Alzheimer’s disease (AD) is a chronic neurodegenerative condition widely recognized as a global health crisis; as the general population ages and AD prevalence grows, the need for drugs to treat, delay, or stop the disease is paramount. While current therapies used to treat AD are generically available in Europe, the next five years look set to bring several premium-priced new brands addressing the cognitive as well as the behavioral symptoms of AD. This research examines the current impact of payer policy on prescribing and probes how neurologists and cost-conscious European payers will react to novel agents that, while innovative, will drive up healthcare costs considerably.

Table of contents

  • Alzheimer's Disease - Access & Reimbursement - Detailed, Expanded Analysis (EU5)
    • Key Updates
      • November 2017
        • August 2017
          • May 2017
          • Market Access Overview
            • Actionable Recommendations to Optimize Market Access
              • Optimizing Market Access Opportunity for Alzheimer's Disease Therapies in the EU5
            • Successes and Stumbles
              • Successes Among Alzheimer's Disease Therapies in the EU5
              • Stumbles Among Alzheimer's Disease Therapies in the EU5
              • Overview of Successes and Stumbles Among Alzheimer's Disease Therapies in the EU5
            • Key Stakeholders in the Road to Market Access
              • France
              • Germany
              • Italy
              • Spain
              • United Kingdom
            • Key Market Access Roadblocks
              • Reimbursement Dynamics
                • France
                  • France: Crucial HTA Criteria
                  • France: P&R Drivers and Key HTA Considerations
                  • France: HTA Review Details
                  • France: Reimbursement Regulations and Prescribing Parameters
                  • France: Key Takeaways
                • Germany
                  • Germany: Crucial HTA Criteria
                  • Germany: P&R Drivers and Key HTA Considerations
                  • Germany: HTA Review Details
                  • Germany: HTA Review Details
                  • Germany: Reimbursement Regulations and Prescribing Parameters
                  • Germany: Key Takeaways
                • Italy
                  • Italy: Crucial HTA Criteria
                  • Italy: P&R Drivers and Key HTA Considerations
                  • Italy: HTA Review Details
                  • Italy: Reimbursement Regulations and Prescribing Parameters
                  • Italy: Key Takeaways
                • 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: Reimbursement Regulations and Prescribing Parameters
                  • Spain: Key Takeaways
                • United Kingdom
                  • United Kingdom: Crucial HTA Criteria
                  • United Kingdom: P&R Drivers and Key HTA Considerations
                  • United Kingdom: HTA Review Details
                  • United Kingdom: Reimbursement Regulations and Prescribing Parameters
                  • United Kingdom: Key Takeaways
              • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
                • Prescriber Preferences for Alzheimer's Disease
                  • Current Patient Share of Key Alzheimer's Disease Therapies Across Severities
                  • Eligibility Criteria's Influence on Prescribing of Current Alzheimer's Disease Therapies
                  • Surveyed Neurologists' Use of Biomarkers in the Diagnosis of Alzheimer's Disease
                • Impact of Payer Policy on Prescribing for Alzheimer's Disease
                  • Overall Impact of EU5 Payer Policy on Prescribing for Alzheimer's Disease
                  • Overall Impact of EU5 Payer Policy on Prescribing for Alzheimer's Disease
                  • Impact of Country-Specific Payer Policy on Prescribing for Alzheimer's Disease
                  • Surveyed French Neurologists' Opinion on the CT's Reevaluation of Alzheimer's Disease Therapies
                  • Surveyed Italian, Spanish, and U.K. Neurologists' Opinion on Continued Reimbursement of Alzheimer's Disease Therapies
                  • Reimbursement of Biomarker Tests for Alzheimer's Disease According to Surveyed Neurologists
                • Top Prescribing Drivers in Alzheimer's Disease
