The rising prevalence in EU5 markets of neuropathic pain associated with multiple conditions represents commercial opportunities for drug manufacturers. However, a growing generic presence among multiple drug classes, particularly with generic availability in 2017 of key antiepileptic drugs prescribed for neuropathic pain will result in increasing market access challenges for branded therapies. New products in this space will struggle to clinically differentiate themselves from current therapies, particularly to market access authorities, but the potential patient share could be considerable for new analgesics that convincingly demonstrate efficacy and/or tolerability benefits over existing therapies and secure favorable pricing and reimbursement terms.

Table of contents

  • Neuropathic Pain - Access & Reimbursement - Detailed, Expanded Analysis (EU5)
    • Actionable Recommendations to Optimize Market Access
      • Optimizing Market Access Opportunity for New Neuropathic Pain Therapies in the EU5
    • Successes and Stumbles
      • Successes Among Neuropathic Pain Therapies in the EU5
      • Stumbles Among Neuropathic Pain Therapies in the EU5
      • France: Successes and Stumbles
        • Germany: Successes and Stumbles
          • Italy: Successes and Stumbles
            • Spain: Successes and Stumbles
              • United Kingdom: 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 Neuropathic Pain
                  • Key Analgesics' Patient Share in Neuropathic 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
                  • Physicians' Reasons for Prescribing Lyrica More Than Gabapentin for Neuropathic Pain
                  • Physicians' Reasons for Prescribing Gabapentin More Than Lyrica for Neuropathic Pain
                • Impact of Payer Policy on Prescribing for Neuropathic Pain
                  • Expected Impact of Cost-Containment Measures on GPs' Prescribing Habits in the Next 12 Months
                  • Expected Impact of Cost-Containment Measures on Pain Specialists' Prescribing Habits in the Next 12 Months
                  • Percentage of Physicians Whose Prescribing for Neuropathic Pain Subpopulations Is Restricted by Economic Considerations
                • Top Prescribing Drivers: Neuropathic Pain
                  • Top Factors Driving Physician Prescribing of Key Drug Classes for Neuropathic Pain
                  • 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
              • Market Access Landscape for Emerging Therapies
                • Likely Impact of Emerging Therapies on Neuropathic Pain
                  • Percentage of Neuropathic Pain Patients Likely to Receive Mirogabalin by Country
                  • Neuropathic Pain Indications for Which Mirogabalin Is Likely to Be Prescribed by Physician Specialty
                  • Neuropathic Pain Indications for Which Cebranopadol Is Likely to Be Prescribed by Physician Specialty
                  • Neuropathic Pain Indications for Which Tanezumab Is Likely to Be Prescribed by Physician Specialty
                  • Likely Positioning of New Analgesics in Neuropathic Pain Treatment Algorithm
                  • Impact of Emerging Analgesics on Physician Prescribing Habits
                • Market Access Challenges for Emerging Therapies for Neuropathic Pain
                  • Likelihood of Emerging Pain Therapies Being Included on Hospital Formulary or Available to Ambulatory Patients Through Retail Pharmacy: Spain
                  • Likelihood of the G-BA Granting Favorable Benefit Ratings to Emerging Therapies for Neuropathic Pain: Germany
                  • Likelihood of Emerging Therapies Receiving Innovative Status for Neuropathic Pain: Italy
                  • Likelihood of Emerging Therapies Being Given an ATU for Neuropathic Pain: France
                  • Impact of Treatment Guidelines on Prescribing of Key Drugs for Neuropathic Pain: United Kingdom
                • Payer Opinion on Emerging Therapies for Neuropathic Pain
                  • France: Payer Opinion on Emerging Therapies for Neuropathic Pain
                  • Germany: Payer Opinion on Emerging Therapies for Neuropathic Pain
                  • Italy: Payer Opinion on Emerging Therapies for Neuropathic Pain
                  • Spain: Payer Opinion on Emerging Therapies for Neuropathic Pain
                  • United Kingdom: Payer Opinion on Emerging Therapies for Neuropathic 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 Neuropathic Pain Under Management per Month by Physician Specialty
                  • Drug Classes Prescribed for Neuropathic Pain by Physician Specialty
              • Appendix
                • Key Therapies for Neuropathic Pain
                  • Profiles of Key Drugs for Neuropathic Pain in the EU5
                  • Mirogabalin
                  • Daiichi Sankyo's Mirogabalin
                  • Cebranopadol
                  • Grünenthal's Cebranopadol
                  • Tanezumab
                  • Pfizer/Eli Lilly's Tanezumab
                • Physician Survey Data
                  • Distribution of Surveyed Physicians' Diagnosed Neuropathic Pain Patients by Subpopulation
                  • Drug-Treatment Rates Across the EU5 by Neuropathic Pain Subpopulation: GPs
                  • Drug-Treatment Rates Across the EU5 by Neuropathic Pain Subpopulation: Pain Specialists
                  • Drug-Treatment Rates Across the EU5 by Neuropathic Pain Subpopulation: All Physicians
                  • Reasons for Not Prescribing Prescription Analgesics to Neuropathic Pain Patients: GPs
                  • Reasons for Not Prescribing Prescription Analgesics to Neuropathic Pain Patients: Pain Specialists
                  • Neuropathic Pain Patient Management and Referral Patterns
                  • Key Analgesics' Patient Share in Neuropathic Pain
                  • Reasons Physicians Do Not Prescribe Opioid Analgesics for Neuropathic Pain
                  • Physicians' Reasons for Prescribing Gabapentin More Than Lyrica for Neuropathic Pain
