yes, for treatment-resistant depression, with prior authorization. Spravato is FDA-approved for TRD and for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior, so it is not treated as experimental for those indications. Self-funded employer plans administered by Anthem set their own rules, so two people with Anthem cards can receive different determinations. Note that Anthem Blue Cross and Blue Shield of California are different companies; see our Blue Shield guide if that is your plan.

What does Anthem generally require?

Typically a diagnosis of major depressive disorder, documentation of at least two antidepressant trials at adequate dose and duration in the current episode without adequate response, a plan to continue an oral antidepressant during treatment, and confirmation that treatment will occur at a certified site. Some plans add prescriber specialty requirements or ask about psychotherapy history. Our guide to what counts as an adequate trial explains the standard reviewers apply, and the full prior authorization walkthrough is here.

Why does the REMS requirement matter?

Spravato is dispensed and administered only at clinics certified under the FDA’s REMS safety program, with about two hours of monitoring after each dose. Insurers verify that certification as part of authorization, so a request from a non-certified setting fails regardless of how strong the clinical record is. Exxceed Wellness is a REMS-certified site; how treatment works here.

What if Anthem denies the request?

Most denials cite missing or insufficient documentation rather than ineligibility. The path is an internal appeal with the plan, and if that fails, a free Independent Medical Review through the state for most California commercial plans, decided by outside physicians and binding on the insurer. The process is the same one used for TMS denials, walked through in our appeals guide.

How do I check my own plan?

Call member services and ask whether esketamine, brand name Spravato, is a covered benefit under your medical or pharmacy benefit, whether prior authorization is required, and whether your plan is fully insured or self-funded. Benefit type matters because Spravato is sometimes processed under pharmacy rather than medical coverage. We verify benefits and handle authorization as part of the intake process; candidacy is assessed here.

This article is educational and is not legal or personalized medical advice. Coverage criteria vary by plan and change over time. Verify benefits with your insurer. Reviewed by Nefretiri Abat, PMHNP-BC, JD.