Yes. Cigna covers Spravato (esketamine) for treatment-resistant depression in Maryland when prior authorization criteria are met. Cigna's IP0220 policy is unusual in quantifying nonresponse: per Cigna, “Patient has demonstrated nonresponse (≤25% improvement in depression symptoms or scores) to at least two different antidepressants, each from a different pharmacologic class” (IP0220, page 4). Cigna does not require a specific rating scale; the documentation is left to the prescriber.
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.
Cigna covers Spravato for adults with treatment-resistant major depressive disorder when the following are documented (per Cigna Coverage Policy IP0220, Effective Date 2/1/2026):
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 Cigna 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. Cigna requires prior authorization for Spravato per Coverage Policy IP0220.
For TRD: at least two different antidepressants, each from a different pharmacologic class, used at therapeutic dosages for at least 6 weeks in the current depressive episode, with documented nonresponse defined as ≤25% improvement in depression symptoms or scores.
Cigna approves TRD for 6 months initially, and MDD with acute suicidal ideation or behavior for 2 months. Per IP0220, “Extended approvals are allowed if the patient continues to meet the Criteria and Dosing.”
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 Cigna — you don't need to navigate the paperwork or follow-ups.
Cigna policy IP0220 explicitly notes that customer-specific plan documents supersede the standard policy; federal-employee, military, or Medicare Advantage Cigna plans may have different criteria. Lumin Health verifies your specific plan at consultation.
Step 1 — File a Level 1 internal appeal. Deadline: 180 days from receipt of the Explanation of Benefits or initial denial notice. 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. For medical-benefit Spravato denials: mail to Cigna Healthcare, P.O. Box 188062, Chattanooga, TN 37422. For behavioral-health-routed Spravato denials: mail to Evernorth Behavioral Health Central Appeals Unit, P.O. Box 188064, Chattanooga, TN 37422. Phone: the Member Services number printed on your Cigna ID card. If Cigna misses its response deadline: 1-800-882-4462.
Step 2 — Peer-to-peer (P2P) review. Your prescriber can request a peer-to-peer review by calling the Cigna utilization-review number listed in the denial letter, ideally before the appeal is filed. P2P is available pre-appeal and during the appeal review window.
Step 3 — Expedited (urgent) appeal. Federal urgent-care rules require Cigna to resolve expedited appeals within 72 hours. Call Member Services at the number on your ID card and explicitly request an expedited appeal; medical urgency must be documented by your prescriber.
Appeal levels. Most Cigna commercial plans provide a single internal appeal at the member level, followed by the right to external review through the Maryland Insurance Administration. Some plans layer a second internal level — verify on your plan summary.
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. Cigna routes behavioral-health appeals through Evernorth Behavioral Health. If your Spravato denial originated on the BH benefit (rather than the medical or specialty Rx benefit), the appeal goes to the Evernorth Central Appeals Unit address above. 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 Cigna 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 days from receipt of the Explanation of Benefits or initial denial notice. 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. For medical-benefit Spravato denials: mail to Cigna Healthcare, P.O. Box 188062, Chattanooga, TN 37422. For behavioral-health-routed Spravato denials: mail to Evernorth Behavioral Health Central Appeals Unit, P.O. Box 188064, Chattanooga, TN 37422. Phone: the Member Services number printed on your Cigna ID card. If Cigna misses its response deadline: 1-800-882-4462.
Step 2 — Peer-to-peer (P2P) review. Your prescriber can request a peer-to-peer review by calling the Cigna utilization-review number listed in the denial letter, ideally before the appeal is filed. P2P is available pre-appeal and during the appeal review window.
Step 3 — Expedited (urgent) appeal. Federal urgent-care rules require Cigna to resolve expedited appeals within 72 hours. Call Member Services at the number on your ID card and explicitly request an expedited appeal; medical urgency must be documented by your prescriber.
Appeal levels. Most Cigna commercial plans provide a single internal appeal at the member level, followed by the right to external review through the Maryland Insurance Administration. Some plans layer a second internal level — verify on your plan summary.
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. Cigna routes behavioral-health appeals through Evernorth Behavioral Health. If your Spravato denial originated on the BH benefit (rather than the medical or specialty Rx benefit), the appeal goes to the Evernorth Central Appeals Unit address above. 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 Cigna 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.
