Zurzuvae, the first and only oral treatment for postpartum depression, saw slow but steady adoption amid cost and access challenges.
In August 2023, the FDA approved Zurzuvae (zuranolone), the first oral medication specifically designed to treat postpartum depression (PPD). Prior to this approval, the only available treatment was Zulresso (brexanolone), an intravenously administered drug requiring a 60-hour hospital stay. Zurzuvae, a once-daily pill taken over 14 days, offers faster symptom relief, with improvements seen as soon as three days in clinical trials. This is a significant improvement over selective serotonin reuptake inhibitor (SSRI) antidepressants, which often take weeks to show effectiveness. Zurzuvae targets PPD specifically by modulating the GABA-A receptors, which are believed to play a role in mood regulation during the postpartum period.
Zurzuvae became available on the U.S. market in mid-December 2023. However, initial access was limited. Only 17 of more than 1,000 private insurers issued early coverage guidelines. The cost of the drug (nearly $16,000 for the 14-day course) may pose a significant barrier to early adoption. Sage Therapeutics, Zurzuvae’s producer, has thus advocated for broader access and sought to improve reimbursement pathways.
We wanted to see what the uptake of this novel drug looked like in its first six months of availability, as well as which healthcare providers (HCPs) were prescribing it and which patients were receiving it. We used Komodo’s MapLab™ solution, drawing from templates like the Cohort Report, Cohort Events and Patient Counts Over Time, and Payer Analytics, including data on patient counts, demographics, HCP specialties, and payer characteristics.
Here’s what we found:
PPD remains significantly underdiagnosed and undertreated.
PPD is generally defined as a depressive mood disorder that occurs within one year after childbirth and continues for more than a few weeks. Among the ~74,000 postpartum women in our Healthcare Map in the first half of 2024, only 3% had received a PPD diagnosis. This reflects a significant underdiagnosis. There is no clear consensus on the true incidence of PPD in the U.S.: UpToDate cites a rate of 9% from a 2008 study, and the Centers for Disease Control and Prevention cites a rate of 12% to 16% from more recent self-reported data. The low rate seen in our analysis indicates that the vast majority of women with PPD are not being diagnosed or treated.
Our analysis also found that the diagnosis rate of PPD was twice as high among women age 46+ (at 5%) compared to younger age groups (2.5%), which may be in part because these women are more likely to be closely followed in pregnancy and more likely to be diagnosed. Rates were also 48% higher among White women compared to Black women. This highlights significant disparities in diagnosis and is in contrast to research that estimates PPD is more common in certain populations, including Black and Hispanic/Latinx.
We also saw higher rates of PPD among women on Medicare, which could be due to disabled women being at a higher risk of PPD.
In the first six months of its availability, Zurzuvae was prescribed to only 2% of patients with PPD, but its use is broadening quickly.
While initial uptake was limited, the number of patients receiving prescriptions increased month over month by an average of 31% during the first half of 2024. Barriers such as cost, insurance requirements, and provider unfamiliarity likely contributed to this slow start, despite the drug's rapid efficacy and potential to improve postpartum outcomes.
Younger patients with PPD — ages 18 to 25 — were most likely to receive a Zurzuvae prescription (2.2%), followed by those age 26 to 35 (2%) and 36 to 45 (1.9%).
Higher Zurzuvae prescription rates among younger patients may reflect fewer insurance restrictions or greater provider willingness to prescribe Zurzuvae to this cohort. In contrast, older women (46+) had the highest PPD rates but were less likely to receive the drug, suggesting potential hesitancy related to age, clinical risk assessment, or formulary limitations.
The majority (63%) of patients prescribed Zurzuvae received it as a first-line treatment.
This suggests that providers are increasingly considering Zurzuvae as an initial treatment for PPD. However, 37% of patients had previously tried other treatments (e.g., SSRIs, Zulresso) within 90 days of starting Zurzuvae, suggesting it is also being used as a secondary option for those not responding to standard antidepressants.
Non-physician providers played a significant role in prescribing Zurzuvae, writing over one in three prescriptions (35%).
Nurse practitioners, midwives, and physician assistants were responsible for 35% of Zurzuvae prescriptions, reflecting the expanding role of non-physician providers in maternal mental healthcare. Physicians, mainly obstetricians and psychiatrists, accounted for 63% of prescriptions, underscoring the interdisciplinary approach required for effective PPD treatment.
Zurzuvae’s initial uptake illustrates both its potential impact and the complexities of addressing PPD through novel pharmacological interventions. Early data shows promise, but significant disparities persist across racial, socioeconomic, and age groups, indicating the need for targeted outreach and support. Expanding coverage and awareness will be crucial to maximizing the drug’s impact on postpartum mental health.
Komodo’s MapLab solution has been instrumental in uncovering these insights, offering near-real-time data to inform stakeholders and guide strategies for improving maternal mental health outcomes. By providing data-driven solutions, Komodo helps healthcare organizations understand patient needs and enhance treatment access, contributing to a more equitable healthcare landscape.
The launch of Zurzuvae is a significant step forward in PPD treatment, but its early utilization patterns highlight ongoing challenges in equitable access. Continued collaboration among healthcare providers, insurers, and policymakers will be critical in closing these gaps and ensuring that all women with PPD can benefit from this breakthrough therapy.
Read our recent analysis on mammograms among younger women in the lead-up to changes in clinical screening guidelines.
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