In Spain, monetary and non-monetary incentives are sometimes used in the healthcare services, but not as frequently as in other countries. There are already several examples in European countries of initiatives for the promotion of biosimilars through different sorts of incentives, but not in Spain.

Hence, authors Lobo and Río-Álvarez carried out research aimed at identifying the barriers that incentives to prescribe biosimilars might encounter in Spain, with particular interest in incentives in the framework of clinical governance.

Both questions are intertwined. Barriers are presented from two perspectives. Firstly, based on the nature of the barrier:
1. the payment system for healthcare professionals
2. budget rigidity and excessive bureaucracy
3. little autonomy in the management of human resources
4. lack of clinical integration
5. absence of a legal framework for clinical governance
6. other governance-related barriers.

The second perspective is based on the stakeholders involved:
1. gaps in knowledge among physicians
2. misinformation and distrust among patients
3. trade unions opposition to productivity-related payments
4. lack of a clear position by professional associations
5. misalignment of the goals pursued by some healthcare professionals and the goals of the public system.

Finally, the authors advance several recommendations to overcome these barriers at the national level. These included:
1. continuing and intensifying efforts to inform and educate physicians on the pharmacological and clinical characteristics of biosimilars
2. informing patients about biosimilars
3. informing unions and professional corporations of the improvements that clinical governance schemes including incentives (especially those based on gain-sharing programmes) can bring about for the NHS, patients, and professional practice
4. Consensus and support from policymakers are required to implement a growing uptake of biosimilars mainly from the Department of Health but also from the Department of Finance as its endorsement of financial incentive programmes might be necessary.

They concluded that ‘in the long run, structural reforms of the Spanish NHS are required to overcome other barriers to biosimilar prescribing incentives in the context of clinical governance’. However, they also added that in the short term ‘there is room for new limited experiments, particularly with non-monetary incentives and the gain-sharing design, which will incite less opposition’.

Conflict of interest
The authors of the research paper [1] declared conflict of interest, including being an employee of the Spanish Biosimilar Medicines Association. For full details of the authors’ conflict of interest, see the research paper [1].

Abstracted by Félix Lobo, Professor Emérito, Department of Economics, University Carlos III de Madrid and Funcas, ES-28903 Getafe, Madrid, Spain.

Editor’s comment
Readers interested to learn more about policies for biosimilars in Spain are invited to visit www.gabi-journal.net to view the following manuscript published in GaBI Journal:

Improving biosimilars uptake: experience gained in Madrid, Spain

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Improving uptake of biosimilars in Spain

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Reference
1. Lobo F, Río-Álvarez I. Barriers to biosimilar prescribing incentives in the context of clinical governance in Spain. Pharmaceuticals (Basel). 2021;14(3):283.

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