The Effect of Biosimilar Prescription Targets for Erythropoiesis-Stimulating Agents on the Prescribing Behavior of Physicians in Germany

•With prescription volumes of biological drugs rising, decision makers are in search for the optimal policy mix to exploit the cost-containment potential of biosimilars. We use the introduction of regional level prescription targets as natural experiments to evaluate their effectiveness in Germany.•We empirically estimate the effect of introducing minimum quota or preferred prescribing targets for biosimilars on biosimilar share and number of prescriptions use at physician level in the class of erythropoiesis-stimulating agents.•In 3 of the 6 regions, prescription targets effectively increased biosimilar share that was mostly achieved by substitution of original substances with biosimilars. Increasing biosimilar prescriptions were partly accompanied by reductions in total biologic prescription volume in ambulatory care.