                  • Physicians' Reasons for Prescribing Lyrica More Than Gabapentin for Neuropathic Pain
                  • Percentage of Patients Treated with Xeristar/Ariclaim vs. Generic Duloxetine by Country
                  • Physicians' Reasons for Prescribing Generic Duloxetine More Than Xeristar/Ariclaim for Neuropathic Pain
                  • Physicians' Reasons for Prescribing Xeristar/Ariclaim More Than Generic Duloxetine for Neuropathic Pain
                  • Top Factors Driving GPs' Prescribing of Key Drug Classes for Neuropathic Pain
                  • Top Factors Driving Pain Specialists' Prescribing of Key Drug Classes for Neuropathic Pain
                  • Top Factors Driving Physicians' Prescribing of Key Drug Classes for Neuropathic Pain
                  • Top Two Factors Driving Physicians' Prescribing of Key Drug Classes for Neuropathic 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
                  • Percentage of Physicians Whose Prescribing for Neuropathic Pain Subpopulations Is Restricted by Economic Considerations
                  • Neuropathic Pain Patients Not Receiving Branded Pain Therapies Due to Market Access Reasons
                  • GPs' Opinion of the Impact of Usage Requirements/Eligibility Criteria on Prescribing Branded Therapies for Neuropathic Pain
                  • Pain Specialists' Opinion of the Impact of Usage Requirements/Eligibility Criteria on Prescribing Branded Therapies for Neuropathic Pain
                  • Physicians' Opinion of the Impact of Usage Requirements/Eligibility Criteria on Prescribing Branded Therapies for Neuropathic Pain
                  • Physicians' Opinion of the Impact of Usage Requirements/Eligibility Criteria on Prescribing Branded Therapies for Neuropathic Pain by Country
                  • Current and Projected Cost-Containment Measures That Will Impact Prescribing of Analgesics for Neuropathic Pain
                  • Market Access-Related Considerations with the Greatest Impact on GPs' Prescribing of Branded Pain Therapies
                  • Market Access-Related Considerations with the Greatest Impact on Pain Specialists' Prescribing of Branded Pain Therapies
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Pain Therapies
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Pain Therapies: France
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Pain Therapies: Germany
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Pain Therapies: Italy
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Pain Therapies: Spain
                  • Market Access-Related Considerations with the Greatest Impact on Physician Prescribing of Branded Pain Therapies: United Kingdom
                  • GPs' Opinion on the Ability to Secure Funding for Select Pain Therapies: France
                  • Pain Specialists' Opinion on the Ability to Secure Funding for Select Pain Therapies: France
                  • Physicians' Opinion on the Ability to Secure Funding for Select Neuropathic Pain Therapies: France
                  • Impact of Richtgrößen on Patient Access to Key Branded Pain Therapies: Germany
                  • Impact of Ricetta Ripetibile and Ricetta Non Ripetibile Designations on Patient Access to Key Branded Pain Therapies: Italy
                  • Impact of OSP Designation on Patient Access to Qutenza: Italy
                  • Percentage of Patients Not Receiving Qutenza Due to Visado de Inspeccion Requirements: Spain
                  • Impact of Treatment Guidelines on Prescribing of Key Drugs for Neuropathic Pain: United Kingdom
                  • Impact of Guidance on Prescribing of Lyrica vs. Generic Pregabalin for Neuropathic Pain
                  • French Physicians' Insight into ALD Status Regarding Their Patients with Painful Diabetic Neuropathy
                  • Impact of Copay Requirements on Physician Prescribing of Pain Therapies: Spain
                  • 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: All Physicians
                  • Percentage of Neuropathic Pain Patients Likely to Receive Mirogabalin by Country
                  • Neuropathic Pain Indications for Which Mirogabalin Is Likely to Be Prescribed by Physician Specialty
                  • Percentage of Neuropathic Pain Patients Likely to Receive Cebranopadol by Country
                  • Neuropathic Pain Indications for Which Cebranopadol Is Likely to Be Prescribed by Physician Specialty
                  • Percentage of Neuropathic Pain Patients Likely to Receive Tanezumab by Country
                  • Neuropathic Pain Indications for Which Tanezumab Is Likely to Be Prescribed by Physician Specialty
                  • Likely Positioning of New Analgesics in Neuropathic Pain Treatment Algorithm
                  • Likely Positioning of New Analgesics in Neuropathic Pain Treatment Algorithm by Physician Type
                  • Likely Positioning of Emerging Therapies in the Pain Treatment Algorithm: GPs
                  • Likely Positioning of Emerging Therapies in the Pain Treatment Algorithm: Pain Specialists
                  • Likely Positioning of Emerging Therapies in the 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 Neuropathic Pain: France
                  • Likelihood of the G-BA Granting Favorable Benefit Ratings to Emerging Therapies for Neuropathic Pain: Germany
                  • Likelihood of Emerging Therapies Receiving Innovative Status for Neuropathic Pain: Italy
                  • Likelihood of Emerging Pain Therapies Being Included on Hospital Formulary or Available to Ambulatory Patients Through Retail Pharmacy: Spain
                  • Likely Funding Scenarios for Emerging Pain Therapies: United Kingdom
                  • Expected Impact of Cost-Containment Measures on GPs' Prescribing Habits in the Next 12 Months
                  • Expected Impact of Cost-Containment Measures on Pain Specialists' Prescribing Habits in the Next 12 Months
                  • 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.