Access and real-world use patterns of esketamine nasal spray among patients with treatment-resistant depression

A recent and informative paper explores the patterns of use of ketamine in patients with depression. This retrospective analysis (n=535) describes the access and real-world use patterns of esketamine nasal spray among adults with treatment-resistant depression (TRD). Of the pharmacy claims for esketamine, 34.6% were approved, 46.3% were rejected, and 19.1% were abandoned. The approval rate increased to 85.2% by the second treatment session. Among 273 patients who initiated esketamine (mean age 49.3 years; 66.3% female), the mean number of sessions was 11.8 over a mean of 11.8 months, with 47.6% completing at least eight sessions, and 93.8% of those completing induction continuing treatment.

Abstract

“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 (01/2016-03/2021). Patients with evidence of TRD initiating esketamine (index date) after 03/05/2019 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% female), 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% female). 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.”

This paper is highly relevant given that Major depressive disorder (MDD) is a chronic psychiatric condition annually affecting 8.4% of adults in the United States. Approximately 30% of patients with MDD experience treatment-resistant depression.

Esketamine is a novel nasal spray approved for treatment of TRD in adults in the US. It has been shown to reduce depressive symptoms in as early as 24 h after the first dose. Access to esketamine through health insurance in the US is often subject to prior authorization, which requires a patient to demonstrate true medical needs for the medication and to have tried cost-effective alternatives before receiving more expensive therapies.

For more psychedelic news and research, visit the psychedelic health professional network homepage.