                  • Top Drug Development Priorities for Alzheimer's Disease According to Surveyed Neurologists
                  • Most Persuasive Attributes for a DMT in Alzheimer's Disease
                  • Most Persuasive Attributes for an Adjunctive Symptomatic Therapy for the Cognitive Symptoms of Alzheimer's Disease
                  • Most Persuasive Attributes for a Behavioral Therapy in Alzheimer's Disease
              • Market Access Landscape for Emerging Therapies
                • Likely Impact of Emerging Therapies for Alzheimer's Disease
                  • Likely Impact of Emerging Disease-Modifying Therapies for Alzheimer's Disease
                  • Maximum Patient Share for Emerging DMTs According to Surveyed Neurologists
                  • Patients to Whom Surveyed Neurologists Would Prescribe DMTs
                  • Impact of DMTs on Surveyed Neurologists' Use of Biomarkers
                  • Likely Impact of Emerging Symptomatic Therapies for Alzheimer's Disease
                  • Maximum Patient Share for Intepirdine According to Surveyed Neurologists
                  • Most Likely Prescribing Pattern for Intepirdine
                  • Likely Impact of Emerging Behavioral Therapies for Alzheimer's Disease
                  • Maximum Patient Share for Brexpiprazole According to Surveyed Neurologists
                  • Most Common Line of Therapy in Which Surveyed Neurologists Expect to Prescribe Brexpiprazole
                • Market Access Challenges for Emerging Alzheimer's Disease Therapies
                  • Impact of Requirement for Evidence of Amyloid Pathology on DMT Prescribing
                  • Reasons Why Verubecestat Would Not Be Prescribed to More Patients According to Surveyed Neurologists
                  • Impact of Benefit Assessments on German Neurologists' Prescribing of Novel Alzheimer's Disease Therapies
                • Payer Opinion on Emerging Therapies for Alzheimer's Disease
                  • Payer Opinion on Emerging Alzheimer's Disease Therapies
              • Methodology
                • Abbreviations
                • Primary Research Design
                • Background of Payers and Payer-Advising KOLs
                • Physician Demographics and Practice Setting
                  • Distribution of Medical Practice by Country
                  • Average Number of Years Practiced Postresidency
                  • Physician Primary Practice Setting
                  • Average Number of Alzheimer's Disease Patients Under Management per Month
              • Appendix
                • Country-Specific Reimbursement Background Details
                  • France: Key Background Details of the Healthcare System
                  • France: P&R Process
                  • France: P&R Process
                  • Germany: Key Background Details of the Healthcare System
                  • Germany: P&R Process
                  • Germany: P&R Process
                  • Italy: Key Background Details of the Healthcare System
                  • Italy: P&R Process
                  • Italy: P&R Process
                  • Italy: Additional Funding Mechanisms for Off-Label Use
                  • Spain: Key Background Details of the Healthcare System
                  • Spain: P&R Process
                  • Spain: P&R Process
                  • Spain: HTA Bodies
                  • Spain: Autonomic Evaluation Committees
                  • Spain: Autonomic Evaluation Committees (CAEs)
                  • Spain: Commissions for Pharmacy and Therapeutics
                  • Spain: Commissions for Pharmacy and Therapeutics
                  • United Kingdom: Key Background Details of the Healthcare System
                  • United Kingdom: P&R Process
                  • United Kingdom: P&R Process
                • Key Current and Emerging Therapies for Alzheimer's Disease
                  • Profiles of Key Drugs for Alzheimer's Disease in the EU5
                  • Emerging Therapy Profiles
                  • Biogen/Neurimmune's Aducanumab
                  • Merck's Verubecestat
                  • Axovant's Intepirdine
                  • Lundbeck/Otsuka's Brexpiprazole
                • Physician Survey Data
                  • Percentage of Alzheimer's Disease Patients by Severity
