The prevalence of chronic pain associated with numerous indications (e.g., osteoarthritis, cancer) and of idiopathic origin (e.g., chronic back pain) continues to increase throughout the EU5. The mature prescription analgesic landscape, while crowded with many well-established treatment options, nevertheless presents commercial opportunities for drug developers because treatment of refractory chronic pain remains a challenge. However, new therapies will need to compete for positioning in an already-complex treatment algorithm, and a growing generic presence across multiple drug classes—coupled with evolving access and reimbursement requirements throughout the EU5—will result in increasing market access challenges for branded therapies.

Table of contents

  • Chronic Pain - Access & Reimbursement - Detailed, Expanded Analysis (EU5)
    • Actionable Recommendations to Optimize Market Access
      • Optimizing Market Access Opportunity for New Chronic Pain Therapies in the EU5
    • Successes and Stumbles
      • Successes Among Chronic Pain Therapies in the EU5
      • Stumbles Among Chronic Pain Therapies in the EU5
      • France: Reimbursement Successes and Stumbles
        • Germany: Reimbursement Successes and Stumbles
          • Italy: Reimbursement Successes and Stumbles
            • Spain: Reimbursement Successes and Stumbles
              • United Kingdom: Reimbursement Successes and Stumbles
              • Key Stakeholders in the Road to Market Access
                • France
                • Germany
                • Italy
                • Spain
                • United Kingdom
              • Key Market Access Roadblocks
                • France: Key Market Access Roadblocks
                • Germany: Key Market Access Roadblocks
                • Italy: Key Market Access Roadblocks
                • Spain: Key Market Access Roadblocks
                • United Kingdom: Key Market Access Roadblocks
              • Reimbursement Dynamics
                • France
                  • France: Crucial HTA Criteria
                  • France: P&R Drivers and Key HTA Considerations
                  • France: P&R Drivers and Key HTA Considerations
                  • France: HTA Review Details
                  • France: HTA Review Details
                  • France: Lessons Learned and Key Takeaways
                  • France: Key Background Details of the Healthcare System
                  • France: P&R Process
                  • France: P&R Process
                  • France: Reimbursement Details and Mechanisms
                  • France: Prescribing Restrictions, Dispensation, and Monitoring
                • Germany
                  • Germany: Crucial HTA Criteria
                  • Germany: P&R Drivers and Key HTA Considerations
                  • Germany: P&R Drivers and Key HTA Considerations
                  • Germany: HTA Review Details
                  • Germany: HTA Review Details
                  • Germany: Lessons Learned and Key Takeaways
                  • Germany: Key Background Details of the Healthcare System
                  • Germany: P&R Process
                  • Germany: P&R Process
                  • Germany: Reimbursement Details and Mechanisms
                  • Germany: Prescribing Controls and Monitoring
                • Italy
                  • Italy: Crucial HTA Criteria
                  • Italy: P&R Drivers and Key HTA Considerations
                  • Italy: P&R Drivers and Key HTA Considerations
                  • Italy: HTA Review Details
                  • Italy: HTA Review Details
                  • Italy: Lessons Learned and Key Takeaways
                  • Italy: Key Background Details of the Healthcare System
                  • Italy: P&R Process
                  • Italy: P&R Process
                  • Italy: Reimbursement Details and Mechanisms
                • Spain
                  • Spain: Crucial HTA Criteria
                  • Spain: P&R Drivers and Key HTA Considerations
                  • Spain: P&R Drivers and Key HTA Considerations
                  • Spain: HTA Review Details
                  • Spain: HTA Review Details
                  • Spain: Lessons Learned and Key Takeaways
                  • Spain: Key Background Details of the Healthcare System
                  • Spain: P&R Process
                  • Spain: P&R Process
                  • Spain: Reimbursement Details and Mechanisms
                • United Kingdom
                  • United Kingdom: Crucial HTA Criteria
                  • United Kingdom: P&R Drivers and Key HTA Considerations
