OBJECTIVES: Evaluate the current prescription trend in Italy and estimate the impact of alternative market hypothesis including the introduction of infliximab biosimilars. METHODS: Biologics currently indicated for psoriasis include tumor necrosis factor (TNF)-α inhibitors adalimumab, etanercept, and infliximab, as well as the interleukin-12/23 inhibitor ustekinumab. A deterministic Markov model was developed to simulate the evolution of bio-naïve psoriatic patients in Italy for 3 years. Event rates (mortality, malignancies, infections and MACEs) and persistence curves, were modeled for each biologic drug used in first, second and third line, basing on published data. Hospitalization costs were calculated as average of  Italian DRGs weighted for event-related frequency. The cost of a dermatological visit was considered every two months and  in case of therapy switch. All costs were calculated from the perspective of NHS. The current Italian  market mix of biologic treatments was compared with the total substitution of infliximab with its biosimilars combined with ustekinumab  increasing its market share to 40% at the expenses of the remaining biologics, proportionally to their current shares. RESULTS: In the next three years, 515 bionaive patients are  expected to start a new biological treatment annually. Total cost results in about 45.7 million Euro for 3 years in the current scenario corresponding to 15,148 Euro/patient yearly.  Increasing in ustekinumab market shares and the introduction of infliximab biosimilars lead to estimated annual savings of about 670 Euro/patient (1.7 million Euro in 3 years). Cost of biologic therapy is the main driver, while dermatological visits and adverse events management represent less than 1% of the total cost.  CONCLUSIONS: Biological treatment cost of psoriasis depends almost completely from pharmacological therapy. Changes in the current prescription scenario, with adoption of the most persistent biologic (ustekinumab), can lead to valuable savings through lower cost of maintenance phase, avoided re-inductions, and reduced visits.