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

• Drug repurposing faces multiple policy barriers. • Prioritizing policy-related barriers hindering drug repurposing. • A shortlist of the most important barriers contains 22 barriers. • Prioritizing barriers enables targeted development of recommendations. • Recognizing differing stakeholder views is vital for building consensus. 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 de novo development, barriers to successful DR remain pervasive. 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. 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. 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. 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.