How Hard is it to Get a Prescription for SPRAVATO®?

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If you follow the news – online or in print – you probably know mental health is a topic that generates significant interest these days, and one thing people who need treatment for mental health issues wonder is how hard it is to get a prescription for one of the new, innovative therapies, such as SPRAVATO (SPRAVATO®).

There are various reasons we see stories about mental health in the news more often and see articles of reviews of new approaches to treating mental health diagnoses such as depression, anxiety, and others. One is the fact that the stigma around mental health diagnoses and treatment for mental health diagnoses is finally fading.

We now accept that anyone can experience mental health issues. We’ve seen Olympic athletes, NFL stars, movie/tv/music celebrities, and national politicians discuss challenges with diagnoses like depression and anxiety openly, in the news, in ways that only ten years ago they likely wouldn’t have. This is important progress: when people in the public eye have the courage to discuss their challenges, many people see that and have a breakthrough.

They realize that receiving a diagnosis like depression is nothing to be ashamed of, but rather a medical diagnosis that responds well to evidence-based treatment administered by licensed and qualified mental health professionals.

Nevertheless, some patients are not comfortable with the idea of talk therapy – i.e. psychotherapy – but still want to engage in treatment. They’re interested in a new wave of treatments that act on the brain, and don’t always require talk therapy – although most providers offer psychotherapy in conjunction with this new wave or therapies as an additional option.

New therapies that generate significant interest include:

In this article, we’ll answer a question we raised above, which we hear often:

How hard is it to get a prescription for SPRAVATO®?

Medication: As Indicated by a Qualified Mental Health Professional

We should be clear from the beginning:

There’s nothing hard about getting a prescription for SPRAVATO®.

However, it’s absolutely critical for anyone interested in receiving treatment with SPRAVATO® to understand that SPRAVATO® is a real medication for real diagnoses that has a very real effect on the human brain and body.

Think of the commercials you see on TV that sell brain boosters, fruit and vegetable supplements, and other health products. We should be clear about this as well:

SPRAVATO IS NOTHING LIKE THOSE. SPRAVATO IS A PSYCHIATRIC MEDICATION. IT’S NOT A SUPPLEMENT AND NOT A DIETARY AID: IT’S A PSYCIATRIC MEDICATION.

One more thing:

ONLY A PHYSICIAN CAN PRESCRIBE SPRAVATO®.

In some cases, a physician’s assistant (PA) or a nurse practitioner (NP) can prescribe a medication like SPRAVATO® under the supervision of a physician. However, when this happens, it requires physician supervision and is dictated by the prescribing rules of each state.

With that said, let’s back up and pose a question of our own:

Why would someone ask how hard it is to get a prescription for SPRAVATO®?

Here are possible reasons:

They think they’re having symptoms of depression, and read somewhere SPRAVATO® is a promising new medication that can help reduce depressive symptoms.
A friend or loved one has depression, and they’re researching various treatments that may help, and found information about SPRAVATO®.
They have depression, have pursued therapy and medication, are not satisfied with the results, and heard – either from a professional, word of mouth, or article like this – that SPRAVATO® may be effective when other treatments are not.

Those reasons are all valid and logical. Now let’s get to the question behind the question:

How do you get a prescription for SPRAVATO®?

SPRAVATO®: Indications and Prescription Process

SPRAVATO® is approved by the Food and Drug Administration for the following mental health diagnoses:

Treatment-resistant depression (TRD):

TRD is defined as major depressive disorder (MDD) that does not improve after two treatment attempts of appropriate dosage and duration with standard antidepressants.
Research shows about 31% of people with MDD have TRD.

Major depressive disorder (MDD) with suicidal thought or actions:

The most common symptoms of MMD include persistent feelings of hopelessness or sadness that last for more than two weeks, withdrawal from friends and family, loss of interest in favorite activities, problems with memory and concentration, and a decline in work or academic performance. People with MDD may also display symptoms like anger, agitation, and/or irritability.
In some cases, people with MDD also report suicidal ideation and/or suicidal behavior. Suicidal ideation means thinking or talking about suicide. Suicidal behavior includes suicidal ideation, with the addition of taking concrete steps toward suicide, including making a suicide plan, setting a date, securing means, and attempting suicide.
Research on records of people with MDD shows 58% of people diagnosed with MDD engage in suicidal ideation, and 15% have attempted suicide.

In order to receive a prescription for SPRAVATO, the FDA requires an individual to receive one of the two diagnoses listed above. Here’s the process, including what happens after you receive a prescription and consent to treatment.

Step 1:

If you’ve never received a diagnosis for depression, you need an evaluation from a physician or psychiatrist and a diagnosis of TRD or MDD with suicidal thoughts or actions.
If you receive a diagnosis for MDD, you need to make at least two attempts at a standard antidepressant before you meet the requirements for SPRAVATO® before you can proceed to step two.
If you receive a diagnosis for TRD or MDD with suicidal thoughts or actions, you may receive a referral for treatment with a SPRAVATO® provider, like us here at Crownview Psychiatric Institute (CPI).

Step 2:

Find and contact a licensed provider that offers treatment with SPRAVATO®.
The provider – either inpatient or outpatient – must have an up-to-date certification as a healthcare provider.
The provider must be approved by an FDA program called SPRAVATO® REMS (Risk Evaluation and Mitigation Strategy).
When you find an appropriate provider, they order the medication from a specialist pharmacy that’s certified to distribute SPRAVATO®.

You cannot get SPRAVATO® on your own from a typical pharmacy. Nor can you administer SPRAVTO yourself, in the absence of a licensed, REMS-certified provider.

Your provider will acquire the medication and arrange a time for a treatment session.
You must enroll in the SPRAVATO® REMS program before treatment begins.

We’ll pause here for a moment, because we’ve answered the question we pose in the title of this article. As you can see, it’s not necessarily hard to get a prescription for SPARAVATO (SPRAVATO®), but there are specific requirements you need to meet before you can get a prescription. If you meet the requirements, it’s not hard. If you don’t meet the requirements, it should be more than hard: if you don’t meet the FDA-established rules and regulations, it should be impossible to get a prescription for SPRAVATO®.

Once you get a prescription for SPRAVATO®, what happens next?

Treatment With Prescription SPRAVATO (SPRAVATO®)

Once you meet the requirements for a prescription and find a licensed and certified provider, you arrange for treatment sessions. The process we describe below is for outpatient treatment. Before your first treatment session.

Your provider must review the risks and benefits of treatment.
Both you and your provider must sign the REMS treatment form.

Signing the form ensures that the patient and provider understand the risks and benefits of treatment and agree to follow the rules and regulations for treatment established by the FDA. The rules and regulations safeguard the health and wellness of the patient, and guide/inform established treatment protocols the provider must follow.

An outpatient treatment session with SPRAVATO® works like this:

After arriving at your outpatient treatment location, you and your provider take about 15 minutes to prepare.
You sit in a comfortable chair in a treatment room.
Under the direct supervision of a certified clinician, you self-administer SPRAVATO®. The medication comes in a powered form. You administer it like a nasal allergy spray: administration is simple, fast, and easy.
Your clinician will keep you under observation for around two hours after self-administration.
Due to potential side-effects such as sedation, drowsiness, or dizziness, you need to arrange for transportation to and from a treatment session.
Treatment sessions typicall last about 2.5 hrs.

In most cases, you’ll receive treatment twice a week for the first month, once a week for the second month, then collaborate with your provider on a schedule determined by your results. A course of treatment typically takes place over 8-9 weeks, with the final treatment plan and duration dictated by your therapeutic needs, your treatment history, and your response to treatment – all of which are unique to you.