Both are covered for treatment-resistant depression — but only after you've documented failed antidepressant trials plus an add-on step that differs by insurer. Check your situation against your plan's real criteria below.
TMS and esketamine sit at the top of the depression-treatment ladder, so insurers require you to have climbed it first:
For esketamine, two more hard requirements: it must be given at a REMS-certified site with 2 hours of monitoring after each dose, and taken alongside an oral antidepressant.
Usually a step that was done but not documented — an antidepressant tried at too low a dose or too briefly to count, or a missing psychotherapy/augmentation trial. The tool above shows exactly which rung of the ladder your insurer still needs in writing.
Answer a few plain questions about your treatment history and see exactly what to document before the request is filed — about two minutes, free.
Check my coverageGenerally at least two, from different drug classes, each taken at an adequate dose for several weeks — or stopped due to a documented intolerance. Trials that were too short or at too low a dose usually don't count toward the requirement.
It depends on the insurer. Cigna's TMS policy specifically requires an adequate trial of evidence-based psychotherapy (such as CBT) in addition to failed medications, while Aetna instead requires an augmentation (add-on medication) trial. Esketamine accepts either an augmentation trial or psychotherapy.
No. Esketamine can only be given at a REMS-certified healthcare setting, where you're monitored for at least two hours after each dose, and it's taken together with an oral antidepressant. That supervised-administration requirement is part of every payer's coverage criteria.
TMS is generally covered from age 15 and up by Aetna and Cigna (Cigna requires two failed antidepressants from two classes for adults 18+, and two trials for adolescents 15–17). Many other plans set the minimum at 18.
Related: Why prior authorizations get denied · Drug Lookup · all coverage tools