                  • United Kingdom: P&R Drivers and Key HTA Considerations
                  • United Kingdom: HTA Review Details
                  • United Kingdom: HTA Review Details
                  • United Kingdom: Lessons Learned and Key Takeaways
                  • United Kingdom: Key Background Details of the Healthcare System
                  • United Kingdom: P&R Process
                  • United Kingdom: P&R Process
                  • United Kingdom: Reimbursement Details and Budget Control
                  • United Kingdom: Prescribing Controls and Monitoring
              • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
                • Prescriber Preferences for Chronic Pain
                  • Key Analgesics' Patient Share in Chronic Pain
                  • Most Common Reason to Prescribe Top Analgesics: French Physicians
                  • Most Common Reason to Prescribe Top Analgesics: German Physicians
                  • Most Common Reason to Prescribe Top Analgesics: Italian Physicians
                  • Most Common Reason to Prescribe Top Analgesics: Spanish Physicians
                  • Most Common Reason to Prescribe Top Analgesics: U.K. Physicians
                  • Physician Opinion on Use of Abuse-Deterrent Opioid Analgesic Formulations in Patients with No History of Drug Abuse
                  • Importance of Patient Opioid Dependence/Abuse Potential on Physician Prescribing Decisions
                • Impact of Payer Policy on Prescribing for Chronic Pain
                  • Future Impact of Cost-Containment Measures on GP Prescribing in Chronic Pain
                  • Future Impact of Cost-Containment Measures on Pain Specialist Prescribing in Chronic Pain
                  • Impact of Payer Policy on Prescribing for Chronic Pain Subpopulations by Drug Class Across the EU5
                • Top Prescribing Drivers: Chronic Pain
                  • Primary Reasons Driving Physicians' Choice of Analgesic Class by Country
                  • Most Influential Factors to Prescribing New Analgesics: French Physicians
                  • Most Influential Factors to Prescribing New Analgesics: German Physicians
                  • Most Influential Factors to Prescribing New Analgesics: Italian Physicians
                  • Most Influential Factors to Prescribing New Analgesics: Spanish Physicians
                  • Most Influential Factors to Prescribing New Analgesics: U.K. Physicians
                  • Prescribing Rates Among Chronic Pain Subtypes by Region
              • Market Access Landscape for Emerging Therapies
                • Likely Impact of Emerging Therapies on Chronic Pain
                  • Chronic Pain Subpopulations to Whom Cebranopadol Is Likely to Be Prescribed: by Physician Specialty
                  • Chronic Pain Subpopulations to Whom Tanezumab Is Likely to Be Prescribed: by Physician Specialty
                  • Likely Positioning of New Analgesics in Chronic Pain Treatment Algorithm
                  • Impact of Emerging Analgesics on Physician Prescribing Habits
                • Market Access Challenges for Emerging Therapies for Chronic Pain
                  • Impact of Regional Formulary Differences on Future Prescribing
                  • Impact of Richtgrößen on Patient Access to Key Branded Chronic Pain Therapies: Germany
                  • Impact of CCG Policy on Patient Access to Select Chronic Pain Drug Classes: United Kingdom
                  • Likelihood of Emerging Chronic Pain Therapies Being Included on Hospital Formulary or Available to Ambulatory Patients Through Retail Pharmacy: Spain
                • Payer Opinion of Emerging Therapies for Chronic Pain
                  • France: Payer Opinion of Emerging Therapies for Chronic Pain
                  • Germany: Payer Opinion of Emerging Therapies for Chronic Pain
                  • Italy: Payer Opinion of Emerging Therapies for Chronic Pain
                  • Spain: Payer Opinion of Emerging Therapies Chronic Pain
                  • United Kingdom: Payer Opinion of Emerging Therapies for Chronic Pain
              • Methodology
                • Primary Research Design
                • Background of Payers and Payer-Advising KOLs
                • Physician Demographics and Practice Setting
                  • Distribution of Medical Practice by Country
                  • Physician Specialty
                  • Physician Practice Setting
                  • Average Number of Years Practiced Postresidency
                  • Average Number of Patients with Chronic Non-Neuropathic Pain Under Management per Month, by Physician Specialty
