Biologic drugs represent a large and growing portion of health expenditures. Increasing\nthe use of biosimilars is a promising option for controlling spending growth in pharmaceutical care.\nAmid the considerable uncertainty concerning physiciansâ?? decision to prescribe biosimilars, explicit\ncost control measures may help increase biosimilar use. We analyze the role of regional cost control\nmeasures for biosimilars and their association with physician prescriptions in ambulatory care in\nGermany. We collect data on cost control measures implemented by German physician associations and\nnational claims data on statutory health insurance covering 2009 to 2015. We perform panel regressions\nthat include time and physician fixed effects to identify the average associations between cost control\nmeasures and biosimilar share/use while controlling for unobserved physician heterogeneity, patient\nstructure, and socioeconomic factors. We identify 44 measures (priority prescribing, biosimilar quota)\nfor erythropoiesis-stimulating substances, filgrastim, and somatropin. Estimates of cost control\nmeasures and their consequences for biosimilar share and use are heterogeneous by drug, measure\ntype, and physician group. Across specialists, biosimilar quotas accounted for 5.13% to 9.75% of the\ntotal average biosimilar share of erythropoiesis-stimulating substances. Explicit quota regulations are\nmore effective than priority prescribing. Regional variation in biosimilar use can be partly attributed\nto the presence of cost control measures.
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