We have been talking about zuranolone for a long time, and it is now available.  Zuranolone will be marketed under the brand name ZURZUVAE by Sage Therapeutics in partnership with Biogen.  Zuranolone represents a new option for the treatment of PPD, a rapidly acting oral medication with a good safety profile and a novel mechanism of action.  

We received news about a month ago that the full 14-day course of zuranolone treatment would cost about $15,900.  At that point it was not clear how insurers would handle access to the new medication.  A few weeks into the game, we have a little bit of information to share.  

Will Insurance Cover the Cost of the New Medication for PPD?

The Policy Center for Maternal Mental Health has been closely following the rollout of ZURZUVAE, has been monitoring distribution and insurance coverage for ZURZUVAE. In a recent update published on their website, they have provided preliminary information on how insurance companies are handling access to the new medication. They found that few insurance companies have published guidelines regarding the use of ZURZUVAE:

  • Only 17 of over 1000 insurers (less than 1%) and one pharmacy benefit manager (PBM) have published coverage guidelines. 
  • Without published coverage guidelines from insurers, prescribers and patients are more likely to experience delays and restricted access to this new treatment. 
  • Of the 17 insurers with published coverage guidelines, five require patients to try another antidepressant first, three do not permit OB/GYNs to prescribe zuranolone, three require a comprehensive psychological evaluation, and one requires a diagnosis of severe postpartum depression.

The Policy Center for Maternal Mental Health will continue to provide relevant updates regarding any barriers to accessing the drug.

For those without insurance coverage, Sage has announced that it will provide copay assistance, so that the patient will have no out of pocket costs for the medication. In addition, some states, such as California, are starting to limit or cap the cost of drug copays/coinsurance. For example, California just passed a law capping prescription copays at $250

Patients and prescribers can also contact the Sage access line Sage Central for support with ZURZUVAE coverage at 844-472-4379 (Mon-Fri, 8am-6pm ET).  Dedicated case managers are available to assist with understanding insurance and coverage options and financial assistance programs for eligible patients.  In addition, they are able to provide educational resources and assistance with connecting patients to support within their communities.

Although ZURZUVAE has only been available for a couple of weeks, a few of our colleagues have reported that it has been relatively easy to obtain the new medication for their patients using the support provided by Sage Central.  This is great news, as many were so frustrated by the difficulty in accessing ZULRESSO, the intravenous version of zuranolone, after it was released.

We are very excited to have a new option for the treatment of postpartum depression, especially one that appears to be relatively well tolerated and rapidly effective.  However, it is important to remember that while ZURZUVAE and ZULRESSO are FDA-approved for the treatment of postpartum depression, they are not the only options for treatment, even for severe postpartum depression.

For milder PPD symptoms, psychotherapy, especially cognitive behavioral therapy, has been shown to be effective.  More severe depressive symptoms and anxiety repostond to traditional antidepressants, including selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs).  Although these antidepressants typically take longer than zuranolone to take effect, they do work, and we have data to support the safety of these antidepressants in breastfeeding women.

Ruta Nonacs, MD PhD

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