Policy barriers to drug repurposing in Europe: different stakeholder perspectives identified during survey-based shortlisting of key challenges.

Background: Finding new therapeutic indications for established medicines continues to have important impact. Although drug repurposing (DR) offers the potential for a faster and more affordable complement to Objective: To prioritize barriers identified earlier in a systematic literature review by the REMEDi4ALL Horizon Europe project, involving multiple stakeholder groups, to create a shortlist of the most important barriers and to examine differences in stakeholders' perceptions. Methods: A policy survey was conducted among stakeholder groups involved in DR. Participants rated the barriers based on their impact and actionability, using 5-point categorical scales. A weighted scoring method was used to create the shortlist by combining scores across domains, while ensuring that each stakeholder group's preferences were retained in the final shortlist. Results: 60 individual responses were collected. The final shortlist contained 22 barriers, including 4 barriers related to exclusivity rights for repurposed medicines (RMs), 2 to pricing of RMs, 5 to market authorization of RMs, 2 to perception off-patent RMs, 2 to business case for off-patent RMs, 2 to non-industry funded DR, 2 to health technology assessment of RMs, 2 to ecosystem for non-profit or small-medium sized enterprises-driven DR, and 1 to business case for repurposing on-patent compounds. Conclusion: Prioritizing barriers helps identify solutions by addressing the critical challenges first. Acknowledging that different stakeholder groups may perceive the impact and actionability of these barriers differently is crucial for building a shared, multi-stakeholder perspective when formulating policy recommendations to address the barriers.