OBJECTIVES:  Until recently, the anti-immunoglobulin (anti-IgE) therapy omalizumab was the only biologic drug approved in Europe to treat asthma, but labeling, cost, and payer policy limit its use to patients with severe/refractory symptoms, elevated IgE levels, and perennial allergen sensitization. Several novel anticytokine agents are expected to launch for asthma within 2 to 3 years. We sought to determine the likely impact of payer policy on asthma biologics prescribing in the EU5. METHODS:  In March 2016, 255 pulmonologists across the EU5 were surveyed regarding their current and expected prescribing for asthma and the extent to which it is impacted by payer policy. Additionally, 16 payers who influence national/regional reimbursement were interviewed. RESULTS:  By 2019, more surveyed EU5 pulmonologists expect to prescribe tiotropium (53-88%) than biologics (8-32%) or oral corticosteroids (2-14%) as first-line therapy in severe, refractory asthmatics. Respondents expect payers to mandate/encourage tiotropium use before biologics in LABA/ICS-refractory patients (27-48%) and/or to impose fewer usage requirements overall for tiotropium (20-47%). Pulmonologists expect clinical efficacy to drive the choice between new biologics, but cite non-clinical influencers of drug selection, including incorporation in regional/local guidelines (11-26%), availability of effective companion diagnostics (16-28%), overall diagnostic/treatment cost (14-37%), and budgetary limitations (8-20%). Respondents anticipate prescribing mepolizumab more than other new biologics, but its labeling and high price versus conventional drugs will largely relegate it to patients who fail triple therapy (ICS + LABA + LAMA) or who are only controlled by high-dose oral corticosteroids. Payers suggest that superiority studies based on exacerbations, hospitalizations and/or mortality, as well as voluntary discounts and rebates, are levers in drug pricing and reimbursement negotiations and formulary inclusion. CONCLUSIONS:  Choice between novel asthma biologics will be driven by clinical efficacy and comparative cost after discounts/rebates, but EU5 budgetary concerns will dictate policies concentrating biologics use among more difficult-to-treat patients.