Spravato Prior Authorization Documentation Checklist: What Your Chart Must Show

Spravato prior authorization is won or lost on documentation. Reviewers never meet you, they read a file. This checklist covers exactly what that file must contain so you can gather your part before the first appointment and avoid the delays that come from an incomplete history.

The checklist

• Diagnosis matching the label. Treatment-resistant depression, or depressive symptoms in major depressive disorder with acute suicidal ideation or behavior, coded correctly.
• Antidepressant trial history. For each trial: drug name, dose reached, weeks taken, and what happened. Trials stopped early for intolerable side effects can count when documented as such.
• Any concurrent oral antidepressant, if your plan requires one. Since January 2025 the FDA has approved Spravato as a standalone monotherapy for treatment-resistant depression, but many plan policies still ask for a concurrent oral antidepressant. Check your plan and name the medication if it applies.
• A baseline symptom score, most often the PHQ-9, recorded before the first dose.
• REMS enrollment for the treatment setting, the prescriber, and the patient, all active before dose one.
• Confirmation of monitored administration, since coverage assumes at least two hours of in-clinic observation.

Why the medication history is the hard part

Plans apply a specific definition of a failed trial: appropriate drug, adequate dose, adequate duration, insufficient response. Many patients have taken six or seven antidepressants over a decade but can document only two properly. See what counts as an adequate antidepressant trial.

What you can do before your first visit

Request pharmacy dispensing histories from every pharmacy you have used, ask prior prescribers for records, and write out your own medication timeline from memory as a starting map. Patients who arrive with this in hand shorten the process substantially. We assemble and submit the packet, and we verify benefits first so you know where you stand before anything begins.

Related: Spravato prior authorization in California · re-authorization and continued coverage · appealing a denial · how long approval takes.

Frequently asked questions

What documentation does Spravato prior authorization require?

A diagnosis matching the labeled indication, a documented history of adequate antidepressant trials with drug, dose, duration and outcome, a baseline symptom score, REMS enrollment for the setting and prescriber, confirmation the medication will be administered under observation, and a concurrent oral antidepressant if your plan’s policy requires one.

Do I need my old psychiatric records?

They help significantly. Pharmacy dispensing histories and prior clinician notes are the fastest way to establish trial history. Incomplete history is the single most common cause of delay.

Does Spravato have to be taken with another antidepressant?

Not necessarily. The FDA approved Spravato as a standalone monotherapy for treatment-resistant depression in January 2025, so the label no longer requires pairing it with an oral antidepressant for that indication. Many plan policies still ask for one, and some are removing that requirement, so this is a plan-by-plan question worth confirming before you submit.

How long does the review take once everything is submitted?

Most decisions come within days to about two weeks when the packet is complete. Incomplete submissions are what turn a two-week process into a two-month one.

This article is educational and is not personal medical or billing advice. Plan rules vary and change over time. If you are in crisis, call or text 988.

References

• FDA prescribing information: Spravato (esketamine)
• SPRAVATO REMS Program