The HSE could save almost €149 million a year by using more biosimilar medicines, according to an estimate from Sandoz reported by The Irish Times on 21 October 2026. A separate Irish commentary finds that hospital cancer drug costs rose more than 3,100% in a decade while biosimilar uptake in oncology lagged Europe's leaders.
The savings figure was given to The Irish Times by Diane DiGangi Trench, country head and general manager of Sandoz UK and Ireland. It is a company estimate, not an HSE figure: no report or calculation method was published with it, and Sandoz, the world's largest biosimilar maker, supplies seven of the 11 biosimilars used in Ireland. Two days later, the Center for Biosimilars summarised a peer-reviewed Irish commentary on biosimilar use in cancer care, which points to the same gap from the hospital side.
- Savings claim: Sandoz estimates biosimilar competition saved the Irish health system €239 million in 2025, with a further €148.8 million a year available from wider use.
- Availability: Sandoz says only 11 of the 26 biosimilars available in Europe are marketed in Ireland.
- Ustekinumab: Sandoz puts the potential saving at almost €30 million a year. The HSE spent about €63.1 million on ustekinumab under the High Tech Arrangement in 2024.
- HSE policy: since 1 July 2026, new ustekinumab patients on the High Tech Arrangement are reimbursed only for best-value biological (BVB) medicines, and hospital teams that switch existing patients can access gainshare funding.
- Oncology: hospital cancer drug costs under the Oncology Drug Management Scheme rose from €4.7 million in 2013 to €151 million in 2022, while biosimilars hold 52% to 54% of oncology biologics, against more than 90% in Austria, the Netherlands and Norway.
What Sandoz says Ireland is missing
According to The Irish Times, Ms DiGangi Trench estimated that competition from biosimilars delivered about €239 million in savings for the Irish healthcare system in 2025. She said a further €148.8 million in potential annual savings could be realised through greater uptake of biosimilars already available here and by introducing others already on the market elsewhere in Europe. She told the newspaper that Ireland could capture considerably more savings.
She said Ireland has the second-lowest uptake of biosimilars in Europe, with 11 of the 26 biosimilars available in Europe marketed here. Ustekinumab, a biologic used for psoriasis, was her main example: she said wider biosimilar use could save the HSE almost €30 million a year, and The Irish Times reported uptake of 30% against an HSE target of 80%. The 80% target does not appear in the HSE documents Priya Life Science reviewed, so it is reported here as stated in the article.
Ms DiGangi Trench linked part of the slow uptake to the design of the HSE's best-value biological programme. She said a process begins only when there are at least four competing products, including the originator, and that it takes 240 days, which the newspaper described as considerably longer than in other countries. She also said some parts of the health service use the lower-cost medicines while others do not. Looking ahead, she pointed to a large number of new biosimilars due to reach the market. The article did not include a response from the HSE, and the method behind the €239 million and €148.8 million figures has not been disclosed.
How the HSE best-value biological programme works
The HSE Medicines Management Programme (MMP) reviews medicines once biosimilars are available and names one or more best-value biological (BVB) products for each molecule. Prescribers are then asked to start new patients on a BVB medicine and to consider switching existing patients. The programme's 2026 work list names 14 biological medicines it may review this year: adalimumab, denosumab, eculizumab, etanercept, filgrastim, follitropin alfa, golimumab, lipegfilgrastim, liraglutide, pegfilgrastim, somatropin, teriparatide, tocilizumab and ustekinumab.
Ustekinumab shows how the process plays out. The supplementary protection certificate for Stelara, the Johnson & Johnson reference product, lapsed on 19 July 2024. The MMP's evaluation report, approved on 27 November 2025, put High Tech Arrangement spending on ustekinumab at about €67.3 million in 2023 and €63.1 million in 2024, with further spending in hospitals. About 2,400 patients a month received it, and at the time about 5% of them were on a biosimilar.
In November 2025 the MMP named Imuldosa (Accord), Otulfi (Fresenius Kabi), Pyzchiva (Sandoz, trading as Rowex) and Wezenla (Amgen) as BVB medicines. It added Uzpruvo (Clonmel Healthcare) in May 2026 and Steqeyma (Celltrion) in August 2026, according to the HSE's October 2026 questions and answers for healthcare professionals.
