Major depressive disorder, which includes different forms of depression that last for more than 14 days, affects over 17 million adults in the United States today. Fortunately for many of these people, there are prescription medications that may offer symptom relief.
Unfortunately, others who have a treatment-resistant form of depression may find standard medications ineffective. In cases such as these, physicians may subscribe another medication for them to take along with other antidepressants. One such medication is esketamine which was recently approved by the FDA for use as a nasal spray to treat this serious form of depression.
Esketamine is the generic name of a type of medication included in the class of receptor antagonists, or NMDAs. A common brand name form of esketamine is Spravato and can be administered as a nasal spray only by a physician in a medical facility. Esketamine works by altering the actions of specific chemicals in the brain to help alleviate symptoms of depression that are not treatable with standard antidepressants alone.
If you have a form of depression that does not improve with treatment from other antidepressants, your health care provider may suggest that you take an additional medication that contains esketamine. If so, it is important to know whether your Medicare benefits cover the cost of the medication.
The Benefits of Taking Esketamine
Many people who experience depression respond well to standard treatment with antidepressant medications. But there is no way to foresee who will not respond well. While treatment-resistant depression tends to affect women and seniors at higher rates than others, it can happen to anyone.
The biological cause of depression is unknown, but it is believed that low levels of serotonin and norepinephrine in the brain may cause depression in most people. In others, inflammation in the brain may be the main cause.
Because antidepressant medications treat the brain’s chemical imbalances and not brain inflammation, those who have inflammation generally do not respond to standard antidepressants alone. That is where esketamine comes in. Taken together with antidepressants, it may provide relief from symptoms of depression in these circumstances.
Medicare Coverage for Esketamine
Esketamine as a treatment for depression in adults is relatively new in the United States. Since 2019, when it was approved for use by the FDA for treatment-resistant depression, people have been paying an average of $4,700.00 to $6,800.00 for their initial month of the nasal spray.
Due to the high cost of this drug, Medicare Part B coverage is extremely important for recipients who need it. If your health care provider has suggested treatment with esketamine, it may be covered under your Original Medicare Part B policy because esketamine cannot be self-administered. This drug is not available for patients to purchase on their own. If your psychiatrist prescribes esketamine for you, the psychiatrist must purchase the drug and administer it in a medical facility.
Medicare Part B may pay for the drug and its administration as a part of the doctor’s visit. In this case, Medicare pays for 80 percent of the Medicare-approved amount and you pay 20 percent. You are also responsible for Part B deductible which is $185.00 in 2019.
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