Application of Actor Network Theory to Evaluate Supply and Demand Strategies Used to Encourage International Biosimilar Uptake

Biosimilar medicines have the potential to reduce costs and expand patient access, yet uptake rate remains uneven world-wide. This policy review will (1) evaluate and compare biosimilar medicine uptake and policy frameworks across eight countries in the Organisation for Economic Co-operation and Development (OECD) including Australia and (2) apply Actor Network Theory (ANT) translation to interpret the mechanisms underlying the observed differences in adoption. Targeted searches of academic databases and grey literature were conducted for the period 2017 to 2025. Policies from Australia, Belgium, Denmark, France, Germany, Italy, Canada, and UK were reviewed and classified as either supply-side or demand-side interventions. Maximum market penetration rates of six selected biosimilar products were assessed as the principal indicators of successful adoption. Actor network theory was applied to interpreting how policy makers align other actors in the network to various interventions and to explain differences in effectiveness. Correlation exists between countries achieving high levels of uptake and implementation of two distinct policy uptake methodologies. The first combined multiple supply- and demand-side measures, including incentives, substitution policies, and educational initiatives. The second relied primarily on coordinated national tendering systems operating across hospital and retail markets. Moderate-performing countries employed similar measures but with less consistent implementation, while lower-uptake countries tended to rely predominantly on price controls with limited demand-side engagement. Overall, policy approaches that either integrate multiple complementary interventions or implement robust tendering frameworks appear to be correlated with highest rates of biosimilar uptake. Applying ANT highlights how policy design interacts with healthcare networks, offering insights that may inform more effective biosimilar policy development. Actor network theory illustrates why the policy combinations may be associated with higher levels of uptake: they translate diverse actors into more stable configurations that support adoption. This study examines how countries can increase the use, or “uptake,” of biosimilar medicines, which are lower-cost versions of existing biological drugs that deliver similar safety and effectiveness. The researchers reviewed policies from eight countries and found that uptake varies widely. Some countries achieve high use by combining different approaches that affect both supply and demand. Supply-side strategies focus on how medicines are priced and purchased, such as through competitive tendering, where suppliers bid to provide medicines at lower cost. Demand-side strategies aim to influence behaviour, including education, financial incentives and prescribing targets for healthcare professionals. To better understand why some approaches work, the study applies Actor Network Theory, a framework that explains how different participants, including governments, clinicians, patients, and suppliers, interact within a system. It highlights a process called “translation,” where a central decision maker defines a goal, encourages others to align with it, and builds agreement across the network. Countries with the highest uptake either use strong, coordinated tendering systems or combine multiple policies that actively engage clinicians and patients. In contrast, countries that rely mainly on price controls tend to have lower uptake because they do not fully engage all parts of the system. Overall, the findings suggest that successful policies are those that align many different actors and create a stable, cooperative network that supports the use of biosimilar medicines.