Formulary Coverage of Esketamine and Ketamine for Depression in Ohio Health Insurance Marketplace and Medicaid Plans.

IF 1.3 4区 医学 Q3 PSYCHIATRY
Brian S Barnett
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引用次数: 0

Abstract

For more than 2 decades, intravenous ketamine has been demonstrated to have rapid antidepressant effects. However, access to this generic drug is limited due to insurers claiming it is "experimental" because ketamine does not have a Food and Drug Administration indication for depression. In contrast, intranasal esketamine, an enantiomer of ketamine, is approved by the Food and Drug Administration for depression and is still under patent. The goal of this column is to provide a clearer understanding of formulary coverage of these similar medications by insurers. Formularies of all 2023 Ohio Health Insurance Marketplace and Medicaid plans were reviewed to determine the inclusion status of intravenous ketamine and intranasal esketamine for depression. This review found that intravenous ketamine was not covered by any Marketplace or Medicaid plan for depression, while intranasal esketamine was on 72.7% and 100% of formularies, respectively. Thus, members of the analyzed insurance plans can more easily access intranasal esketamine than intravenous ketamine for depression, despite the latter being more cost-effective and possibly more efficacious.

俄亥俄州健康保险市场和医疗补助计划中治疗抑郁症的 Esketamine 和 Ketamine 的处方覆盖范围。
二十多年来,静脉注射氯胺酮已被证明具有快速抗抑郁作用。然而,由于保险公司声称氯胺酮是 "试验性 "药物,因此这种非专利药物的使用受到了限制,因为氯胺酮并没有获得美国食品药品管理局的抑郁症适应症。与此相反,氯胺酮的对映体--鼻内注射用艾司氯胺酮已被美国食品药品管理局批准用于治疗抑郁症,并且仍在专利期内。本专栏旨在让读者更清楚地了解保险公司对这些类似药物的处方覆盖范围。我们审查了 2023 年俄亥俄州健康保险市场和医疗补助计划的所有医保目录,以确定静脉注射氯胺酮和鼻内注射艾司氯胺酮治疗抑郁症的纳入情况。审查发现,静脉注射氯胺酮未被任何市场或医疗补助计划纳入抑郁症治疗范围,而鼻内注射艾司氯胺酮则分别被纳入 72.7% 和 100% 的医保目录。因此,与静脉注射氯胺酮相比,分析的保险计划的成员更容易获得鼻内注射艾司氯胺酮治疗抑郁症,尽管后者更具成本效益,疗效也可能更好。
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来源期刊
CiteScore
2.30
自引率
10.50%
发文量
159
审稿时长
>12 weeks
期刊介绍: Journal of Psychiatric Practice® seizes the day with its emphasis on the three Rs — readability, reliability, and relevance. Featuring an eye-catching style, the journal combines clinically applicable reviews, case studies, and articles on treatment advances with practical and informative tips for treating patients. Mental health professionals will want access to this review journal — for sharpening their clinical skills, discovering the best in treatment, and navigating this rapidly changing field. Journal of Psychiatric Practice combines clinically applicable reviews, case studies, and articles on treatment advances with informative "how to" tips for surviving in a managed care environment.
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