| Major Depressive Disorder
Spravato vs Vraylar
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Spravato vs Vraylar 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 signalsVraylar has a higher rate of injection site reactions vs Spravato based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Vraylar but not Spravato, including UnitedHealthcare
Sign up to reveal the full AI analysis
Category
Spravato
Vraylar
At A Glance
Intranasal
Twice weekly to every 2 weeks
NMDA receptor antagonist
Oral
Daily
Atypical antipsychotic
Indications
- Depressive Disorder, Treatment-Resistant
- Major Depressive Disorder
- Schizophrenia
- Manic Disorder
- Depression, Bipolar
- Major Depressive Disorder
Dosing
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.
Schizophrenia Adults: start 1.5 mg once daily; recommended 1.5-6 mg once daily (max 6 mg). Pediatric patients (13-17 years): start 0.5 mg once daily; recommended 1.5-4.5 mg once daily (max 4.5 mg).
Manic Disorder Adults: start 1.5 mg once daily, increase to 3 mg on Day 2; recommended 3-6 mg once daily (max 6 mg). Pediatric patients (10-17 years): start 0.5 mg once daily; recommended 3 mg or 4.5 mg once daily (max 4.5 mg).
Depression, Bipolar Adults: start 1.5 mg once daily; may increase to 3 mg on Day 15 (max 3 mg once daily).
Major Depressive Disorder Adults (adjunctive to antidepressants): start 1.5 mg once daily; may increase to 3 mg on Day 15 (max 3 mg once daily).
Contraindications
- 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
- History of hypersensitivity reaction to cariprazine, including rash, pruritus, urticaria, and reactions suggestive of angioedema (e.g., swollen tongue, lip swelling, face edema, pharyngeal edema, swelling face)
Adverse Reactions
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
Most common (>=5%) Extrapyramidal symptoms, akathisia, nausea, restlessness, insomnia, somnolence, dyspepsia, vomiting
Serious Neuroleptic malignant syndrome, tardive dyskinesia, increased mortality in elderly patients with dementia-related psychosis, suicidal thoughts and behaviors, cerebrovascular adverse reactions, metabolic changes, leukopenia/neutropenia/agranulocytosis, orthostatic hypotension, seizures
Postmarketing Stevens-Johnson syndrome
Pharmacology
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.
Cariprazine is an atypical antipsychotic that acts as a partial agonist at central dopamine D2/D3 and serotonin 5-HT1A receptors and as an antagonist at serotonin 5-HT2A receptors; its two major active metabolites, desmethylcariprazine (DCAR) and didesmethylcariprazine (DDCAR), have in vitro receptor binding profiles similar to the parent drug.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Spravato
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
Vraylar
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (5/12) · Qty limit (3/12)
UnitedHealthcare
Spravato
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (6/8) · Qty limit (3/8)
Vraylar
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (8/8)
Humana
Spravato
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (1/3) · Qty limit (1/3)
Vraylar
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (2/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
$10/fillfill
Spravato with Me Savings ProgramCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
$75/fillfill
Vraylar Savings Card - Non-covered benefitCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
Compare Other Drugs
Let us handle your prior authsJust enter your patient's info and we'll:
- Verify eligibility with the payer.
- Pull the right PA forms directly from the payer.
- Submit, track & send live updates to your dashboard.
Free to start · HIPAA compliant
Next Steps for Your Patient
SpravatoView full Spravato profile
VraylarView full Vraylar profile
Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.