TABLE 3.

Role of tendering and internal reference pricing for biosimilar medicines.

Country	Inpatient sector		Outpatient sector
	Tendering	Organization	Tendering or tendering elements	Biosimilars in the reference price system
AT	Yes	At hospital level	No	No reference price system
BE	Yes	At hospital level	No	No
CZ	Yes	At hospital level	Yes	Yes
DE	Yes	At hospital level	Yes, as part of discount contracts	Yes (few biosimilars included)
DK	Yes	Centrally (procurement agency AMGROS)	Yes, every two weeks	Yes
ES	Yes	At hospital level	No	Yes
FI	Yes	Common “procurement pools” of university hospitals	No	No
FR	Yes	At hospital level or regionally	No	No
IE	Yes	At hospital level	No	No
IT	Yes	Regionally	No	Reference price system in place but biosimilars are not included in these “transparency lists” of equivalent medicines which would imply automatic biosimilar substitution
NL	Yes	At hospital level or by groups of hospital or in collaboration with payers (insurers)	Yes	Yes
NO	Yes	Centrally (procurement agency Sykehusinnkjop)	No	Yes
PT	Yes	Centrally (procurement agency Serviços Partilhados do Ministério da Saúde/SPMS)	No	No
SE	Yes	Regionally, collaboration of regions	No (not for biosimilars, tendering-like process of defining a “product of the month” only applied for generics)	No reference price system
SK	Yes	At hospital level	Yes	Yes
UK	Yes	Centrally (NHS England)	No	No reference price system; however, country-wide reference/reimbursement prices for Adalimumab