According to Surveyed PCPs and Pain Specialists in the EU5, Prescribing of Recently Approved Qutenza and Palexia SR is Limited Currently but Will Increase Somewhat as Physicians Become More Comfortable with These Agents
Decision Resources
Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that, for the treatment of neuropathic pain, less than half of surveyed primary care physicians (PCPs) in all EU5 countries (France, Germany, Italy, Spain and the United Kingdom) currently prescribe the newly emerged brands Palexia SR (Johnson & Johnson/Grünenthal—which is marketed in the U.S. as Nucynta ER) and Qutenza (NeurogesX/Astellas Pharma Europe). Although prescribing is greater for these agents among surveyed pain specialists, for Qutenza especially, uptake remains constrained in comparison with more established agents, likely owing to administration requirements and prescribing restrictions as use of Qutenza is restricted to hospitals across much of the EU5. Overall, the percentage of surveyed physicians prescribing Palexia SR and Qutenza for their neuropathic pain patients is expected to increase in 12 months’ time, but prescribing of Qutenza will remain notably low among PCPs, especially those in France, Germany and the United Kingdom.
The new European Physician & Payer Forum report entitled also finds that, according to interviewed payers, prescribing of generics for neuropathic pain is heavily encouraged across the EU5. Interviewed EU5 payers report that as more key brands prescribed for neuropathic pain—such as Eli Lilly/Boehringer Ingelheim’s Cymbalta/Xeristar/Ariclaim—lose patent exclusivity in the next few years, prescribing of premium-priced agents for neuropathic pain will be increasingly constrained. Furthermore, price premiums for emerging therapies will become more limited as generic comparators set the bar for reimbursement price.
“In all EU5 countries, physicians are prescribing, to varying extents, key pain therapies to multiple neuropathic pain subpopulations for which they are not specifically labeled,” said Decision Resources Analyst Andrea Buurma. “However, as the EU5 strives to reduce healthcare costs, payers report that off-label prescribing across neuropathic pain subpopulations is an area of increasing concern, and one that will be closely monitored in the future.”
The report also finds that neuropathic pain prescribers in France and, to a lesser extent, in Spain face fewer reimbursement/budgetary/guideline-related hurdles than their counterparts in Germany, Italy and the United Kingdom. However, in 12 months’ time, prescribers in these countries will feel the impact of evolving cost-containment measures. In France and Spain, few prescribing restrictions are currently in place for key neuropathic pain drugs, and in France, most notably, payers report little monitoring of physician prescribing and indicate that off-label use of drugs for neuropathic pain occurs frequently. While healthcare cost-containment measures are increasing in all EU5 countries, the December 2011 Act to Strengthen the Safety of Medicines and Healthcare Products in France (aimed at curbing off-label prescribing) and the recently implemented Royal Decree Laws in Spain (which focus on constraining use of premium-priced branded therapies) will have a significant impact on prescribing.
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