The Cost of ZURZUVAE™ – After Insurance Coverage
By Joy Burkhard, MBA
On November 7, 2023, Sage Therapeutics announced the wholesale cost of ZURZUVAE™, the postpartum depression pill, at $15,900 for a 14-day treatment cycle. The price has been startling to most (just like the wholesale price of Zulresso was when it was introduced to the market). However, it’s important to understand the wholesale price is not the price individual consumers will pay.
How Will Insurers Cover ZURZUVAE?
We have reason to believe insurance companies and state Medicaid agencies will cover ZURZUVAE (by listing it on their drug lists - called formularies) because it’s the only drug of its kind. Insurers use pharmacy benefit management (PBM) companies to negotiate discounted drug rates (or rebates). The cost to the patient will be her health insurance benefit plan’s copay/coinsurance based on the PBM’s negotiated rate.
What we are concerned about is not necessarily the cost the patient will pay but rather whether the insurer/state Medicaid agency will require a patient to try another drug (an antidepressant/SSRI) first. As I noted in our FDA approval announcement, this is a game-changer, as the patient’s obstetric provider (OB/GYN, Midwife, or Family Practice Provider) can now prescribe this new treatment without consulting or referring to a psychiatrist, and a mother is likely to experience significant improvements in depressive symptoms in as little as three days.
We argue this should not be the case for any mother with moderate to severe postpartum depression whose provider has prescribed the treatment. Research and discussions with mothers have illustrated they don’t decide to take medication during the perinatal period lightly. This will be the case with ZURZUVAE, too. If a patient and provider together decide she is ready to take ZURZUVAE, insurers should not stand in the way of immediate access by requiring the use of other medications first.
What About the Uninsured or Underinsured (Those With High Rx Coinsurance)
Sage has announced it will provide copay assistance - for uninsured or functionally uninsured - so the patient will pay zero out of pocket. Further, some states are starting to cap drug copays/coinsurance. For example, California just passed a law capping Rx copays at $250.
What if Patients or Providers Have Coverage Concerns?
Patients and prescribing providers can reach the Sage access line “Sage Central” for support with ZURZUVAE coverage. Patients and providers can also contact the Policy Center if they are concerned about undue delays or requirements by insurers. We are prepared to support appeals when patients with moderate to severe PPD are denied coverage of ZURZUVAE.