Access and real-world use patterns of esketamine nasal spray among patients with treatment-resistant depression covered by private or public insurance

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 (January 2016–March 2021). Patients with evidence of TRD initiating esketamine (index date) after 05 March 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% females), 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% females). 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.

PLAIN LANGUAGE SUMMARY

Esketamine nasal spray is a novel therapy for treatment-resistant depression (TRD). In the United States, insurance plans often regulate access to esketamine. Additionally, for patients, it may be challenging to comply to the treatment schedule, because patients must receive esketamine in a certified treatment center, be monitored for 2 h for potential side effects, and they cannot drive until the next day. This real-world study used insurance claims data and found that patients with TRD had difficulties accessing esketamine. Among those with access, esketamine use patterns were suboptimal.

Keywords:

• Esketamine
• depression
• access to therapy
• adults
• treatment pattern

Transparency

Declaration of funding

This study was funded by Janssen Scientific Affairs, LLC.

Declaration of financial/other relationships

Amanda Teeple and Kruti Joshi are employees of Janssen Scientific Affairs, LLC and are stockholders of Johnson & Johnson. Maryia Zhdanava, Dominic Pilon, Gabrielle Caron-Lapointe, and Patrick Lefebvre are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, which funded the development and conduct of this study and manuscript. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Maryia Zhdanava, Dominic Pilon, Gabrielle Caron-Lapointe, and Patrick Lefebvre contributed to study conception and design, collection and assembly of data, and data analysis and interpretation. Amanda Teeple and Kruti Joshi contributed to study conception and design, data analysis and interpretation. All authors reviewed and approved the final content of this manuscript.

Acknowledgements

Medical writing assistance was provided by Flora Chik, PhD, an employee of Analysis Group, Inc. Abigail Nash and Ella Daly contributed to the study design and interpretation of results and were employees of Janssen Scientific Affairs, LLC at the time this study was conducted. Isabelle Ghelerter contributed to data collection and interpretation of results and was an employee of Analysis Group, Inc. at the time this study was conducted.

Previous presentations

Part of the material in this manuscript has been presented at the Virtual US Psych Congress, 29 October–1 November 2021; at the Psych Congress 2022, 17–20 September 2022, in New Orleans, Louisiana; and at the NEI/MAX 2022 Neuroscience Education Institute (NEI) Congress 2022, 3–6 November 2022, in Colorado Springs, as a poster presentation.