Yes. Aetna's commercial medical plans cover Spravato (esketamine) for treatment-resistant depression in Maryland when prior authorization criteria are met. Aetna requires precertification through their Specialty Pharmacy program (per Aetna Clinical Policy Bulletin 0950, last reviewed February 25, 2026).
Latest medical review on: May 5th, 2026. Medically reviewed by Instructor in Psychiatry at Harvard Medical School and Lumin Health Co-founder, Chief Medical Officer Dr. Ben Yudkoff.
Aetna covers Spravato for adults with treatment-resistant major depressive disorder when all of the following are documented (per Aetna Clinical Policy Bulletin 0950, last reviewed February 25, 2026):
Antidepressant classes Aetna recognizes (CPB 0950): Aminoketone (bupropion), MAOIs, NASSAs, SSRIs, SNRIs, TCAs, and Serotonin modulators.
Aetna's augmentation definition (CPB 0950): any one of the following used concomitantly — (1) two antidepressants with different mechanisms of action, (2) an antidepressant plus a second-generation antipsychotic, (3) an antidepressant plus lithium, or (4) an antidepressant plus thyroid hormone.
Evidence-based psychotherapies Aetna recognizes (CPB 0950): cognitive behavioral therapy (CBT), interpersonal therapy (IPT), supportive therapy (ST), or psychoeducational intervention (PEI).
Aetna's separate suicidal-ideation pathway: CPB 0950 also covers MDD with acute suicidal ideation or behavior under a separate criteria set. The prescriber must represent that, in the absence of Spravato, the member would within the next 24 to 48 hours require confinement in an acute care psychiatric institution; Spravato must be used in combination with an oral antidepressant; up to 4 weeks of initial coverage applies (84 mg twice weekly, reducible to 56 mg twice weekly per tolerability).
TRD dosing schedule (CPB 0950): Induction (Weeks 1–4) 56 or 84 mg twice weekly; Maintenance (Weeks 5–8) 56 or 84 mg once weekly; Week 9+ 56 or 84 mg every 2 weeks or once weekly, individualized to the least frequent dosing that maintains response.
Continued treatment is reauthorized in 6-month increments when documented improvement on standardized rating scales is sustained.
Two Maryland insurance statutes apply when a commercial carrier reviews a Spravato prior authorization:
Step therapy prohibition for non-FDA-approved alternatives. Under Maryland Insurance Article §15-142, a commercial carrier may not require step therapy when (a) the step-therapy drug is not FDA-approved for the condition being treated, or (b) the prescriber documents that a covered drug ordered for the same condition within the past 180 days was clinically effective. For Spravato — FDA-approved specifically for treatment-resistant depression — this means a carrier cannot require trials of drugs not FDA-approved for TRD as a precondition.
Grievance and adverse-decision review. Under Maryland Insurance Article §15-10A-02, commercial carriers must issue a standard adverse-determination decision within 30 working days, an emergency review within 24 hours, and a behavioral-health emergency-admission review within 2 hours. After internal review, members can request external review through the Maryland Insurance Administration: 120-day filing window, 60-day decision (4 business days for emergencies).
Spravato treatment at Lumin Health in the Maryland/DMV area is available at Lumin Health Bethesda, which serves patients from across Maryland, the District of Columbia, and Northern Virginia. Lumin Health Bethesda is REMS-certified per FDA requirements.
How Aetna compares with other major Maryland commercial payers on published Spravato prior authorization criteria:
Each linked cell opens the full Lumin Health Spravato coverage page for that payer.
Yes — Aetna requires precertification across all commercial medical plans, regardless of state. Submission goes through Aetna Specialty Pharmacy: phone (866) 752-7021, fax (888) 267-3277.
Two from at least two different classes (different mechanisms of action), each at the maximally tolerated labeled dose for at least 8 weeks within the past 5 years — plus an inadequate response to either an adequate augmentation trial or evidence-based psychotherapy (CBT, IPT, supportive therapy, or psychoeducational intervention) during the current depressive episode.
Aetna reauthorizes TRD treatment in 6-month increments when documented improvement (or sustained improvement) from baseline on a standardized rating scale is shown. The MDD-with-acute-suicidal-ideation pathway is approved for up to 4 weeks total at initial review.
Lumin Health handles everything on your behalf so you don't have to worry. If your prior authorization is denied, our team manages the appeal process directly with Aetna — you don't need to navigate the paperwork or follow-ups.
Aetna Better Health of Maryland (Aetna's Maryland Medicaid managed-care plan) follows different coverage criteria than commercial Aetna plans — the criteria above are for Aetna's commercial plans (per CPB 0950). For Maryland Medicaid coverage, Lumin Health verifies your specific plan at consultation.
Step 1 — File a Level 1 internal appeal. Deadline: 180 calendar days from receipt of the denial notice (per Aetna: "You have 180 days from when you get the notice of the denied claim, unless your plan brochure (or Summary Plan Description) gives you a longer period of time."). Include the original denial letter, your prescriber's letter of medical necessity, your antidepressant trial history, and any standardized rating-scale documentation that supports the medical-necessity argument.
