Application of Actor Network Theory to Evaluate Supply and Demand Strategies Used to Encourage International Biosimilar Uptake.

Biosimilar medicines have the potential to reduce costs and expand patient access, yet uptake rate remains uneven world-wide. This policy review will (1) evaluate and compare biosimilar medicine uptake and policy frameworks across eight countries in the Organisation for Economic Co-operation and Development (OECD) including Australia and (2) apply Actor Network Theory (ANT) translation to interpret the mechanisms underlying the observed differences in adoption. Targeted searches of academic databases and grey literature were conducted for the period 2017 to 2025. Policies from Australia, Belgium, Denmark, France, Germany, Italy, Canada, and UK were reviewed and classified as either supply-side or demand-side interventions. Maximum market penetration rates of six selected biosimilar products were assessed as the principal indicators of successful adoption. Actor network theory was applied to interpreting how policy makers align other actors in the network to various interventions and to explain differences in effectiveness. Correlation exists between countries achieving high levels of uptake and implementation of two distinct policy uptake methodologies. The first combined multiple supply- and demand-side measures, including incentives, substitution policies, and educational initiatives. The second relied primarily on coordinated national tendering systems operating across hospital and retail markets. Moderate-performing countries employed similar measures but with less consistent implementation, while lower-uptake countries tended to rely predominantly on price controls with limited demand-side engagement. Overall, policy approaches that either integrate multiple complementary interventions or implement robust tendering frameworks appear to be correlated with highest rates of biosimilar uptake. Applying ANT highlights how policy design interacts with healthcare networks, offering insights that may inform more effective biosimilar policy development. Actor network theory illustrates why the policy combinations may be associated with higher levels of uptake: they translate diverse actors into more stable configurations that support adoption.