From 1 July 2026, reimbursement of ustekinumab on the High Tech Arrangement for people starting treatment is supported only for BVB medicines. The HSE says the BVB products "are provided to the HSE at a much lower cost" and that "funding to facilitate access to new medicines for patients in 2026 is dependent on the delivery of savings from within the medicines budget." There is no change for existing patients, but the MMP recommends they be considered for switching "at the earliest possible opportunity".
Where gainshare fits in
To encourage switching, the HSE offers a gainshare arrangement to "consultant-led teams in public hospitals who switch patients established on treatment with ustekinumab on the High Tech Arrangement" to a BVB medicine. The HSE says gainshare funds "will be used to fund service delivery and enhancements in areas that are responsible for generating the savings." To qualify, the prescription must be issued through the High Tech Hub, the national electronic prescribing system for High Tech medicines. The amount paid per switch is not disclosed in the current guidance.
The approach has worked for older biologics. In July 2025, 69.5% of patients on adalimumab 40 mg pens or syringes under the High Tech Arrangement were on a BVB biosimilar, as were 78.6% of patients on etanercept and 96.1% on teriparatide, the MMP reports. Uptake for pegfilgrastim, a drug used to protect white blood cell counts during chemotherapy, was 39.5%. Since May 2019, more than 25,000 patients have started on or switched to a BVB biosimilar of adalimumab or etanercept.
Why oncology biosimilar uptake is in focus
The oncology figures come from a commentary by E. Burton, K.E. Coakley, S. Gaynor, M. McDonagh, C. Palmer, L.J. Sahm and S. O'Reilly, led from University College Cork on behalf of the Bio ImPAcT Consortium. It was published online on 24 July 2026 in the International Journal of Clinical Pharmacy (2026;48(5):2179-2186) under the title "Biosimilar use in medical oncology in Ireland: a missed opportunity to mitigate financial toxicity?" Using HSE reporting, the authors show that the cost of hospital-administered cancer medicines funded through the Oncology Drug Management Scheme grew from €4.7 million in 2013 to €151 million in 2022, a rise of more than 3,100%.
That figure does not capture all cancer drug spending: medicines approved before 2012, including some biologics such as trastuzumab, are still paid for from hospital base budgets. The commentary also does not split the increase between higher prices, more patients and longer treatment.
The authors report that biosimilars account for 52% to 54% of the Irish oncology biologics market, compared with more than 90% in Austria, the Netherlands and Norway, and that uptake varies widely between hospitals. They point to resistance to substitution in community pharmacies, and to subcutaneous versions of reference biologics that extend protection from competition, as barriers. The Center for Biosimilars notes that Irish law, the Health (Pricing and Supply of Medical Goods) Act 2013, does not list biosimilars as interchangeable, leaving switching decisions to prescribers. "There remains significant potential to improve biosimilar adoption rates in Ireland," the authors write.
Earlier work points the same way. A 2024 review, Optimising oncology drug expenditure in Ireland, found per-capita spending on cancer medicines roughly doubled between 2008 and 2018 and said biosimilar integration "provides €80 million in cost savings annually". A separate study of four Irish hospitals, published in the Irish Journal of Medical Science in 2024, found use of biosimilar intravenous trastuzumab ranged from 39% to 100% between sites, and biosimilar rituximab from 0% to 89%.
The key figures side by side
The table brings together the figures from the Sandoz interview, the HSE and the oncology commentary. They come from different sources, years and scopes, and should not be added together.
