OBJECTIVES: To analyze the potential cost savings associated with utilization of a quota for biosimilar RA medicines in a biologic naïve but potentially biologic eligible population (those defined as severe). METHODS: High patient numbers in rheumatoid arthritis (RA) and biologic therapy costs place significant pressures on healthcare budgets. Currently biologic therapies are underutilized in severe RA (DAS Score ≥3.7) patient populations that may be eligible for treatment. Biosimilar treatments are expected to reach the market (for the top 3 molecules adalimumab, etanercept and infliximab) by 2017 and may provide an avenue to reduce treatment costs and increase patient access to these agents. Biologic naïve RA populations were estimated for France, Germany and the UK as severe RA patients are assumed to be eligible for biologic therapy. Total cost of applying biologic treatment to a 50% quota of the estimated eligible patient population was compared to a situation of initiating patients on a biosimilar equivalent with a price point 30% lower than the originator. Reinvestment potential was calculated, defining how many more patients could be treated with yearly savings RESULTS: By 2017, when all 3 biosimilars are expected to be available, the assumed 50% quota resulted in yearly savings of €98 million for the UK, €351 million for Germany and €26 million for France compared to the budget impact of using the originator. If these savings were reinvested potentially 40%, 36% and 39% of the remaining biologic naïve patients could be initiated on biosimilar treatment in the UK, Germany and France respectively. CONCLUSIONS: The cost savings from biosimilar adoption in naive severe RA patients presented potentially increase access by removing budgetary pressures from healthcare systems. Proactive payer encouragement for biosimilar utilization is necessary through the use of guidelines and prescription quotas so that healthcare systems can realize significant savings.