A Survey of Nephrologists and Interviews with Payers in the EU5

Renal anemia and hyperphosphatemia, or elevated serum phosphorous, are two primary complications of chronic kidney disease (CKD) that are treated with erythropoiesis-stimulating agents (ESAs)/oral/IV iron and phosphate binders, respectively. The market for renal therapies is poised to expand owing to the growing size of the CKD patient population, as well as the expected launches of novel therapies such as oral hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors to treat renal anemia (i.e., roxadustat, AKB-6548, GSK-1278863A), an IV iron that could reduce the need for ESAs (i.e., Triferic), an IV calcimimetic (i.e., AMG-416), and iron-based phosphate binders to treat hyperphosphatemia and potentially iron deficiency anemia as well (i.e., Auryxia).

Questions Answered in This Report:

  • Nonclinical factors limit nephrologist prescribing of ESAs, but the extent of the limitation varies by country. What factors, including market access decisions by payers, most strongly influence and constrain physician prescribing of new agents over available treatments, including biosimilars in the case of the ESA drug class?

  • Assuming EMA regulatory approval for use of oral HIF-PHis in CKD-ND patients, physician responses vary on whether these new agents would be used before or after an ESA. How will medical practice for the treatment of renal anemia change in light of new therapies such as the oral HIF-PH inhibitors poised to enter the EU5 market?

  • Payers’ opinion on Auryxia, an iron-based phosphate binder recently approved in the United States, appears to be positive. Which drug and patient characteristics will most influence prescribing decisions by clinicians and formulary positioning by payers?

  • Payers believe that tightening budgets, need to reduce costs, changes to their healthcare systems, and saving money for more expensive agents, among other factors, make pricing critically important. How will the price of new agents influence market access?


This European Physician & Payer Forum report entitled EU5 Physician and Payer Perspectives on Improved Renal Therapies Versus Tightening Healthcare Budgets examines the dynamics that will limit or drive market access for these emerging agents in the renal pipeline. We analyze physician prescribing of current therapies, future prescribing practices, the impact and uptake of emerging agents on current therapy use, and formulary decision making for current and emerging agents, among other topics.

- Markets covered: France, Germany, Italy, Spain, and the UK.

- Primary research: Interviews with 15 EU5 payers and payer-advising KOLs. A survey of 253 nephrologists in France (50), Germany (49), Italy (50), Spain (53), and the UK (51).

Author(s): Rob Dubman, M.B.A.
Jihan Khan, Ph.D.
Vivian Georgiou, M.Sc.