The European type 2 diabetes market is contending with the convergence of innovative pharmaceutical offerings, such as Johnson & Johnson’s Invokana, AstraZeneca’s Xigduo, and Takeda’s Vipidia, and an increasingly cost-conscious reimbursement climate. The expanding treatment armamentarium could almost double the EU5 type 2 diabetes market by 2022. However, the German GBA (Joint Federal Committee of Physicians, Dentists, Hospitals, and Health Insurance Funds)’s benefit assessment of novel diabetic agents is having ongoing consequences for novel drugs in Germany, and ripple effects are likely throughout Europe given the influence of German reference pricing on country-specific reimbursement policies.

Questions Answered in This Report:

  • Physician and payer perspective on current and evolving prescribing trends: What role do key brands play in the treatment of type 2 diabetes in the EU5, and how do prescribing patterns vary by country? What have been the main cost/clinical constraints to the uptake of the early-line staples, available orals, and later-line alternatives? What is the impact of such constraints on use of novel agents, and how might it evolve? How will physicians embrace new entrants such as Johnson & Johnson’s Invokana and Takeda’s Vipidia? How will the launch of the new SGLT-2 inhibitor drug class and the availability of new insulin options affect prescribing trends for other drug classes?

  • Payer and physician perspectives on approved type 2 diabetes therapies: How does reimbursement of approved type 2 diabetes therapies vary between countries? How do national, regional, and local healthcare authorities regulate the prescribing of these agents? What is the ongoing impact of evolving cost-containment strategies and increasingly complex health technology assessment in each market? What are payers’ reactions to recently approved agents (e.g., Invokana, Xigduo, Vipidia)? How and to what extent does price prevent access to these branded agents in the increasingly price-sensitive EU5 markets?

  • Physician and payer attitudes toward novel type 2 diabetes agents: How will prescribing patterns change with the launch of new GLP-1 receptor agonists, DPP-IV inhibitors, and SGLT-2 inhibitors? What types of clinical advantages could secure reimbursement for emerging agents, according to payers? How might evolving healthcare reforms and cost-containment strategies affect reimbursement of novel agents? What role will head-to-head and pharmacoeconomic outcomes play in differentiating the reimbursement of novel, high-cost agents versus current mainstays? What market access levers can drug developers use to better position new type 2 diabetes agents in the EU5?


Decision Resources’ European Physician & Payer Forum report, “The Dynamic Type 2 Diabetes Landscape: Market Access Levers and Barriers amid Increasing Austerity in the EU5” explores the many international, national, and local market access factors that can influence the treatment of type 2 diabetes in the EU5 (France, Germany, Italy, Spain, and the United Kingdom) as health technology assessment becomes increasingly challenging and pricing and reimbursement negotiations more complex. This report draws on insights from 256 surveyed diabetologists, endocrinologists, and general practitioners in the EU5 and from interviews with 15 European payers, all of whom have influence at a national or regional level. Interviewed payers include the following:

- France: Hospital pharmacy director; hospital formulary committee member, who advises HAS; regional payer and national adviser for the HAS.

- Germany: Hospital formulary committee member who advises on national medical guidelines regarding rebate contracts, member of national boards and ex-GBA member who works in close contact with IQWIQ, hospital formulary committee member who is head of the Federal Joint Committee of Physicians.

- Italy: Prontuario terapeutico ospedaliero (PTO) and prontuario terapeutico ospedaliero regionale (PTOR) members and pharmacy directors with responsibility for assessing new drugs for formulary inclusion; Agenzia Italiana del Farmaco (AIFA; Italian Medicines Agency) advisors.

- Spain: Advisors to Dirección General de Farmacia y Productos Sanitarios (DGFPS; General Directorate of Pharmacy and Health Products) and to the Comisión Nacional para el Uso Racional del Medicamento (CNURM; National Commission for the Rational Use of Medicines), and to Hospital/Regional Formulary Committee; hospital/regional formulary committee members.

- United Kingdom: Hospital pharmacy director; hospital formulary committee member and clinical commissioning group CCG/head of medicine management; CCG advisor, PCT/hospital formulary member.

Author(s): Kate Sullivan

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