OBJECTIVES: To establish the key drivers of purchasing, pricing, access, and profitability for biologics in markets where biosimilars, bio-originals, and new innovative biologics compete. To provide insight into how sustainability, profit, pricing and access are driven by differentiation. METHODS: A meta-analysis was conducted across all studies (n=14) undertaken by GfK since January 2014 involving the pricing and market access of biologics in Europe in inflammatory disease and oncology. The studies involved primary research, system dynamics modelling, and war gaming (competitive simulation).  Primary research comprised interviews (n=250) across 7 European markets: France, Germany, Hungary, Italy, Poland, Spain and the UK, collecting insight at pan-European, National and Regional levels, Physicians, Payers, Patients, and Industry. System dynamics modelling, based on delphi panels of expert opinion, focused on 2 oncology products (trastuzumab, bevacizumab) and 3 anti-TNFs (infliximab, etanercept, adalimumab). War gaming was used to explore the forces of supplier and buyer power, impact of new entrants, impact of substitutes, and competitive rivalry. The impact of price referencing was included in the analysis, as was consideration of parallel trade.      RESULTS: The analysis showed that the key drivers of purchasing, access, and profitability in markets where biosimilars compete are product differentiation, relative effective net pricing, and multi-criteria decision-making. Both sustainability and profitability are driven by differentiation. War gaming indicates that a market that recognizes these drivers and dynamics will deliver benefits to all stakeholders, including the opportunity for cost savings that can be used to fund access to the next generation of innovative new high cost / high value therapies. CONCLUSIONS: Acceptance of multi-criteria decision making that includes non-price criteria, a willingness to pay for differentiation, and the evolution of policies relating to interchangeability, substitution and switching will increase the stability, sustainability and profitability of markets that include biosimilars.