| Major Depressive Disorder
Rexulti vs Spravato
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Rexulti vs Spravato with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsSpravato has a higher rate of injection site reactions vs Rexulti based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Spravato but not Rexulti, including UnitedHealthcare
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Category
Rexulti
Spravato
At A Glance
Oral
Once daily
Atypical antipsychotic
Intranasal
Twice weekly to every 2 weeks
NMDA receptor antagonist
Indications
- Major Depressive Disorder
- Schizophrenia
- Agitation in Dementia
- Depressive Disorder, Treatment-Resistant
- Major Depressive Disorder
Dosing
Major Depressive Disorder Start 0.5 mg or 1 mg orally once daily; titrate to target 2 mg once daily; maximum 3 mg once daily.
Schizophrenia Adults: start 1 mg once daily, titrate to target 2-4 mg once daily (max 4 mg); pediatric patients 13-17 years: start 0.5 mg once daily, titrate to target 2-4 mg once daily (max 4 mg).
Agitation in Dementia Start 0.5 mg orally once daily; titrate to target 2 mg once daily; maximum 3 mg once daily.
Depressive Disorder, Treatment-Resistant Induction (Weeks 1-4): 56 mg or 84 mg intranasally twice weekly; Maintenance (Weeks 5-8): 56 mg or 84 mg once weekly; Week 9 and after: 56 mg or 84 mg every 2 weeks or once weekly, individualized to the least frequent dosing to maintain remission/response.
Major Depressive Disorder 84 mg intranasally twice weekly for 4 weeks in conjunction with an oral antidepressant; dose may be reduced to 56 mg twice weekly based on tolerability.
Contraindications
- Known hypersensitivity to brexpiprazole or any excipient (reactions include rash, facial swelling, urticaria, and anaphylaxis)
- Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial, and peripheral arterial vessels) or arteriovenous malformation
- History of intracerebral hemorrhage
- Hypersensitivity to esketamine, ketamine, or any excipient
Adverse Reactions
Most common (>=5%) weight increased, akathisia, headache, somnolence, insomnia
Serious neuroleptic malignant syndrome, tardive dyskinesia, metabolic changes, leukopenia, neutropenia, agranulocytosis, orthostatic hypotension, falls, seizures, body temperature dysregulation
Postmarketing neuroleptic malignant syndrome
Most common (>=5%) dissociation, dizziness, nausea, sedation, vertigo, hypoesthesia, anxiety, lethargy, blood pressure increased, vomiting, feeling drunk
Serious sedation, dissociation, respiratory depression, blood pressure increase, cognitive impairment, impaired ability to drive and operate machinery, ulcerative or interstitial cystitis, embryo-fetal toxicity
Postmarketing bradycardia, respiratory depression (including respiratory arrest), hypotension
Pharmacology
Brexpiprazole is an atypical antipsychotic whose efficacy may be mediated through partial agonist activity at serotonin 5-HT1A and dopamine D2 receptors combined with antagonist activity at serotonin 5-HT2A receptors; the exact mechanism of action in the approved indications is unknown.
Esketamine is the S-enantiomer of racemic ketamine and a non-selective, non-competitive NMDA receptor antagonist; the mechanism by which it exerts its antidepressant effect is unknown.
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Most Common Insurance
Anthem BCBS
Rexulti
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (5/12) · Qty limit (11/12)
Spravato
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
UnitedHealthcare
Rexulti
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (6/8)
Spravato
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (6/8) · Qty limit (3/8)
Humana
Rexulti
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (3/3)
Spravato
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (1/3) · Qty limit (1/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableHealthWell: Cancer-Related Behavioral Health
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
$10/fillfill
Spravato with Me Savings ProgramCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.