Anthem BCBSMedium ImpactPrior Auth
[New York] Spravato prior authorization requirement
Published May 18, 2026
AI Summary
Anthem in New York now requires prior authorization for Spravato (esketamine nasal spray) used to treat treatment-resistant depression. This is a fresh policy change that will impact psychiatric and mental health billing workflows.
Action Required
Immediately: Billing team must update system to require prior authorization for all Spravato (esketamine) claims for Anthem New York members. Contact providers to obtain prior auth before administering treatment. Update encounter forms and EMR templates to remind staff of this requirement. Claims submitted without prior authorization will be denied.
Plan Types
Commercial
States
NY
Specialties
psychiatry