| Measure | Figure and source |
|---|---|
| Savings from biosimilar competition, 2025 | About €239 million (Sandoz estimate) |
| Further potential annual savings | €148.8 million (Sandoz estimate, method not disclosed) |
| Biosimilars marketed in Ireland | 11 of 26 available in Europe (Sandoz) |
| Ustekinumab spend, High Tech Arrangement | About €67.3 million (2023) and €63.1 million (2024) (HSE) |
| Adalimumab biosimilar share, July 2025 | 69.5% of High Tech patients on a BVB biosimilar (HSE) |
| Etanercept biosimilar share, July 2025 | 78.6% (HSE) |
| Pegfilgrastim biosimilar share, July 2025 | 39.5% (HSE) |
| Oncology Drug Management Scheme costs | €4.7 million (2013) to €151 million (2022) (Burton et al.) |
| Biosimilar share of oncology biologics | 52% to 54% in Ireland; above 90% in Austria, the Netherlands and Norway (Burton et al.) |
For comparison with other health systems, our drug spending register tracks what NHS England and US Medicaid pay for each medicine, and the compound pages for ustekinumab, adalimumab and trastuzumab show spending, trials and mechanism side by side. The HSE's approach to funding new medicines from savings also features in our report on the Mounjaro funding decision.
Frequently Asked Questions (FAQ)
Q: What is a biosimilar medicine?
A: A biosimilar is a biological medicine that is highly similar to an existing biological medicine, the reference product, whose protection has expired. In September 2022 the European Medicines Agency and the Heads of Medicines Agencies said biosimilars approved in the EU are interchangeable with their reference medicine, as the HSE notes in its guidance.
Q: Where does the €150 million figure come from?
A: It is an estimate of €148.8 million a year given by Sandoz's Irish and UK head to The Irish Times. It is not an HSE or government figure, and Sandoz has not published how it was calculated.
Q: What is a best-value biological medicine?
A: It is a product the HSE Medicines Management Programme recommends for a given molecule after reviewing price and other criteria. Prescribers are asked to use it for new patients and to consider switching existing ones.
Q: Do patients already on Stelara have to switch?
A: No. The 1 July 2026 change applies to people starting ustekinumab. The HSE recommends that existing patients be considered for switching, and hospital teams that switch them can access gainshare funding.
Q: Why have cancer drug costs risen so much?
A: The commentary reports a rise from €4.7 million in 2013 to €151 million in 2022 under the Oncology Drug Management Scheme. It does not separate the effect of new, more expensive medicines from more patients being treated or for longer.
Conclusion and Outlook
The Sandoz estimate and the oncology commentary come from very different places, a supplier with a commercial interest and a group of Irish researchers, but they point to the same issue: Ireland has made strong progress with some biosimilars, such as adalimumab and teriparatide, while others lag. The HSE's response so far is molecule by molecule, using BVB recommendations, reimbursement rules for new patients and gainshare for hospital teams. Its 2026 list includes denosumab, tocilizumab and other biologics, so further BVB decisions are likely this year and next. Whether the gap Sandoz describes is closed will show in the MMP's own uptake figures, which Priya Life Science will report as they are published.
Sources
- The Irish Times, HSE could be saving nearly €150m annually by using more biosimilar drugs, 21 October 2026
- Center for Biosimilars, Irish Oncology Drug Costs Rose Over 3100% as Biosimilar Uptake Lagged, 23 October 2026
- Burton E, Coakley KE, Gaynor S, et al., Biosimilar use in medical oncology in Ireland: a missed opportunity to mitigate financial toxicity?, International Journal of Clinical Pharmacy, 2026;48(5):2179-2186
- HSE Medicines Management Programme, Reimbursement of Medicinal Products containing Ustekinumab: Questions and Answers for Healthcare Professionals, October 2026
- HSE Medicines Management Programme, Evaluation Report: Best-Value Biological Medicines, Ustekinumab, November 2025
- HSE Medicines Management Programme, Best-value biological medicines and best-value medicines 2026, January 2026
- Kieran R, Hennessy M, Coakley K, et al., Optimising oncology drug expenditure in Ireland, Irish Journal of Medical Science, 2024;193(4):1735-1747
- Coakley KE, Bambury RM, McGuinness E, et al., An evaluation of the utilisation of biosimilar monoclonal antibody drugs in Ireland and barriers to their usage, Irish Journal of Medical Science, 2024;193(3):1191-1199
Cover image: Dr Steevens' Hospital, Dublin, head office of the Health Service Executive. Photo by Thoslee, Wikimedia Commons, licensed under CC BY-SA 4.0, cropped.
