OBJECTIVES: EU5 reimbursement authorities are promoting cost-effective treatment practices against a backdrop of tightening healthcare budgets. However, label expansions for novel oral anticoagulants (NOACs) threaten to dramatically increase expenditure for the treatment of atrial fibrillation (AF), venous thromboembolism (VTE), and acute coronary syndrome (ACS). This study explores the impact of payer policies and physician preferences on prescribing for these indications. METHODS: In December 2014/January 2015, 252 cardiologists across the EU5 were surveyed regarding their current and expected prescribing of the NOACs for AF, VTE, and ACS. In addition, 15 payers who influence reimbursement at national/regional level were interviewed. RESULTS: The impact of cost-containment strategies on NOACs uptake varies across the EU5, but is most notable in Spain, where over one-third of physicians report that NOACs prescribing is severely restricted by the inspection visa system. In all countries studied, cost-containment strategies least impact AF prescribing, while the greatest impact is on prescribing of rivaroxaban in ACS. Overall, surveyed physicians report that, on average, 32-60% of their VTE patients, and 48-71% of their AF patients currently receive a NOAC. Uptake is highest in France (VTE) and Italy (AF), and lowest in the UK. By 2018, over 60% of physicians in each EU5 country anticipate increased use of rivaroxaban and apixaban for both AF and VTE.  However, expected prescribing of dabigatran etexilate is more varied, and is least likely for VTE. Interviewed payers caution that pressure on physicians to prescribe cheaper vitamin K antagonists (VKAs) will likely increase, as will negotiations with manufacturers to secure lower NOAC prices are essential. CONCLUSIONS: Surveyed EU5 cardiologists expect to increase their use of NOACs by 2018. However, aggressive payer policies encouraging VKA prescribing are expected across the EU5, together with extended pricing and reimbursement negotiations following each NOAC label expansion, in order to manage healthcare budgets.