Ketamine therapy can be very helpful in psychotherapy to deal with mental health and trauma issues linked to chronic depression. But, does Aetna cover ketamine therapy in Arizona?

Aetna for Ketamine Therapy

Yes, Aetna covers esketamine (Spravato) nasal spray as long as you have “pre-certification.”

“…Aetna considers esketamine (Spravato) nasal spray medically necessary for treatment-resistant depression (TRD) or major depressive disorder (MDD) with acute suicidal ideation or behavior when all of the criteria are met.”

Precertification is a check to make sure that the program administering the ketamine therapy is licensed, and meets their requirements for treatment. See Aetna’s Scope of Policy for Additional information.

What is the Criteria for Pre-Certification for Aetna to Cover Ketamine Therapy?

1. Patient Must Have a Confirmed Diagnosis of Severe Major Depressive Disorder. This must be corroborated with the results of a test that measures depressive symptoms. Approved tests include (but are not limited-to):
   1. Beck Depression Scale (BDI)
   2. Patient Health Questionnaire (PHQ-2, PHQ-9)
   3. Montgomery-Asberg Depression Rating Scale (MADRS)
   4. Hamilton Depression Rating Scale (HDRS)
2. The Medication Must Be Prescribed-By Or In Consultation-With A Psychiatrist.
3. The Medication Must Be Administered Under The Direct Supervision of a Health Care Provider.
4. The Patient Must Be Monitored By A Healthcare Provider For At Least 2 hours After Administration of the Medication.
5. The Medication Must Be Administered In Combination With An Oral Antidepressant.
6. The Patient Must Have Tried And Had An Unsuccessful Response to 2 Different Classes of Antidepressants in the Past (This is the basis for diagnosing your depression as “Treatment-Resistant Depression”).
   1. CLASSES OF ANTIDEPRESSANTS
      1. Selective Serotonin Reuptake Inhibitors(SSRIs):
         1. Celexa, Citalopram, etc.
      2. Aminoketone:
         1. Wellbutrin
      3. Noradresnalin and Serotoninergic Antidepressants (NASSAs):
         1. Amoxapine, Maproiline, mirtazapine, oleptro, remeron, etc.
      4. Monoamine Oxidase Inhibitors (MAOI Inhibitors):
         1. Marplan, Nardil, Parnate, Phenelzine, tranylcypromine, phenelzine, etc.
      5. Trycyclic Antidepressants (TCAs):
         1. Amitrptyline, desipramine, etc.

Does Aetna Cover Ketamine Infusions?

No, Aetna does not currently cover any other form of ketamine therapy except via nasal route (esketamine). IV Ketamine therapy is therefore not covered by Aetna insurance.

Does Aetna Cover Ketamine Therapy for Suicidal Thoughts, Feelings, or Behaviors?

Yes, Aetna covers ketamine therapy (esketamine/Spravato) for the treatment of 2 specific disorders:

1. Treatment Resistant Depression (TRD)
2. Depressive Symptoms with Major Depressive Disorder (MDD) with acute suicidal ideation or behavior.

It is important to note that suicidal thoughts and behaviors will not exclude a patient from approval for treatment with ketamine therapy. However, Aetna coverage for ketamine therapy is excluded in patients with moderate or severe substances abuse or alcohol use disorders that are not currently being treated or managed. It is important for patients to seek substance abuse treatment before seeking ketamine therapy.

Does Ketamine Therapy for Depression Work?

The question is subjective, but Aetna considers ketamine therapy for treatment resistant depression successful when the patient shows evidence of therapeutic benefits at the end of the induction phase of treatment (1-4 weeks after the first dosage of ketamine therapy is administered).

Therefore, by Aetna Insurance standards, yes – many patients see ketamine therapy begin to work in 1-4 weeks of starting treatment.

Ketamine Therapy for Obsessive Compulsive Disorder and (OCD)

While using ketamine therapy for the treatment of OCD is an off-label use for esketamine, Aetna recognizes the work of Martinotti and colleagues (2021). This research shows that: “ketamine has been indicated to produce remarkable results in patients with treatment-resistant depression, post-traumatic stress disorder (PTSD) and OCD in dozens of small studies accrued over the past 10 years.”

Ketamine Treatment for Those Suffering From PTSD, Depression, and OCD

For those with treatment resistant depression and 1 or more co-morbidities (multiple mental health concerns), ketamine therapy could be a strong option for showing therapeutic relief. And, ketamine therapy may be covered by your Aetna insurance plan.

Ketamine Therapy in Arizona

The Arizona Psychedelic Assisted Psychotherapy Institute (AZPAPTI)  offers ketamine therapy in Arizona, administered by a doctor and accompanied by therapeutic treatment from our licensed therapists. Contact us today to start the approval process to see if Aetna or other insurance coverage will be accepted.

This is your first step to starting Ketamine Therapy in Arizona.