Insurers Push Postpartum Depression Drug Out of Reach

July 29, 2021

One in seven. That’s how many women experience postpartum depression.

It’s a serious mental health condition that drastically impacts the wellbeing of moms and the way they interact with their new baby. It causes feelings of anguish and apathy, even suicidal thoughts.

It puts two lives in jeopardy, yet access to meaningful treatment often takes time.

Treating Postpartum Depression

Postpartum depression has historically been addressed with talk therapy or antidepressants. But those approaches can take several months to work – and they may not be effective in some cases.

An alternative, an intravenous drug called brexanolone is faster-acting and can be more effective. The U.S. Food and Drug Administration approved it for postpartum depression. It can alleviate the condition over the course of a three-day hospital stay.

Despite its ability to quickly restore a new mom’s mental health, however, some insurers make brexanolone nearly impossible to get.

Requiring New Moms to “Fail First”

California offers a striking example. The state’s largest insurer, Kaiser Permanente, asks that moms try and fail four other drugs before they can access brexanolone. Called step therapy, the approach is a common strategy insurers use to cut costs. Even Medi-Cal, the state-sponsored plan for low-income women, requires moms to fail on two drugs.

The time it takes a new mom to work her way through one – or four – other medications is precious. And it comes when her new baby needs her the most. Perhaps that’s why delaying access to brexanolone has been called “harsh” and even “insane.”

And according to a new California law, the tactic may also be illegal.

Making Treatment Accessible

Effective January 1, 2021, California will require health plans to follow “generally accepted standards of care” when making decisions about mental health treatment. Scientific literature, expert consensus and non-profit guidelines can inform those standards.

New efforts are underway to review whether or not Kaiser and other health plans violate the state’s law through their use of overly restrictive utilization management techniques like step therapy or prior authorization.

In the meantime, it’s critical for policymakers in other states to revisit insurers’ authority to delay access to brexanolone using step therapy. Timely access to effective treatment can protect new moms’ mental health, optimize the time they have with their newborns and set babies up for optimal early childhood development.

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