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Radar On Market Access: New Postpartum Depression Drug Presents Payer Challenges

Posted by Judy Packer Tursman on Apr 2, 2019


The FDA's recent approval of the first medication specifically aimed at treating postpartum depression is drawing a favorable response from clinicians, while payers could face challenges.

PBM executives tell AIS Health that the postpartum depression drug, Zulresso (brexanolone) injection, is likely to be covered under the medical, not the pharmacy, side of the benefit.
Zulresso's initial U.S. list price "will be $7,450 per vial, resulting in a projected average course of therapy cost of $34,000 per patient before discounts," says Alexis Smith, a spokesperson for Zulresso's manufacturer, Sage Therapeutics, Inc.

As the medication must be administered as a 60-hour continuous intravenous infusion, it's a challenge for a new mother to be hospitalized in an approved facility for two-and-a-half days for an IV infusion, says Dea Belazi, Pharm.D., president and CEO of AscellaHealth. Moreover, he says, there is "the fact that there are possible extensive side effects and the data on its [Zulresso's] effectiveness [are] moderately better than placebo. The cost will also play a barrier," he adds.

Camille Hoffman, M.D., associate professor in the University of Colorado's Department of Ob/Gyn, describes the newly approved drug as "a breakthrough medication" that "rapidly improves postpartum depression out to, at least, 30 days following the one-time treatment."

She acknowledges that the need to administer Zulresso via a 60-hour IV drip and its restricted distribution might present challenges. However, she says, "I hope that payers will consider these potential barriers in light of how quickly it acts to help women with severe postpartum depression." 

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Topics: Specialty, Market Access, Product Release, Provider, Payer