| Educational initiatives |
| (i) Instigate programmes that educate patients where pertinent regarding similar effectiveness and safety between the originator and biosimilar insulin glargine. This includes actively disseminating the findings from previous and current studies including studies with real-world data |
| (ii) Instigate/help with additional research regarding the potential savings/cost-effectiveness from increasing use of biosimilar insulin glargine—building on current studies, with potential savings used to enhance either greater availability and use of long-acting insulin analogues in suitable patients with rising prevalence rates; alternatively, increase the number of professionals available to improve the care of patients with diabetes requiring insulin with the savings made |
| (iii) Alongside this, work with patients to ensure they are familiar with the different pens/devices where this exists in cases where switching between unfamiliar devices may cause confusion—the objective being to minimise any potential for hypoglycaemia |
| (iv) Concurrently, work with patient organisations to facilitate greater use of biosimilar insulin glargine especially where resources/copayments are an issue and help with patient education to enhance optimal use of available devices where pertinent [132] |
| (v) Increased competition with greater availability of biosimilars should help to further lower prices benefitting all key stakeholder groups |
| Other suggested activities |
| (i) Encourage greater discounts from companies to enhance the use of biosimilar insulin glargine at lower costs—building on examples with oral generics [122, 133, 134]. This includes helping to cover the costs of any educational activities needed to enhance familiarity with different devices to minimise potential hypoglycaemia |
| (ii) Potential activities to encourage increased prescribing of biosimilars (and hence competition) could include the following: |
| (a) Introducing/progress annual procurement practices—with preference given to biosimilar companies |
| (b) Consider potentially delisting originator insulin glargine 100 IU/ml from reimbursement and formulary lists and/or only authorising reimbursement for biosimilars—building on successes in other disease areas and situations [118, 135] |
| (c) Introduce target prescribing goals for biosimilars for both new and existing patients with diabetes requiring insulin for their management—and where necessary provide additional educational support (with the help of patient organisations and other healthcare professionals) |
| (d) Introduce prescribing restrictions/guidance for still patented Gla-300 IU/ml to further enhance the market attractiveness for 100 IU/ml formulations—similar to the situation in Scotland [86]. This builds on the successful introduction of prescribing restrictions in other disease areas across Europe [91, 136–138] |
| (iii) Potentially form consortia surrounding the purchasing of biosimilar insulin glargine to encourage greater competition among manufacturers to reduce the current monopoly of insulin availability from the three leading pharmaceutical companies. This can build on current Pan-European consortia activities [139–141] |
| (iv) Look to increase European production of biosimilar insulin glargine building on current activities in countries such as Poland and Malaysia [130, 131, 142]. Lower prices for biosimilar insulin glargine should help lower- and middle-income countries struggling to fund long-acting insulin analogues due to issues of affordability [35, 143, 144] |
