Recent European approval of three anti-CGRP-targeted MAbs—Aimovig (Novartis), Ajovy (Teva) and Emgality (Eli Lilly)—together with the expected market penetration of the fourth anti-CGRP-targeted MAb eptinezumab (Alder Biopharmaceuticals) and CGRP receptor antagonist atogepant (Allergan) will see the cost of prescription therapy for migraine prophylaxis escalate dramatically by year-end 2022. As European payers strive to balance clinical need with budget constraints and competing disease priorities, this research draws on perspectives from interviewed payers and surveyed prescribers to analyze the rapidly evolving reimbursement and access environment for migraine prophylaxis treatments in the top five European markets (France, Germany, Italy, Spain, United Kingdom).


  • How do neurologists currently prescribe anti-CGRP-targeted MAbs for migraine prophylaxis? To what extent does this vary between countries? How will prescribing practices evolve as more targeted agents emerge? What points of differentiation are/will be most compelling to neurologists?
  • How are rising costs in migraine prophylaxis controlled by payers? How does payer policy impact prescribing practices? How will cost-containment strategies and the impact of them change as the market becomes more competitive and as points of differentiation become more pivotal?
  • What efficacy endpoints best demonstrate the value of new prophylactics for payers and prescribers? What pharmacoeconomic-related endpoints might resonate with regional and local payers especially
  • To what extent do route and frequency of administration impact treatment positioning and uptake? Will such factors emerge as key differentiators in this increasingly competitive market?
  • What will the reimbursement and prescribing landscape look like in three years, assuming all four anti-CGRP MAbs and atogepant are available


European Access & Reimbursement provides integrated brand-level and country-specific analysis of primary market research conducted with payers and prescribers to examine reimbursement dynamics and evaluate the impact of payer policy on prescribing behavior.


France, Germany, Italy, Spain, and United Kingdom


  • Survey of 250 neurologists across the top 5 European markets (50 per country)
  • Interviews with 10 payers across the top 5 European markets (2 per country


Aimovig, Ajovy, Emgality, eptinezumab, atogepant, botox, topiramate, soldium valproate, amitriptyline, nortriptyine, propranolol, verapamil.


  • Actionable recommendations to optimize market access
  • Market access success and stumbles
  • Market access roadblocks
  • Pricing and reimbursement dynamics
  • Impact of payer policy and coverage on prescribing
  • Market access outlook for emerging therapies

Table of contents

  • Migraine - Access & Reimbursement - Detailed, Expanded Analysis - Top 5 European Markets
    • European Access & Reimbursement Migraine November 2019

Author(s): Yulia Privolnev, MA; Audreza Das, P.G. Dip.

Yulia Privolnev is a manager 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. Yulia’s specific focus is on all aspects of market access in Western and Eastern Europe, as well as external reference pricing (ERP) and managed entry agreements (MEAs) on a global scale. Yulia holds a bachelor’s degree from the University of Toronto and a master’s degree from the London School of Economics.

Audreza Das is a Senior Analyst in the CNS/Ophthalmology team at Decision Resources Group

She has authored content across indications, including neuropathic pain, age-related macular degeneration, treatment-related depression, painful diabetic neuropathy, and migraine. Ms. Das has previously worked at Novo Nordisk, as a Market Analyst for European markets. Previous experience at a SME, included developing disease competitive landscapes, covering global conferences etc. Ms. Das received her B.E. degree in Biotechnology from Birla Institute of Technology, a deemed university and her P.G. Diploma in Cancer Immunology & Biotechnology from University of Nottingham.

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