OBJECTIVES: To understand how EU healthcare decision makers define value when assessing biosimilar treatments METHODS: Combination of desk research to track current biosimilar market trends, followed by qualitative research including one-to-one interviews with six EU sub-national payers and key opinion leaders.   RESULTS: European payers consider more than just list and net prices when purchasing and supplying novel biosimilar treatments for patients. Whilst payers do consider key aspects such as product attributes in the decision making process, it is economic and public health benefits, supply chain quality, reputation of the manufacturer, national guidance, support and demand from key units or physicians within their region, that remain as the most influential factors in the decision making process. CONCLUSIONS: Many EU payers still consider value beyond just price of a new medicine. However, recent biosimilar launches in the Nordics are challenging this paradigm and affecting discount expectations on biosimilars vs. original compounds in western EU countries. While sub-national payers need to ensure that biosimilar medicines can be supplied to their patients at a consistent level of quality and quantity, biosimilar manufacturers need to ensure new compounds are launched into the market, at suitable price, with a successful commercial strategy that includes dedicated sales and marketing efforts. Moving forward, it will be important for biosimilar manufacturers to understand what payers, physicians and patients value within a new medicine before entering price discussions.