Access and real-world use patterns of esketamine nasal spray among patients with treatment-resistant depression covered by private or public insurance.

Jul 26, 2023Current medical research and opinion

Use and access to esketamine nasal spray in patients with hard-to-treat depression covered by private or public insurance

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Abstract

Among 535 patients with pharmacy claims for esketamine nasal spray, 34.6% received treatment approval on their first claim.

The approval rate for esketamine claims increased to 85.2% by the second treatment session.
Main reasons for initial claim rejections included lack of coverage (57.1%), claim errors (52.6%), and the need for prior authorization (22.7%).
Patients who initiated treatment had a mean of 11.8 esketamine sessions over approximately 11.8 months.
47.6% of patients completed at least 8 sessions, which is the number required during the induction phase.
Only 17.6% of patients completed the induction phase according to label recommendations, yet 93.8% of these continued to maintenance treatment.

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OBJECTIVE: To describe access and real-world use patterns of esketamine nasal spray among adults with treatment-resistant depression (TRD) with private or public insurance.

METHODS: Adults with ≥1 claim for esketamine nasal spray were selected from Clarivate's Real World Data product (January 2016-March 2021). Patients with evidence of TRD initiating esketamine (index date) after 05 March 2019 were included. Esketamine access, as measured by pharmacy claim approval rate for each treatment session, and use patterns were described post-index (follow-up period).

RESULTS: Among 535 patients with pharmacy claims for esketamine nasal spray (mean age 49.1 years; 65.4% females), 534 had the first esketamine claim being a pharmacy claim, of which 34.6% were approved, 46.3% were rejected, and 19.1% were abandoned. Main reasons for rejection included "claim not covered by plan" (57.1%), "claim errors" (52.6%), and "prior authorization required" (22.7%). The approval rate increased to 85.2% by the second esketamine treatment session. A total of 273 patients initiated esketamine (mean age 49.3 years; 66.3% females). Patients had a mean ± standard deviation (SD) of 11.8 ± 13.3 esketamine sessions over a mean ± SD of 11.8 ± 6.4 months; 47.6% of patients completed ≥8 sessions (i.e. the number of sessions in induction phase) over a mean ± SD of 80.1 ± 71.9 days (per label, 28 days); 48 (17.6%) patients completed induction per label, and among them 93.8% continued treatment.

CONCLUSIONS: Initial access to esketamine nasal spray may be hindered by prior authorization or claim filing errors. Among patients who initiated esketamine, treatment compliance generally deviates from label recommendations; yet, most of those who received induction per label successfully transition to maintenance with esketamine.

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Access and real-world use patterns of esketamine nasal spray among patients with treatment-resistant depression covered by private or public insurance.

Abstract

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