Prior Authorization Updates for Esketamine (Spravato) Effective May 1, 2025, for Texas Medicaid

Date: June 30, 2025

Attention: All Providers

Effective date: May 1, 2025

Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after May 1, 2025, prior authorization criteria for esketamine (Spravato) will change.

Treatment Indications

Esketamine (Spravato) will also be indicated as monotherapy for adult clients who are 18 years of age or older with treatment-resistant depression.

Refer to the current Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, subsection 6.46, “Esketamine (Spravato)” for additional indications for esketamine (Spravato).

Diagnosis Requirements

The following diagnosis codes for major depressive disorder will also be considered for prior authorization:

Next steps: Providers should refer to the current TMPPM, Outpatient Drug Services Handbook, subsection 6.46.1, “Prior Authorization,” for additional diagnosis codes that will be considered for prior authorization.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts,log into:
www.texaschildrenshealthplan.org/provideralerts.