When Zuranolone was approved by the FDA back in August, it made headlines (here included) as the first approved oral medication to treat postpartum depression. Considering that PPD is something that one in seven women will develop, disproportionately women of color, the flurry of interest made sense. This week, the drug made news again when Biogen Sage Therapeutics announced the price for the required 14-day course of treatment of the drug: $15,900. A staggering sum that puts the drug far out of reach for the majority of women who could potentially benefit from it.
Biogen Sage’s validation for the sky-high price is that its IV infusion–version of the drug, introduced in 2019, will set you back $30,000, so, comparatively, the oral medication is a bargain. Though the company claims to be actively communicating with insurers to ensure that the treatment will be available with minimal restrictions, physicians like Sarah Oreck, MD, a reproductive psychiatrist and cofounder of Mavida Health, have their doubts. “Who can use this and in what context will they be able to use it and will insurance companies just dole it out?” asks Oreck. “My prediction is that it’s going to be an uphill battle for physicians.” She imagines hurdles with prior authorizations from insurance companies asking patients to do three to five trials of other antidepressant medications before being approved for Zuranolone.
Of course, exorbitant drug prices, particularly for medications that are singular in class for what they treat, is not a new issue. Popular semaglutides like Wegovy or Ozempic can run up to $1,000 a week, though companies will often help patients bridge the payment gap with coupons. Ten years ago, Sovaldi, a drug designed to treat hepatitis C, raised many questions of accessibility— remarkably effective in curing hepatitis C infections (in 90% of patients), it was priced at $1,000 per pill when it was released in 2013, with total cost of the recommended 12-week course of treatment running close to $84,000. “It was a revolutionary blockbuster treatment which eradicates hepatitis C like nothing else had in the past, and it was, back then, completely inaccessible,” says Oreck.
It should be noted that Zuranolone isn’t guaranteed to eradicate PPD. Though the company is positioning it as a stand-alone two-week treatment, Oreck is wary of anyone thinking there’s a one-and-done solution for what is often a multi-factorial issue: Though chemical factors may well be at work, postpartum social, financial, and interpersonal stressors are also implicated in PPD. “While it’s exciting to have something targeted for a women’s health issue, we also have to be careful because it’s not a cure,” adds Oreck. “It’s very American to think that a pill is going to solve all of our problems in two weeks, but we know that’s not the case.”
Even if patients are able to afford a course of treatment with Zuranolone, Oreck strongly believes that supportive types of treatments like psychotherapy or CBT (cognitive behavioral therapy) will be crucial for bolstering and maintaining its effect. It’s also important to mention that Zuranolone is approved as a treatment just for PPD, but often it’s something that doesn’t occur in a vacuum. “Most people don’t have just postpartum depression; actually, postpartum anxiety is even more common,” explains Oreck. Also common are perinatal mood and anxiety disorders that start during pregnancy—one third of postpartum anxiety and depression cases start during pregnancy. Britney Spears recently spoke to her own experience with them in her memoir—and Zuranolone is contraindicated during pregnancy.
The impact of not addressing symptoms of PPD when it first arises can be serious and enduring. “Without treatment, there may be some resolution, but that can take months to years,” says Oreck. Meanwhile, postpartum depression has serious knock-on effects, impacting relationships, partners (if there is one), and sufferers’ ability to return to work, which is often inextricably linked to their identity and self-esteem. “I’ve had patients come to me in year three or five postpartum to finally seek treatment,” says Oreck, adding that it’s imperative that if you’re feeling any symptoms of PPD to seek help right away.
As far as help goes, Zuranolone is an incredible advance—studies of the drug showed discernible improvements in patients in as little as three days, radically better than the progress seen when using the SSRIs that are currently the standard of care. This makes the treatment’s exorbitant pricing all the more disappointing. “To see a potentially great solution waved in front of us that could help all of these people that are suffering, and then to just be told that it’s completely inaccessible is heart-wrenching,” says Oreck. While not a one-and-done solution and not suitable for everyone dealing with PPD, Zuranolone does have the potential to offer dramatic relief for some. With the cost of entry so high though, it will remain unattainable for many of those it could have helped.