                  • Drug Classes Prescribed for Chronic Non-Neuropathic Pain, by Physician Specialty
              • Appendix
                • Key Therapies for Chronic Pain
                  • Profiles of Key Therapies for Chronic Pain in the EU5
                  • Cebranopadol
                  • Grünenthal's Cebranopadol
                  • Tanezumab
                  • Pfizer/Eli Lilly's Tanezumab
                • Physician Survey Data
                  • Distribution of Surveyed Physicians' Diagnosed Chronic Pain Patients by Chronic Pain Subpopulation
                  • Drug-Treatment Rates Across the EU5 by Chronic Pain Subpopulation: GPs
                  • Drug-Treatment Rates Across the EU5 by Chronic Pain Subpopulation: Pain Specialists
                  • Prescribing Rates Among Chronic Pain Subtypes by Region
                  • Reasons for Not Prescribing Prescription Analgesics to Chronic Pain Patients: GPs
                  • Reasons for Not Prescribing Prescription Analgesics to Chronic Pain Patients: Pain Specialists
                  • Chronic Pain Patient Management and Referral Patterns
                  • Key Analgesics' Patient Share in Chronic Pain
                  • Importance of Patient Opioid Dependence/Abuse Potential on Physician Prescribing Decisions
                  • Physician Opinion on Requirement for Abuse-Deterrent Properties of ER/LA Opioid Analgesics
                  • Physician Opinion on Use of Abuse-Deterrent Opioid Analgesic Formulations in Patients with No History of Drug Abuse
                  • Impact of the Introduction of Opioid Analgesics with Abuse-Deterrent Claims on Prescribing of Opioid Analgesics by Pain Severity: GPs
                  • Impact of the Introduction of Opioid Analgesics with Abuse-Deterrent Claims on Prescribing of Opioid Analgesics by Pain Severity: Pain Specialists
                  • Impact of the Introduction of Opioid Analgesics with Abuse-Deterrent Claims on Prescribing of Opioid Analgesics by Pain Severity: All Physicians
                  • Primary Reasons Driving GPs' Choice of Analgesic Class by Country
                  • Primary Reasons Driving Pain Specialists' Choice of Analgesic Class by Country
                  • Primary Reasons Driving Physicians' Choice of Analgesic Class by Country
                  • Two Most Common Factors Driving Physicians' Prescribing of Select Drug Classes for Chronic Pain
                  • Most Common Reason to Prescribe Top Analgesics: French Physicians
                  • Most Common Reason to Prescribe Top Analgesics: German Physicians
                  • Most Common Reason to Prescribe Top Analgesics: Italian Physicians
                  • Most Common Reason to Prescribe Top Analgesics: Spanish Physicians
                  • Most Common Reason to Prescribe Top Analgesics: U.K. Physicians
                  • Impact of Payer Policy on Prescribing for Chronic Pain Subpopulations by Drug Class Across EU5
                  • Patients Not Receiving Branded Chronic Pain Therapies Due to Market Access Reasons
                  • GPs' Opinion of the Impact of Usage Requirements/Eligibility Criteria on Prescribing Branded Chronic Pain Therapies
                  • Pain Specialists' Opinion of the Impact of Usage Requirements/Eligibility Criteria on Prescribing Branded Chronic Pain Therapies
                  • Physician Opinion of the Impact of Usage Requirements/Eligibility Criteria on Prescribing Branded Chronic Pain Therapies
                  • Physician Opinion of the Impact of Usage Requirements/Eligibility Criteria on Prescribing Branded Chronic Pain Therapies by Country
                  • Current and Projected Cost-Containment Measures That Will Impact Prescribing of Chronic Pain Therapies
                  • Market Access-Related Considerations with the Greatest Impact on GPs' Prescribing of Branded Chronic Pain Therapies
                  • Market Access-Related Considerations with the Greatest Impact on Pain Specialists' Prescribing of Branded Chronic Pain Therapies
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Chronic Pain Therapies
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Chronic Pain Therapies: France
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Chronic Pain Therapies: Germany
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Chronic Pain Therapies: Italy
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Chronic Pain Therapies: Spain
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Chronic Pain Therapies: United Kingdom
