OBJECTIVES: Nalmefene (Lundbeck’s Selincro) is the only marketed drug that aims to reduce alcohol consumption rather than maintain abstinence in alcohol-dependent patients. By examining reimbursement and uptake of nalmefene in the EU5, we explore market access challenges for the novel treatment pathway this drug represents. METHODS: In February 2015, 253 psychiatrists in France, Germany, Italy, Spain, and the UK were surveyed regarding their prescribing of nalmefene. In addition, 15 EU5 payers involved in determining and regulating access to alcohol addiction pharmaceuticals were interviewed. RESULTS: On average, 10% (UK) to 30% (France) of surveyed physicians’ drug-treated alcohol-addicted patients receive nalmefene. The most commonly cited reasons for not prescribing nalmefene are unfamiliarity with the drug (especially in the UK), a belief that the treatment goal should be abstinence, and preference for another pharmacotherapy. Furthermore, 20% of all surveyed EU5 psychiatrists cite maintaining abstinence/reducing relapse as the greatest unmet need in the pharmacological treatment of alcohol addiction, while 18% (UK) to 38% (France) identify efficacy for maintaining complete abstinence from alcohol after withdrawal and detoxification as their key driver for prescribing a new therapy. Interviewed payers similarly consider nalmefene’s goal of reducing alcohol consumption rather than maintaining abstinence to be a reimbursement challenge, and one that, alongside perceived modest efficacy, has contributed to suboptimal HTA ratings in France and Germany, and to total lack of reimbursement in Italy. CONCLUSIONS: Perception of abstinence as the main aim of treatment for alcohol addiction is a considerable market access hurdle for nalmefene and emerging alcohol consumption-reducing agents. Robust superiority over comparators, persuasive marketing that illustrates the benefits of alcohol reduction versus abstinence, and effective targeting of national, regional and local stakeholders are essential to encourage payers to think beyond the price tag, and to maximize familiarity with and use of this novel treatment pathway among prescribers.