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Research & Reports

Searching in Biopharma (1575)

The Complex Parkinson’s Disease Treatment Algorithm: U.S. Physician and Payer Perspectives on the Current and Future Landscape

Parkinson’s disease (PD) is one of the most common chronic neurodegenerative diseases in the elderly, and its prevalence is expected to grow 20% over the next decade as the general population ages. Despite the large and growing presence of generics in this market, several high-cost brands remain important to PD treatment, such as the MAO-B inhibitor Azilect (Teva’s rasagiline) and the dopamine agonist Neupro (UCB’s rotigotine), recently relaunched in the United States. Moreover, new premium-priced entrants from current drug classes (such as Newron Pharmaceuticals/Zambon Pharma/Meiji Seika Pharma’s safinamide), first-in-class agents (Acadia Pharmaceuticals’ pimavanserin), and novel reformulations (IPX-066 [Impax Laboratories’ Rytary]) are expected to launch over the next several years, targeting niche populations (e.g., patients experiencing motor response complications, PD-related psychosis). The evolving PD marketplace will make physicians’ treatment decisions more complex, while payers’ coverage decisions will likely be increasingly strained by the need to contain growing PD-related healthcare expenditures.

This primary-research based report presents and analyzes the results of a survey of 101 U.S. neurologists treating PD patients and 30 managed care organization (MCO) directors. The report explores key market access features and clinical factors impacting PD treatment today and in the future. In particular, we assess physicians’ and payers’ attitudes, expectations, receptivity, and reservations regarding current and emerging PD therapies.

Questions Answered in This Report:

  • Understand how surveyed neurologists treat PD patients across a spectrum of symptoms and comorbidities. How does treatment initiation differ between patients younger or older than age 70? How common are levodopa-sparing approaches? Have physicians incorporated the recently relaunched dopamine agonist Neupro into their treatment algorithms? How do current therapies compare on a collection of clinical and market access attributes? What are the most common first-, second-, and third-line approaches to treating patients presenting with motor response complications, psychotic symptoms, or dementia?

  • Explore the standing of current PD therapies in commercial plans and Medicare PDPs and how surveyed neurologists perceive access hurdles. What percentage of commercial plans and Medicare PDPs reimburse key PD drugs and therapies for treating nonmotor aspects of the disease? What is the formulary status of key brands? Is coverage for PD drugs expected to change in the near future? What reimbursement hurdles are typically imposed on key brands? What reimbursement hurdles do surveyed neurologists find most burdensome to prescribing?

  • Examine how surveyed neurologists and MCO directors expect to receive emerging PD therapies. What near-term drug development opportunities, if realized, are surveyed neurologists most likely to prescribe?  To which emerging agents are surveyed payers most likely to grant favorable tier status? What patient shares do surveyed neurologists estimate for the four emerging agents profiled within the first year of launch, depending on the drugs’ tier status? What percentage of surveyed prescribers expect to use pimavanserin first for PD-related psychosis? On what attributes do surveyed neurologists expect safinamide to differentiate itself from Azilect? How do MCO directors expect to reimburse emerging PD therapies, if at all, on commercial and Medicare plans? How will price impact formulary coverage and tier placement? What does neurologist and payer receptivity to these emerging therapies imply for drug developers hoping to enter the PD space?


This U.S. Physician &, Payer Forum report contains insights from a survey of 101 neurologists and 30 MCO pharmacy/medical directors regarding physician and payer dynamics that affect prescribing practices for the treatment of PD in the United States. In this report, we explore the use, reception, and formulary status of key current PD therapies by neurologists and MCO directors and gauge surveyed physician and payer outlook on four late-stage emerging therapies. By understanding the attitudes and expectations of prescribers and payers toward current and emerging PD therapies, stakeholders can gain an understanding of the complex PD treatment algorithm and the reimbursement climate for PD.

Markets covered: United States.

Primary research: Online survey of 101 neurologists and 30 MCO pharmacy or medical directors.

Epidemiology: 2012-2022 prevalent cases of PD in the United States.

Market analysis: 2012 U.S. market and patient share by drug class.