# Biosimilar-first defaults and payment parity in every cancer day unit

Source: https://onco.cc/ideas/idea-reg-biosimilar-first-default-switching/  
OnCo record `idea-reg-biosimilar-first-default-switching` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cheaper copies of biological cancer drugs exist but are used far less in some countries than others. Making them the default choice saves billions with no loss of benefit.

## Summary

NHS England moved most patients to trastuzumab and rituximab biosimilars within a year of launch through commissioning defaults and shared savings; US uptake was slower because reimbursement incentives favoured the originator. The proposal is a bundle of implementation measures for every payer: prescribing systems default to the lowest-cost interchangeable biologic, payment parity so clinics do not lose revenue by switching, pharmacist-led switching protocols with patient information, and public reporting of biosimilar share by centre.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: The bundle raises biosimilar share for oncology monoclonals above 80% within 12 months of launch in adopting systems, saving at least 30% of prior spend on those molecules with no change in clinical outcomes.
- Rationale: Biosimilar uptake is a behavioural and incentive problem, not a scientific one; where defaults and incentives were aligned, switching was fast and safe.
- Proposed test: Compare biosimilar share and spend between health systems adopting the bundle and matched systems that do not, over the first two years of each new oncology biosimilar launch.
- Maturity: being-tested-at-scale
- Actor: payer

## Sources

- Bottleneck evidence (Prices and value): Prasad, De Jesús & Mailankody, The high price of anticancer drugs: origins, implications, barriers, solutions (Nat Rev Clin Oncol 2017): https://doi.org/10.1038/nrclinonc.2017.31

## Connected records

- technologies: [Monoclonal antibodies](https://onco.cc/technologies/monoclonal-antibody/)
- drugs: [Trastuzumab](https://onco.cc/drugs/trastuzumab/)
- bottlenecks: [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)
- key papers: [The high price of anticancer drugs: origins, implications, barriers, solutions](https://onco.cc/key-papers/paper-prasad-nat-rev-clin-oncol/)
- roadmaps: [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/)

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