OBJECTIVES:  Although generic substitution has largely been accepted as desirable, the prescribing of biosimilars remains contentious. Biosimilar market penetration is expanding leading to a growing need to understand how this will affect global pharmaceutical markets. The objectives of the study were to provide insights into (1) payers’ perceptions towards biosimilar products and how the landscape will evolve in the coming years (2) payer expectations on the pricing of biosimilars and the impact on reference products (3) barriers to uptake and potential differences in attitudes between clinicians and payers. METHODS:  A 10 question online semi-quantitative survey was conducted which covered 9 markets: the UK, Germany, France, Netherlands, Sweden, Spain, Poland, Russia, and the US. The participants selected for the survey hold or have held senior positions within their respective country payer organisations. RESULTS:  The research showed that 7 out of 9 analysed markets have or plan to implement an active policy of switching to biosimilars. Cost difference between a biosimilar and a reference product was chosen as the most important factor in payer decision-making by 100% responders. The current level of discount for biosimilars compared to reference products varied across the studied markets (range 10-40%). The potential for the introduction of a biosimilar to trigger price negotiations was inconsistent across markets, although there was an acknowledged impact on the price of the original brand (range 0-40%). 8 out of 9 responders anticipated the market share for biosimilars to be >25% in the next 5 years with oncology and immunology the most desirable areas for biosimilar penetration. CONCLUSIONS:  The study has demonstrated a wide-variation in how markets approach biosimilar products; however, there are clearly signs of convergence in payer thinking as biosimilar usage expands. Respondents highlighted clinical advocacy and defensive approaches from reference product manufacturers as the main barriers to biosimilar uptake.