                  • GPs' Opinion on the Ability to Secure Funding for Select Chronic Pain Therapies: France
                  • Pain Specialists' Opinion on the Ability to Secure Funding for Select Chronic Pain Therapies: France
                  • Physicians' Opinion on the Ability to Secure Funding for Select Chronic Pain Therapies: France
                  • Impact of Richtgrößen on Patient Access to Key Branded Chronic Pain Therapies: Germany
                  • Impact of Ricetta Ripetibile and Ricetta Non Ripetibile Designations on Patient Access to Key Branded Chronic Pain Therapies: Italy
                  • Impact of OSP Designation on Patient Access to Qutenza: Italy
                  • Impact of Copay Requirements on Physician Prescribing of Chronic Pain Therapies: Spain
                  • Impact of CCG Policy on Patient Access to Select Chronic Pain Drug Classes: United Kingdom
                  • Impact of NICE Guidelines on Drug Selection Within Chronic Pain Subpopulations: United Kingdom
                  • Most Influential Factors to Prescribing New Analgesics: French Physicians
                  • Most Influential Factors to Prescribing New Analgesics: German Physicians
                  • Most Influential Factors to Prescribing New Analgesics: Italian Physicians
                  • Most Influential Factors to Prescribing New Analgesics: Spanish Physicians
                  • Most Influential Factors to Prescribing New Analgesics: U.K. Physicians
                  • Most Influential Factors to Prescribing New Analgesics: EU5
                  • Influence of G-BA Assessments on Prescribing of New Analgesics for Chronic Pain: Germany
                  • Impact of HTAs on Physician Prescribing of New Analgesics for Chronic Pain: Italy
                  • Percentage of Chronic Pain Patients Likely to Receive Cebranopadol: by Country
                  • Chronic Pain Subpopulations for Which Cebranopadol Is Likely to Be Prescribed: by Physician Specialty
                  • Percentage of Chronic Pain Patients Likely to Receive Tanezumab: by Country
                  • Chronic Pain Subpopulations for Which Tanezumab Is Likely to Be Prescribed: by Physician Specialty
                  • Likely Positioning of New Analgesics in Chronic Pain Treatment Algorithm
                  • Likely Positioning of Emerging Therapies in the Chronic Pain Treatment Algorithm: GPs
                  • Likely Positioning of Emerging Therapies in the Chronic Pain Treatment Algorithm: Pain Specialists
                  • Likely Positioning of Emerging Therapies in the Chronic Pain Treatment Algorithm: All Physicians
                  • Most Likely Prescribing Scenario for Tanezumab: France
                  • Reasons to Not Prescribe Emerging Analgesics
                  • Impact of Regional Formulary Differences on Future Prescribing
                  • Likelihood of Emerging Therapies Being Given an ATU for Chronic Pain: France
                  • Likelihood of the G-BA Granting Favorable Benefit Ratings to Emerging Chronic Pain Therapies: Germany
                  • Likelihood of Emerging Chronic Pain Therapies Receiving Innovative Status: Italy
                  • Likelihood of Emerging Chronic Pain Therapies Being Included on Hospital Formulary or Available to Ambulatory Patients Through Retail Pharmacy: Spain
                  • Likely Funding Scenarios for Emerging Chronic Pain Therapies: United Kingdom
                  • Future Impact of Cost-Containment Measures on GP Prescribing in Chronic Pain
                  • Future Impact of Cost-Containment Measures on Pain Specialist Prescribing in Chronic Pain
                  • Impact of Emerging Analgesics on Physician Prescribing Habits

            Author(s): Joyce Spadafora, ALM

            Joyce is a business insights analyst in Decision Resources Group’s central nervous systems and ophthalmology division, where she provides expert insight into commercial aspects of drug development and market sizing across psychiatric and pain indications. She has worked extensively in DRG’s schizophrenia and chronic pain content.

            Prior to joining DRG, Joyce spent several years in the biotech industry focused in research and development and in biotech consulting. Her project experience covered indications including psychiatry, pain, infectious diseases, respiratory, and ophthalmology. Beyond my therapeutic and industry knowledge, she holds a Masters in Extension Studies in Psychology from Harvard University and a B.S in Mechanical Engineering with Biology from the Massachusetts Institute of Technology.


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