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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
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.
Updated August 2026 · Reviewed by Nefretiri Abat, PMHNP-BC
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.
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.
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.
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.
Generally yes for treatment-resistant depression, with prior authorization required. Spravato is FDA-approved for TRD and for depressive symptoms in adults with MDD who have acute suicidal ideation or behavior, so it is not considered experimental for those uses.
Documentation of at least two adequate antidepressant trials without adequate response, a plan to continue an oral antidepressant during treatment, and administration at a REMS-certified clinic. Some plans add prescriber specialty or psychotherapy requirements.
It varies by plan. Because Spravato is administered in a certified clinic, some plans process it under the medical benefit and others under pharmacy, which changes how authorization is submitted. Ask member services which applies to your plan.
File an internal appeal addressing the specific reason cited. If that is denied, most Californians can request a free Independent Medical Review through the state, which is decided by outside physicians and is binding on the plan.
Across commercial plans the core requirement is consistent: an adult with major depressive disorder who has had an inadequate response to at least two oral antidepressants, each taken at an adequate dose for an adequate duration. Plans increasingly specify that those two trials come from different drug classes. Most also expect the prescription to come from, or in consultation with, a psychiatric prescriber, and many ask for a baseline depression rating scale such as the PHQ-9 or MADRS.
One point worth raising with Anthem Blue Cross directly: the FDA approved Spravato as a standalone monotherapy for treatment-resistant depression in January 2025. Some plan policies still require a concurrent oral antidepressant and others have begun removing that condition. If your plan still requires it, that is a policy position rather than a label requirement, and it is worth naming in an appeal.
Coverage generally follows the labeled schedule: twice weekly during weeks 1 through 4, weekly during weeks 5 through 8, then weekly or every two weeks in maintenance. Insurers typically authorize against those phases rather than approving an open-ended course, so a renewal request usually lands at each transition and turns on documented response. Our guide to Spravato re-authorization covers what those reviews weigh.
Because Spravato must be given in a REMS-certified setting with at least two hours of monitoring, the treatment setting and prescriber must be enrolled before the first dose. See REMS and monitoring requirements.
See our Spravato documentation checklist and, if a request is turned down, how to appeal in California.
Yes. Anthem reviews Spravato through its Behavioral Health Utilization Management process. The criteria depend on which Anthem product you carry, and requests generally need documented inadequate response to at least two oral antidepressants.
Not under the FDA label since January 2025, when Spravato was approved as a standalone monotherapy for treatment-resistant depression. Some insurance policies still require a concurrent oral antidepressant, so it is worth confirming your plan’s current position before submitting.