                  • Percentage of Drug-Treated Alzheimer's Disease Patients by Severity
                  • Reasons Why More Pre-Alzheimer's Disease Patients Do Not Receive Drug Treatment
                  • Country-Specific Alzheimer's Disease Referral and Management Practices
                  • Current Patient Share of Key Alzheimer's Disease Drugs in Pre-Alzheimer's Disease Patients
                  • Current Patient Share of Key Alzheimer's Disease Drugs in Mild Alzheimer's Disease Patients
                  • Current Patient Share of Key Alzheimer's Disease Drugs in Moderate Alzheimer's Disease Patients
                  • Current Patient Share of Key Alzheimer's Disease Drugs in Severe Alzheimer's Disease Patients
                  • Most Preferred Agents for Pre-Alzheimer's Disease Patients
                  • Most Preferred Agents for Mild Alzheimer's Disease Patients
                  • Most Preferred Agents for Moderate Alzheimer's Disease Patients
                  • Most Preferred Agents for Severe Alzheimer's Disease Patients
                  • Eligibility Criteria's Influence on Prescribing of Current Alzheimer's Disease Therapies
                  • Overall Impact of EU5 Payer Policy on Prescribing of AChEIs
                  • Overall Impact of EU5 Payer Policy on Prescribing of Memantine
                  • Overall Impact of EU5 Payer Policy on Prescribing of Antipsychotics
                  • Clinical Factors That Constrain or Limit Prescribing of AChEIs
                  • Clinical Factors That Constrain or Limit Prescribing of Memantine
                  • Clinical Factors That Constrain or Limit Prescribing of Antipsychotics
                  • Difficulty Prescribing Alzheimer's Disease Therapies to Pre-Alzheimer's Disease Patients
                  • Difficulty Prescribing Antipsychotics Off-Label to Alzheimer's Disease Patients
                  • Surveyed Neurologists' Use of Biomarkers in the Diagnosis of Alzheimer's Disease
                  • Reimbursement of Biomarker Tests for Alzheimer's Disease According to Surveyed Neurologists
                  • Surveyed French Neurologists' Impressions of ALD Status for Alzheimer's Disease
                  • Impact of Richtgrößen on Surveyed German Neurologists' Prescribing of Alzheimer's Disease Therapies
                  • Impact of the Nota 85 on Surveyed Italian Neurologists' Treatment of Alzheimer's Disease
                  • Impact of the Visado de Inspección on Surveyed Spanish Neurologists' Prescribing of Alzheimer's Disease Therapies
                  • Impact of NICE Guidance on Surveyed U.K. Neurologists' Prescribing of Alzheimer's Disease Therapies
                  • Surveyed French Neurologists' Opinion on the CT's Reevaluation of Alzheimer's Disease Therapies
                  • Surveyed German Neurologists' Prescribing for Alzheimer's Disease
                  • Surveyed Italian, Spanish, and U.K. Neurologists' Opinion on Continued Reimbursement of Alzheimer's Disease Therapies
                  • Most Important Drug Development Priorities for Alzheimer's Disease According to Surveyed Neurologists
                  • Most Persuasive Attributes for a DMT in Alzheimer's Disease
                  • Impact of DMTs on Alzheimer's Disease Diagnosis and Drug Treatment
                  • Patients to Whom Surveyed Neurologists Would Prescribe DMTs
                  • Reasons Why Aducanumab Would Not Be Prescribed to More Patients According to Surveyed Neurologists
                  • Reasons Why Verubecestat Would Not Be Prescribed to More Patients According to Surveyed Neurologists
                  • Maximum Patient Share for Aducanumab According to Surveyed Neurologists
                  • Maximum Patient Share for Verubecestat According to Surveyed Neurologists
                  • Impact of Requirement for Evidence of Amyloid Pathology on DMT Prescribing
                  • Mechanisms by Which French Neurologists Expect to be Able to Prescribe Aducanumab
                  • Impact of Benefit Assessments on German Neurologists' Prescribing of Novel Alzheimer's Disease Therapies
                  • Impact of Regional Reimbursement Variations on Surveyed Neurologists' Prescribing in Italy, Spain, and the United Kingdom
                  • Impact of DMTs on Surveyed Neurologists' Use of Biomarkers
