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Acquiring SPRAVATO®

Determine if SPRAVATO® will be acquired through a specialty pharmacy, buy and bill, or both.

Benefit Design Will Determine the Way You Acquire SPRAVATO® for Your Patients

Desktop version of how benefit design could determine the acquisition method for your patients

Mobile version of how benefit design could determine the acquisition method for your patients

If SPRAVATO® is covered under both benefits, check with your patient's insurance plan to choose the pathway that best meets the patient’s needs and is compatible with their benefit design.

Buy and Bill: Buy and bill is the process of acquiring SPRAVATO® through an authorized specialty distributor and is typically covered under the medical benefit. Buy and bill allows for flexibility with patient treatment and provides a measure of control with on-demand inventory. The buy-and-bill pathway requires the treatment center to complete a benefits investigation and obtain prior authorization before purchasing and storing the product.

Specialty Pharmacy: The specialty pharmacy pathway is the process of acquiring SPRAVATO® through a REMS-certified specialty pharmacy. This pathway allows treatment centers to treat patients who are covered under the pharmacy benefit. The pharmacy pathway does not require your treatment center to purchase SPRAVATO® but does require shipment coordination before each treatment session. Using the specialty pharmacy pathway, your treatment center receives patient-assigned product from a REMS-certified pharmacy and bills for associated healthcare services only.

Setting Up Your Treatment Center for Acquiring Product Through Buy and Bill

When completing the SPRAVATO® REMS certification, select the option that you will acquire product from an authorized SPRAVATO® REMS-qualified specialty distributor (also known as buy and bill), and complete the Janssen Know Your Customer Questionnaire*

Consider connecting with your payers to understand coverage policies and ensure the appropriate codes for SPRAVATO® buy-and-bill acquisition are added to your payer contracts

Select and establish a contract with an Authorized Specialty Distributor(s)

Explore the Janssen Physician Contracting Pricing Program to determine if your treatment center is eligible

Order SPRAVATO® from an Authorized Specialty Distributor(s) and store inventory for patient treatment

Acquiring product through the buy-and-bill pathway allows treatment centers to manage the inventory of product, providing flexibility to treat patients in real time.

Setting Up Your Treatment Center for Acquiring Product Through a Specialty Pharmacy (SP)

When completing the SPRAVATO® REMS certification, select the REMS-certified specialty pharmacy option

Consider connecting with your payers to understand coverage policies and ensure the appropriate codes for SPRAVATO® SP acquisition are added to your payer contracts

Determine which pharmacy you're using—national or local—and what benefit design they can accept. Most national SPs cover both medical (via AOB) and pharmacy benefits

Store and manage inventory of SPRAVATO®, as SPs ship patient-assigned product prior to each treatment session

Acquiring through a national specialty pharmacy may help you provide more patients with access to SPRAVATO®.

*If you are already a REMS-certified treatment center, please contact the REMS Coordinating Center to add this acquisition method to your account.

REMS=Risk Evaluation and Mitigation Strategy.