Key Findings:

• Biosimilars generate savings for the healthcare system and can expand access to biologics. Despite representing only 5% of biologics spending in 2024, biosimilars have already contributed €75 billion in cumulative list-price savings in Europe and enabled over 7 billion treatment days.
• Ophthalmology represents a high-burden therapy area with a rapidly growing patient population driven by aging demographics. Retinal diseases—including wet age-related macular degeneration (wAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO)—are leading causes of visual impairment and blindness.
• Ophthalmology systems across Europe face capacity constraints—stemming from clinician shortages, increasing demand, and limited clinic infrastructure—which lengthen waiting times and risk avoidable vision loss due to delayed care. Evidence suggests that lapses in anti-VEGF treatment can lead to irreversible deterioration in visual outcomes. Since biosimilars can generate significant cost savings, their adoption could play an important role in alleviating ophthalmology capacity pressures.
• To understand these challenges, 142 in-depth interviews with ophthalmologists, retina specialists, nurses, pharmacists, payers, and patient advocacy representatives across five European countries were conducted in Q1 2025. Findings reveal low overall confidence and limited use of biosimilars in ophthalmology. Confidence scores ranged from 2/7 in France, Germany, and Spain to 5.5/7 in the UK. A similar pattern was observed for actual use. Lack of familiarity with biosimilars, concerns about comparability, and insufficient exposure to clinical evidence emerged as recurring themes.
• The report identifies several systemic barriers based on stakeholder input. First, limited stakeholder experience and education undermine clinician confidence. Ophthalmologists’ prescribing habits can be conservative due to the precision and risk associated with intravitreal therapy. Second, prior experience with biosimilars—particularly the lack of a PFS option for ranibizumab biosimilars—has impacted perceptions of biosimilars. Third, fragmented and slow decision-making processes across national, regional, and institutional levels delay biosimilar access.