What We're Reading: Postpartum Depression Coverage Criteria; Lawmakers Block Health Care Mergers; Medicaid Extensions Boost Postnatal Coverage

Insurers Yet to Decide How to Handle New Postpartum Depression Drug

Although the postpartum depression drug zuranolone hit the market in December 2023, a recent analysis of insurance policies reported that most private health insurers have yet to publish coverage criteria for it, according to KFF Health News. This lack of guidance could limit the use of the drug, which targets hormone function to relieve symptoms instead of the brain’s serotonin system. Lawyers, regulators, and advocates are closely watching how insurance companies will shape policies for zuranolone due to how some handled brexanolone, its predecessor that came on the market in 2019. Previously, many insurers used the fail-first approach, requiring patients to try other, cheaper medications first before they could be approved for brexanolone. As most health plans have yet to issue guidelines for zuranolone, maternal health advocates worry that they will adopt similar restrictive approaches. So far, out of the country’s 6 largest private insurers, only Centene has set a policy for zuranolone, making advocates worried about the lack of coverage.

Health Care Companies are Abandoning Hospital Deals After Facing Public Backlash

State lawmakers, who are concerned about hospitals closing and higher costs for patients, are increasingly opposing health care mergers that they believe do not serve the public interest, according to Stateline. Despite the steady rise of health care mergers and acquisitions over the past 2 years, some proposed deals in states like Connecticut, and Minnesota have faced strong opposition from both lawmakers and organized labor and grassroots organizations; at least 10 health care “megadeals” were called off just last year due to increased oversight. For example, lawmakers in Minnesota passed a bill in May 2023 to ban anti-competitive health care mergers and enhance state oversight, leading to the cancellation of a proposed merger between Fairview Health Services and Sanford Health. Similar concerns and opposition from community groups also led to the cancellation of a proposed acquisition by Covenant Health in Connecticut. This trend reflects a growing pushback against health care mergers, resulting in some states strengthening regulations to ensure better scrutiny and protection for consumers.

Pandemic-Era Medicaid Extensions Increased Postpartum Insurance Coverage

A recent study published in JAMA Health Forum reported that Medicaid extensions made in 2021 led to a 40% decline in postpartum lack of insurance, according to CIDRAP. This included the Families First Coronavirus Response Act (FFCRA) that went into effect during the first month of the pandemic, which prevented Medicaid programs from disenrolling people, meaning Medicaid-enrolled postpartum mothers were allowed insurance for more than 60 days past birth for the first time in history. The researchers found that the FFCRA was associated with an 8% increase in postpartum Medicaid coverage and a 40% reduction in those with a Medicaid-paid birth being uninsured. Also, from baseline, a lack of insurance decreased among Black and White people with Medicaid-paid births by 96.9% and 69.3%, respectively. The researchers noted that increasing maternal insurance coverage in the postpartum year through policy changes like the FFCRA is the first step to fighting increasing US maternal death rates, which are higher than those of other Western countries.