{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T17:52:06Z","timestamp":1771955526416,"version":"3.50.1"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T00:00:00Z","timestamp":1709078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Foundation for Science and Technology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>While biosimilar medicines can contribute to the sustainability of healthcare systems, their utilization rate varies across European countries. This study aims to identify and systematize policy measures and instruments used in European countries to increase biosimilar market share.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review was conducted according to PRISMA 2020 recommendations. Medline-PubMed, Web of Science and ScienceDirect databases were searched using inclusion criteria that required full articles published in English between January 2006 and November 2023. Reviews, letters, reports, editorials and comments or opinion articles were excluded from this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 1,137 articles, only 13 met the eligibility criteria for analysis, which covered a total of 28 European countries. Pricing regulation measures were found in 27 of these countries with tendering, price-linkage and internal reference price being the most used. Tendering was used by 27 countries to procure biosimilars in inpatient setting. Prescribing guidelines and recommendations were the widely used instrument. Some European countries adopted physician incentives, quotas, and prescription by international non-proprietary name.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Automatic substitution was not commonly recommended or applied. Interchangeability and switching will become increasingly relevant issues. It is important that the positive results from some countries serve as an example for the future of these medicines in the European market.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p><jats:ext-link>https:\/\/inplasy.com\/<\/jats:ext-link>, Identifier INPLASY2023120032.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1263472","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T04:20:16Z","timestamp":1709094016000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Policy measures and instruments used in European countries to increase biosimilar uptake: a systematic review"],"prefix":"10.3389","volume":"12","author":[{"given":"Sara","family":"Machado","sequence":"first","affiliation":[]},{"given":"Agostinho","family":"Cruz","sequence":"additional","affiliation":[]},{"given":"Pedro Lopes","family":"Ferreira","sequence":"additional","affiliation":[]},{"given":"Carminda","family":"Morais","sequence":"additional","affiliation":[]},{"given":"Rui Esteves","family":"Pimenta","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2024,2,28]]},"reference":[{"key":"ref1","volume-title":"Biosimilar medicines handbook","year":"2016"},{"key":"ref2","volume-title":"Health at a glance: Europe 2022: State of health in the EU cycle","year":"2022"},{"key":"ref3","volume-title":"Health at a glance 2021: OECD indicators","year":"2021"},{"key":"ref4","article-title":"Perspectiva hol\u00edstica sobre o valor dos medicamentos em Portugal (holistic perspective on the value of drugs in Portugal)","year":"2018"},{"key":"ref5","article-title":"Perce\u00e7\u00e3o dos Medicamentos Gen\u00e9ricos em Portugal (Perception study on generic drugs)","year":"2021"},{"key":"ref6","volume-title":"The impact of biosimilar competition in Europe","year":"2022"},{"key":"ref7","volume-title":"What you need to know about biosimilar medicinal products: Process on corporate responsibility access to medicines in Europe","year":"2013"},{"key":"ref8","unstructured":"2023"},{"key":"ref9","unstructured":"Biosimilar medicines [internet]2023"},{"key":"ref10","unstructured":"Biosimilar Medicines [Internet]2023"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1007\/s40259-020-00452-9","article-title":"European stakeholder learnings regarding Biosimilars: part I\u2014improving biosimilar understanding and adoption","volume":"34","author":"Barbier","year":"2020","journal-title":"BioDrugs"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1007\/s40259-019-00395-w","article-title":"Identifying key benefits in European off-patent biologics and biosimilar markets: it is not only about Price!","volume":"34","author":"Dutta","year":"2020","journal-title":"BioDrugs"},{"key":"ref13","first-page":"135","article-title":"O pre\u00e7o dos Medicamentos Gen\u00e9ricos em Portugal (The price of generic drugs in Portugal) (2011-2012): Estado","volume":"2","author":"Gomes","year":"2013","journal-title":"Cidad\u00e3o e Farm\u00e1cia Acta Farmac\u00eautica Portuguesa"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1080\/14737167.2023.2146579","article-title":"How do hospital characteristics and ties relate to the uptake of second-generation biosimilars? 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