                  • Impact the Availability of a Validated, Easy-to-Use Biomarker Would Have on DMT Reimbursement
                  • Level of Unmet Need for an Adjunctive Symptomatic Treatment for the Cognitive Symptoms of Alzheimer's Disease
                  • Most Persuasive Attributes for an Adjunctive Symptomatic Therapy for the Cognitive Symptoms of Alzheimer's Disease
                  • Maximum Patient Share for Intepirdine According to Surveyed Neurologists
                  • Reasons Why Intepirdine Would Not Be Prescribed to More Patients According to Surveyed Neurologists
                  • Anticipated Prescribing of Intepirdine by Surveyed Neurologists
                  • Anticipated Prescribing Patterns for Intepirdine
                  • Evidence That Would Persuade Surveyed Neurologists to Prescribe a New Behavioral Therapy for Alzheimer's Disease
                  • Current Drugs Used to Treat the Behavioral Symptoms of Alzheimer's Disease
                  • Impact of the Safety Warning on Prescribing of Antipsychotics in Alzheimer's Disease Patients
                  • Maximum Patient Share for Brexpiprazole According to Surveyed Neurologists
                  • Reasons Why Brexipirazole Would Not Be Prescribed to More Patients According to Surveyed Neurologists
                  • Most Common Line of Therapy in Which Surveyed Neurologists Expect to Prescribe Brexpiprazole
                  • Surveyed Neurologists' Estimated Delay from EMA Approval to Availability for Emerging Alzheimer's Disease Therapies
                  • ASMR Ratings Emerging Alzheimer's Disease Therapies Are Worthy of and Likely to Receive According to Surveyed French Neurologists
                  • Benefit Rating Emerging Alzheimer's Disease Therapies Are Worthy of and Likely to Receive According to Surveyed German Neurologists
                  • Innovation Rating Emerging Alzheimer's Disease Therapies Are Worthy of and Likely to Receive According to Surveyed Italian Neurologists
                  • Anticipated Reimbursement for Emerging Alzheimer's Disease Therapies in Spain
                  • Anticipated Reimbursement for Emerging Alzheimer's Disease Therapies in the United Kingdom
                  • Emerging Alzheimer's Disease Therapies That Should Receive an ATU According to French Neurologists
                  • Impact Richtgrößen May Have on Surveyed German Neurologists' Ability to Prescribe Emerging Therapies for Alzheimer's Disease
                  • Impact Monitoring of Surveyed Italian Neurologists May Have on the Prescribing of Emerging Therapies for Alzheimer's Disease
                  • Emerging Alzheimer's Disease Therapies Spanish Neurologists Would Lobby to Include on Formulary
                  • Surveyed U.K. Neurologists' Opinion on CCG Funding of Emerging Alzheimer's Disease Therapies

            Author(s): Tamara Blutstein, PhD; Anna Reyes, MSc

            Tamara Blutstein is a Senior Business Insights Analyst on the Central Nervous System, Pain, and Ophthalmology team. She is responsible for analyzing and forecasting pharmaceutical markets, primarily in Neurology indications, with specific expertise in Alzheimer’s disease, Parkinson’s disease, and ischemic stroke.

            Prior to joining the company, Tamara was a postdoctoral fellow at Tufts University School of Medicine, where she studied the role of gliotransmission in the regulation of sleep and sleep homeostasis. She earned a Ph.D. in neuroscience from the University of Maryland School of Medicine where she conducted research on the role of gonadal hormones in modulating neuronal-glial communication. She holds a B.A. in neuroscience from Drew University.

            Anna Reyes is an analyst on the Global Market Access Insights team at Decision Resources Group, primarily focusing on European market access. She is responsible for monitoring, analyzing, and reporting on global market access through the production of DRG’s Global Market Access Solution (GMAS) and Access & Reimbursement products. Anna’s specific focus is on all aspects of market access in the EU5, as well as in select LatAm countries. Anna holds a bachelor’s degree from the University Rovira i Virgili and a master’s degree in bioengineering from IQS Barcelona.


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