February 15, 2024

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Editor's note: Axios published "Rising gender dysphoria diagnoses" in the Jan. 11 newsletter. After publication, the source behind the story, Definitive Healthcare, retracted its report and removed the link to the findings. As a result, Axios no longer has confidence in the report. Read more.

1 big thing: Postpartum coverage resisters

Illustration: Natalie Peeples/Axios

While nearly every state now provides Medicaid coverage for a full year after giving birth, cost concerns and political opposition in some states have prevented the policy from being fully adopted nationwide, Maya writes.

The big picture: The country's maternal health crisis and loss of abortion rights in many states have spurred rapid uptake of a new extended coverage option, even in conservative statehouses that have long resisted the much broader Medicaid expansion under the Affordable Care Act.

  • Arkansas, Idaho, Iowa and Wisconsin are the remaining holdouts.

Context: Medicaid is the largest U.S. funder of pregnancy care, covering about 4 in 10 births.

  • Congress in 2021 passed a law making it easier for states to extend postpartum eligibility from the required 60 days to 12 months.
  • With 1 in 3 pregnancy-related deaths occurring between six weeks and one year after giving birth, the policy is seen as a key strategy for reducing maternal mortality.

Catch up: Most states quickly jumped at the chance to extend postpartum Medicaid coverage.

  • "This is the most popular plan option I've seen, at least in the last 20 years of Medicaid," said Joan Alker, executive director of the Georgetown Center for Children and Families.

Where it stands: In Iowa and Wisconsin, governors have called on lawmakers to approve extended postpartum coverage this year.

  • "Building a robust culture of life means supporting mothers and growing families who are struggling to make ends meet," Iowa Gov. Kim Reynolds said in a statement to Axios.
  • Iowa likely has the clearest path forward — a Republican governor is backing a bill from the GOP-led legislature.
  • Idaho's health department is also calling on the Republican-controlled legislature to approve the expansion.
  • In Wisconsin, the Democratic governor has run into some opposition from Republican lawmakers. And in Arkansas, Gov. Sarah Huckabee Sanders hasn't said if she would support the policy.

Go deeper

2. Middlemen's role in drug shortages probed

Illustration: Sarah Grillo/Axios

The Federal Trade Commission is exploring how drug distributors and group-purchasing organizations may be contributing to ongoing shortages of generic drugs at health care facilities.

Why it matters: It's the latest effort to untangle a complex web of factors driving high levels of shortages, which have affected cancer drugs and antibiotics, among others.

What's happening: The FTC and HHS on Wednesday issued a request for information about the companies' market concentration and contracting practices.

  • Officials are also asking how they affect the generic pharmaceutical market more broadly, including the pricing and availability of drugs.
  • Critics say the high concentration of the middlemen in the drug supply chain has pushed down the prices of generics so low that they've made it hard for manufacturers to maintain production.
  • That's made the U.S. more reliant on countries like China and India for imported products.

The other side: Healthcare Supply Chain Association president and CEO Todd Ebert in a statement said group purchasing organizations are "critical partners" to hospitals and health care providers that help them prevent and mitigate drug shortages.

  • "GPOs take a comprehensive approach to sourcing and contracting that not only accounts for the competitive price offered, but also the reliability and stability of supply," Ebert said.

What we're watching: The FTC hopes "in the coming months" to share results from its inquiry into pharmacy benefit managers, which was launched in June 2022, agency chair Lina Khan told the American Medical Association conference yesterday.

3. "Promising" start for postpartum pill

Photo Illustration: Pavlo Gonchar/SOPA Images/LightRocket via Getty Images

At least 120 prescriptions were written for the first pill treating postpartum depression in the days following its launch, drugmaker Sage Therapeutics disclosed in its year-end earnings report on Wednesday.

Why it matters: Postpartum depression affects an estimated 500,000 people each year. But with a launch price of $15,900 for the drug Zurzuvae, analysts had expressed uncertainty about its potential market and how insurers may cover the treatment, Tina writes.

By the numbers: Zurzuvae, which Sage markets with Biogen, was approved by the FDA in August but didn't become available until around mid-December.

  • Sage CEO Barry Greene told analysts the company is optimistic as payers have picked up the tab for a majority of prescriptions.

What they're saying: These are "solid early patient numbers" wrote RBC Capital analyst Brian Abrahams and senior associate Joe Kim in a note. Early metrics around who's prescribing the drug, insurer coverage, and anecdotal experiences are "promising," they said.

Read more

4. Solo living's link to depression

Share of people who experienced feelings of depression, by living arrangement
Data: National Health Interview Survey. Chart: Will Chase/Axios

Living alone is linked to higher rates of self-reported depression than living with others, Axios' Carly Mallenbaum writes on new CDC data.

Why it matters: The loneliness epidemic has become a major threat to Americans' well-being and a priority for policymakers.

By the numbers: Of the 16% of U.S. adults who lived alone in 2021, 6.4% reported depression, compared to 4.1% of those who lived with others, according to data from the 2021 National Health Interview Survey.

  • The largest disparity by age group was among those 45-64: 9% of people who lived alone reported depressive feelings, compared to 3.9% of those who lived with others.

What they're saying: "It's not that living alone is bad for you, [but] there's something about living with another person that can create a little bit of a push to do habits that can improve your mood," said psychologist Jenny Taitz.

More here

5. Catch up quick

🧠 A proposal to broaden the definition of Alzheimer's to include symptom-less people with elevated levels of certain proteins is drawing objections. (Los Angeles Times)

🥶 The FDA approved the first-ever treatment for severe frostbite, which can reduce the risk of amputation of fingers and toes. (UPI)

📱 New York City is suing social media companies, accusing them of fueling the youth mental health crisis. (Axios)

🏥 Cyberattacks on hospitals are likely to increase, putting lives at risk. (Associated Press)

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