Individual Prescribing Incentives for Biosimilars in Selected European Countries and the USA: a Scoping Literature Review.

The uptake of biosimilar medicines in Europe and the USA remains highly variable and at times slow, despite the significant potential for cost savings for both patients and healthcare systems. One of the most recommended measures to address this issue is the use of prescribing incentives. On the basis of a well-defined concept of individual prescribing incentives, we conducted a scoping literature review aimed at exploring their role in promoting the uptake of biosimilars in six countries with advanced healthcare systems (the USA, Denmark, England, Italy, France and Germany), with a particular focus on gain-sharing initiatives. Online databases and other sources were used to identify papers published between 2010 and 2023, resulting in the selection of 47 publications. The results suggest that there are few real-world programmes that use provider incentives offered by health systems to encourage prescribing of biosimilars. However, we found gain-sharing schemes of particular interest in England, Italy, France and Germany, where savings are reinvested to improve the quality of care, incentivizing physicians and raising satisfaction, but without financial rewards. In contrast, we found unplanned disincentives hindering the uptake of biosimilars in the USA, as well as very successful top-down strategies that do not rely on individual incentives, including centralized procurement in Denmark, although it remains to be seen whether the success is idiosyncratic to its specific circumstances. In addition, the hypothesis that gain-sharing initiatives with the aforementioned characteristics are more adaptable to different cultural, organizational and political settings to promote biosimilar prescribing merits further research.