OBJECTIVES: To control pharmaceutical expenditure, various demand- and supply-side policies are frequently implemented. We sought to compare and interpret biologics market dynamics of the policy context within 12 countries.

METHODS: This study analyzed the trends of the originators’ price (in Fisher index) and overall expenditures (in relative value) for four biologics (Etanercept, Infliximab, Rituximab, and Trastuzumab), and compared their compound quarterly growth rates (CQGRs) using IQVIA-MIDAS^® database. Setting the biosimilars’ entry point as a reference (0Q), descriptive analysis was performed across 12 high-income countries (Australia, Austria, Canada, France, Germany, Italy, Japan, Korea, Spain, Switzerland, and the UK) from -4Q (4Q before biosimilar entry) to Q2 2020. A comprehensive literature review was conducted to investigate each country’s supply-side (including price-link policy) and demand-side policies (including financial incentives).

RESULTS: The results demonstrated that the introduction of biosimilars was associated with the reduction in the originator price indices and relative overall expenditures in most countries, yielding average CQGRs of -1.78% and -1.08%, respectively. The CQGRs for the originator Fisher price indices and relative overall expenditure revealed significant variation across countries, ranging from -7.53% (Australia) to 0.11% (Canada) and from -6.72% (Australia) to 1.28% (Canada), respectively. Korea uniquely showed a significant expenditure rebound following the biosimilar introduction. Interestingly, the seven countries (Australia, Austria, France, Japan, Korea, Spain, and Switzerland) experiencing the greatest price reductions had all implemented price-link policies. The decrease in total expenditure was observed among five countries with aggressive demand-side measures. The other two countries without or with negligible demand-side policies, displayed different outcomes from each other: Japan achieved an indirect reduction in expenditures through stringent price-link policies, whereas Korea where price-link policies are not as activated showed a remarkable expenditure rebound.

CONCLUSIONS: A price-link policy without demand-side measures may not effectively reduce overall expenditures. Further studies are needed to generalize our findings.