The prevalence of the often disabling psychiatric diseases schizophrenia and major depressive disorder (MDD) is growing in Brazil and Mexico. Antipsychotics (older typical or newer atypical antipsychotics) are the standard of care for schizophrenia and an increasingly popular option for  patients with treatment-resistant depression (TRD). In an over-genericized market of well-established key agents, the uptake of new antipsychotics is hampered by stringent budgets and market access obstacles. However, high unmet need remains for therapies with demonstrated efficacy for both conditions. In this Access & Reimbursement analysis, we discuss the current access landscape for antipsychotics in Brazil and Mexico, with a focus on atypical antipsychotics’ use in schizophrenia and TRD. Based on primary research with psychiatrists and payers in these two countries, we also analyze the future uptake of emerging therapies (e.g., Lundbeck/Otsuka’s brexpiprazole) and pinpoint the levers of and roadblocks to their success.


Decision Resources Group’s Access & Reimbursement module for schizophrenia and MDD in Brazil and Mexico explores the prescribing patterns for current antipsychotics for these indications; the potential impact of the anticipated arrival of novel therapies; and key national, regional, and institutional market access factors that will shape the use of antipsychotics over the next two to three years. This module draws on insights from 101 surveyed psychiatrists and interviews with 6 payers in Brazil and Mexico, all of whom have influence at the institutional, regional, or national level.

Markets covered: Brazil and Mexico.

Primary research:

  • 101 psychiatrists
  • 6 payers:
    • Brazil:
      • Member of the Pharmacology Commission in São Paulo’s State Health Department.
      • Medical audit department manager at national HMO.
      • Psychiatrist KOL.
    • Mexico:
      • Head of acquisition and distribution of medicines at ISSSTE.
      • Psychiatrist KOL.
      • Chief of the psychiatry department at an IMSS’s hospital; P&T committee member.

Questions Answered in This Report:

  • How does coverage of antipsychotics for schizophrenia and MDD vary between the profiled countries and public/private settings?
  • How do cost- and coverage-related constraints drive psychiatrists’ prescribing patterns for schizophrenia and MDD?
  • Which are the most prescribed and most preferred antipsychotics for the treatment of schizophrenia and MDD? What are the key drivers for the prescribing of one antipsychotic over another?
  • To what extent does generic availability affect the P&R of branded antipsychotics?
  • What are payers’ expectations for emerging therapies? How will market access barriers evolve, and what challenges will emerging therapies for schizophrenia and MDD be most likely to face in the future?
  • What role will head-to-head trials and pharmacoeconomic outcomes play in the coverage of novel agents versus current standards of care?
  • How do psychiatrists expect to prescribe emerging antipsychotics, and what is their likely impact on current brands in the next three years?

Table of contents

  • Unipolar Depression - Access & Reimbursement - Detailed, Expanded Analysis Schizophrenia And Major Depressive Disorder (Brazil And Mexico)

Author(s): Susana Ribeiro Da Silba; Andreia S. Ribeiro, PhD

Andreia Ribeiro, Ph.D., is a Director in DRG’s Market Access Insights team. In this role, she manages the Emerging and European Markets Access & Reimbursement portfolios, the industry’s only primary market research solution that includes insights from both physicians and payers to get a true sense of how both parties determine access to key pharmaceutical markets. She joined DRG over 4 years ago as a Latin American analyst where she has pioneered extensive primary and secondary research in the Brazil, Mexico, and Argentina payer systems exploring how the different reimbursement contexts impact prescribing.

Dr. Ribeiro has a Ph.D. in chemical and biochemical engineering from the University of Maryland Baltimore County focused on translational biomaterials research. She holds a B.S./M.S. degree from the University of Porto and two professional certifications in biochemical regulatory engineering and biotechnology management. A native of Portugal, Dr. Ribeiro is fluent in Portuguese and Spanish.

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