This CPB is revised to state that esketamine nasal spray (Spravato) is considered medically necessary for (i) members who have had an inadequate response during the current depressive episode with two antidepressants (from at least 2 different classes with different mechanisms of action) at the maximally tolerated labeled dose, each used for at least 8 weeks; and have also had an inadequate response with an adequate trial of augmentation therapy or cognitive behavioral therapy during the current depressive episode; or (ii) members who have profound depression and persistent suicidal ideation. (The previous version of the CPB required a trial of four medications during the current depressive episode (e.g., four antidepressants or two antidepressants with two augmentation agents) and did not include profound depression and persistent suicidal ideation as a criteria option.)