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

Intravenous ketamine has rapid antidepressant effects but is rarely covered by insurance because it lacks FDA approval for depression, while intranasal esketamine, which is FDA-approved and still patented, is widely covered. A review of 2023 Ohio Health Insurance Marketplace and Medicaid plans found that no Marketplace or Medicaid plan covered intravenous ketamine for depression, whereas intranasal esketamine was on 72.7% of Marketplace formularies and 100% of Medicaid formularies. This means patients can more easily access esketamine even though intravenous ketamine is more cost-effective and possibly more efficacious.

Study at a glance

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.