OBJECTIVES:   Biological therapy is effective at slowing disease progression in Rheumatoid Arthritis (RA), particularly in severe RA. Recent clinical trials also demonstrated efficacy of biologics for moderate RA. However, access to biologics varies substantially by country, in part due to differing eligibility criteria of reimbursement policies. Here we investigated the proportion of patients who receive biologics, and whether eligibility criteria were correlated with total costs per RA patient across a range of countries. METHODS: PubMed searches were performed to establish which countries reimburse biologics for RA treatment. Eligibility requirements, percentage of patients who received biologics and cost per patient were extracted from a variety of sources. Simple regression analysis was used to compare total cost of RA treatment per patient and severity of RA (DAS score) required for biologic access. RESULTS: Regarding eligibility criteria, 16 out of 21 countries restricted biologics to patients with severe RA (DAS score >5.1) and/or who failed 2 previous DMARDs. Eligibility was linked to reimbursement policy for 14 countries. New Zealand had the most stringent reimbursement criteria, with only 1 biologic reimbursed and limiting eligibility to severe, active erosive RA >6 months, 4 failed DMARDs including MTX, and DAS score >5.1. Taking into account the relative prevalence of RA, 20% of RA patients received biologics in Norway and Belgium, 10% in the UK, 9% in Australia, 5% in Germany and Italy and only 3% in New Zealand and Austria. Out of 14 countries, there was poor correlation between total cost of RA treatment per patient and the severity of RA required for biologics access (R Square: 0.09, p=0.29). CONCLUSIONS: Reimbursement policies for biologics in RA vary substantially between countries, as does the proportion of RA patients who receive biologics. No significant correlation was found between cost per patient and DAS score required for biologics treatment.