European Physician and Payer Perspective on Current Mainstays and Novel Entrants in the Age of Austerity
Parkinson’s disease (PD) is a debilitating chronic neurodegenerative disease affecting more than one million people in the five major European pharmaceutical markets (France, Germany, Italy, Spain, United Kingdom; EU5). At the core of PD treatment is long-generic standard of care levodopa (multiple brands, generics), but drugs from several other classes, including dopamine agonists and MAO-B inhibitors, have helped improve patients’ quality of life and proved commercially successful. In early 2015, Xadago (Newron/Zambon), a third-in-class MAO-B inhibitor, became one of the first new drugs approved for PD in Europe in many years; the pipeline further includes several late-stage agents that have the potential to reach the market within the next three years. These new agents will enter an increasingly cost-sensitive environment, and marketers will need to provide clear evidence of clinical improvements and/or cost benefits over well-entrenched, often generically available standards-of-care to receive a favorable health technology assessment (HTA) and command premium pricing.

Questions Answered in This Report:

  • Demonstrating improvements over the standards of care in PD treatment will be key during pricing and reimbursement negotiations and to foster market access uptake. What attributes must an emerging therapy possess to secure a favorable HTA review at national and/or regional levels in each of the EU5 markets? How do country-specific cost-containment measures impact uptake of current PD therapies, and how will they impact uptake of emerging agents?

  • The PD market is dominated by effective, safe, and often generic standards of care. What are the most prescribed and preferred therapies for the treatment of PD? What are the key factors that drive or constrain physician prescribing? What do physicians consider to be the major unmet needs in the treatment of PD? What impact will emerging reformulations, adjunctive therapies, and antipsychotics have on the treatment of PD?

  • A few branded agents remain in the EU5 PD markets. How have payer policies, including formulary inclusions/exclusions, regional/local guidelines, prescribing restrictions, and prescription monitoring, impacted uptake of key PD brands? How do financial considerations such as budgetary limitations and/or out-of-pocket expenditures impact brand use? How might payer policies influence emerging agents that may offer only marginal improvements over standards of care?


This European Physician & Payer Forum report titled Parkinson’s Disease: Physician and Payer Perspectives on Current Mainstays and Novel Entrants in the Age of Austerity explores stakeholder perspectives that affect uptake and sales of key PD therapies and the dynamics that will promote or restrict market access and uptake of emerging PD therapies in the EU5.

Markets covered: France, Germany, Italy, Spain, and the United Kingdom.

Primary research: Online survey of 252 neurologists and 15 country-specific interviews with payers, as follows:

- France: pharmacist and consultant to HAS; past CT member and former member, APHP; consultant for HAS and member of ANSM

- Germany: Ex-member of the G-BA; pharmacy director; physician advisor to the G-BA


- Italy: CPR member; ex-CTS member; PTOR member and hospital/regional pharmacy director


- Spain: hospital/regional formulary committee members; advisor for DGFPS/hospital regional pharmacy director


- United Kingdom: CCG/hospital formulary committee members; hospital pharmacy director


Author(s): Tamara Blutstein, Ph.D.

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