Submission. Call Member Services at the phone number on your Aetna ID card, or print and mail the Member complaint and appeal form available at aetna.com/individuals-families/member-rights-resources. For Spravato precertification specifically, Aetna routes through Aetna Specialty Pharmacy (phone 866-752-7021, fax 888-267-3277).
Step 2 — Peer-to-peer (P2P) review. Per Aetna: "Under certain circumstances, your physician may request a peer-to-peer review if they have a question or wish to discuss a medical-necessity precertification determination made by our medical director." For an appeal-stage P2P, your prescriber submits the appeal request form with a written note requesting peer-to-peer; a peer clinician at Aetna will conduct the review.
Step 3 — Expedited (urgent) appeal. Per Aetna: "You or your doctor may ask for an expedited appeal. Call the toll-free number on your Member ID card or the number on the claim denial letter." Federal urgent-care rules require Aetna to resolve expedited appeals within 72 hours when delay would jeopardize life, health, or the ability to regain function.
Appeal levels. Aetna plans provide either one or two levels of internal appeal — your specific plan documents control. Most commercial plans provide a single Level 1 internal appeal followed by external review.
Step 4 — External review. If the internal appeal is denied, you have the right to an independent external review. Maryland external review is administered by the Maryland Insurance Administration (MIA). Filing window: 120 days from the final internal denial. Decision timeline: 60 days standard, 4 business days for emergencies. See Maryland state-level patient protections above for the full pathway.
Spravato-specific caveat — read your denial letter carefully. Spravato is a REMS-restricted specialty drug. Aetna does not carve out behavioral-health appeals to a separate vendor for commercial members. Spravato precertification at Aetna routes through Aetna Specialty Pharmacy (the medical/specialty Rx benefit), and appeals follow the same pathway. The exact appeal submission address differs depending on which benefit your plan uses — always confirm the address printed on your specific denial letter before mailing or faxing.
How Lumin Health helps. Lumin Health's prior-authorization team handles appeal submissions, peer-to-peer scheduling with the Aetna medical director, and assembles the clinical documentation packet — antidepressant trial history with dosing and duration, baseline and follow-up rating-scale data, prescriber attestation, and any state-specific exception arguments — to maximize the likelihood of overturning the denial.
Step 1 — File a Level 1 internal appeal. Deadline: 180 calendar days from receipt of the denial notice (per Aetna: "You have 180 days from when you get the notice of the denied claim, unless your plan brochure (or Summary Plan Description) gives you a longer period of time."). Include the original denial letter, your prescriber's letter of medical necessity, your antidepressant trial history, and any standardized rating-scale documentation that supports the medical-necessity argument.
Submission. Call Member Services at the phone number on your Aetna ID card, or print and mail the Member complaint and appeal form available at aetna.com/individuals-families/member-rights-resources. For Spravato precertification specifically, Aetna routes through Aetna Specialty Pharmacy (phone 866-752-7021, fax 888-267-3277).
Step 2 — Peer-to-peer (P2P) review. Per Aetna: "Under certain circumstances, your physician may request a peer-to-peer review if they have a question or wish to discuss a medical-necessity precertification determination made by our medical director." For an appeal-stage P2P, your prescriber submits the appeal request form with a written note requesting peer-to-peer; a peer clinician at Aetna will conduct the review.
Step 3 — Expedited (urgent) appeal. Per Aetna: "You or your doctor may ask for an expedited appeal. Call the toll-free number on your Member ID card or the number on the claim denial letter." Federal urgent-care rules require Aetna to resolve expedited appeals within 72 hours when delay would jeopardize life, health, or the ability to regain function.
Appeal levels. Aetna plans provide either one or two levels of internal appeal — your specific plan documents control. Most commercial plans provide a single Level 1 internal appeal followed by external review.
Step 4 — External review. If the internal appeal is denied, you have the right to an independent external review. Maryland external review is administered by the Maryland Insurance Administration (MIA). Filing window: 120 days from the final internal denial. Decision timeline: 60 days standard, 4 business days for emergencies. See Maryland state-level patient protections above for the full pathway.
Spravato-specific caveat — read your denial letter carefully. Spravato is a REMS-restricted specialty drug. Aetna does not carve out behavioral-health appeals to a separate vendor for commercial members. Spravato precertification at Aetna routes through Aetna Specialty Pharmacy (the medical/specialty Rx benefit), and appeals follow the same pathway. The exact appeal submission address differs depending on which benefit your plan uses — always confirm the address printed on your specific denial letter before mailing or faxing.
How Lumin Health helps. Lumin Health's prior-authorization team handles appeal submissions, peer-to-peer scheduling with the Aetna medical director, and assembles the clinical documentation packet — antidepressant trial history with dosing and duration, baseline and follow-up rating-scale data, prescriber attestation, and any state-specific exception arguments — to maximize the likelihood of overturning the denial.
