Type 2 diabetes (T2D) has an extremely high prevalence in the top five European markets (France, Germany, Italy, Spain, UK). Low-cost metformin (Merck KgaA’s Glucophage, generics) is entrenched as first-line treatment; however, high-cost SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-IV inhibitors and insulin analogues jostle for later-line treatment positioning, while near-term emerging therapies such as semaglutide oral (Novo Nordisk) and tirzepatide (Eli Lilly) have the potential to make significant advancements in treatment of T2D. As competition continues to increase in this dynamic market, cost-conscious payers demand unequivocal evidence of clinical improvements and/or economic benefits on well-defined endpoints to ensure favorable pricing and reimbursement terms, and, therefore, optimal market access. This research examines the current impact of payer policy on prescribing, and probes how payers and prescribers will react to novel agents that, while potentially innovative, will drive up healthcare costs considerably.


  • What reimbursement terms are in place for current T2D brands in the key European markets? What restrictions do payers impose, and how do these impact prescribing practices? How has the first biosimilar insulin been received by payers and prescribers?
  • How do prescribing patterns for T2D therapies differ between and within the top 5 European markets? What are the key levers and barriers to uptake, and how do clinical restrictions rank against the constraints of payer policy?
  • What attributes do payers and physicians value most in emerging T2D therapies? What can manufacturers do to convince these stakeholders of the value of their products, in order to secure optimal access?
  • How do prescribers plan to incorporate key near-term emerging therapies into their treatment algorithm? What market access challenges will these premium-priced agents face in each of the top 5 European markets given the current economic climate?


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


France, Germany, Italy, Spain, United Kingdom


  • Survey of 150 endocrinologists/diabetologists and 100 primary care physicians across the top 5 European Markets (50 physicians in total per country)
  • Interviews with 10 payers across the top 5 European markets (2 per country)


SGLT-2 inhibitors (e.g. Forxiga and emerging agent Steglatro), DPP-IV inhibitors (e.g. Januvia), GLP-1 receptor agonists (e.g. Victoza and emerging agent semaglutide), long-acting insulins (e.g. Lantus), rapid-acting insulins (e.g. Novolog).


  • 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

  • Type 2 Diabetes - Access & Reimbursement - Detailed, Expanded Analysis (EU) Top 5 European Markets
    • Access & Reimbursement - Type 2 Diabetes - Top 5 European Markets - 2019

Author(s): Gideon Heap

As a Principal Analyst on the Cardiovascular, Metabolic and Renal Disorders team, Gideon has a wealth of experience and expertise in pharmaceutical market analysis. In addition to creating Disease Insights covering metabolic disorders, Gideon has experience in company strategy and portfolio analysis for DRG’s Company & Drug platform.

Gideon has a Masters in Biochemistry with Biological Chemistry from the University of Nottingham, and his industry experience dates back to 2009.

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