Michelsen, BrigitteØstergaard, MikkelNissen, Michael JohnCiurea, AdrianMöller, BurkhardMidtbøll Ørnbjerg, LykkeHorák, PavelGlintborg, BenteMacDonald, AlanLaas, KarinSokka-Isler, TuulikkiGudbjornsson, BjornIannone, FlorenzoHellamand, PasoonKvien, Tore KristianRodrigues, Ana MariaCodreanu, CatalinRotar, ZigaCastrejón, IsabelWallman, Johan KarlssonPavelka, KarelLoft, Anne GitteHeddle, MaureenVorobjov, SigridRelas, HeikkiGröndal, GerdurGremese, Elisavan der Horst-Bruinsma, IreneKristianslund, Eirik KlamiSantos, MariaMogosan, CorinaTomsic, MatijaDiaz-Gonzalez, FedericoGiuseppe, Daniela DiNielsen, Stig WintherHetland, Merete Lund2025-06-032025-06-032025Health Policy. 2025 Jun:156:1053110168-8510http://hdl.handle.net/10400.5/101243© 2025 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/)Background: Studies on national policies for biologics are warranted. Objectives: To map and compare national healthcare set-ups for prescription, start, switch, tapering, and discontinuation of biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis and axial spondyloarthritis across Europe, and assess the healthcare set-ups in relation to countries' socio-economic status. Methods: An electronic survey was developed to collect and compare information on national healthcare systems. The relationship between the cumulative score of biologic/targeted synthetic DMARD regulations, socioeconomic indices, and biologic originator costs were assessed by linear regression. Results: National healthcare set-ups differed considerably across the 15 countries, with significantly fewer regulations with increasing socioeconomic status measured by GDP/current health expenditure/human development index, and with increasing biologic originator costs. In most countries, the biologic/targeted synthetic DMARD prescribing doctor was required to adhere to country and/or hospital recommendations, and about a third of countries had a national/regional tender process. Prescription regulations for biologic/targeted synthetic DMARDs, including pre-treatment and disease activity requirements, varied substantially. Approximately a third of countries had criteria for discontinuation and tapering, whereas only few had for switching. Notably, two countries disallowed biologic/targeted synthetic DMARD retrials, and one imposed limit on the maximum number of biologic/targeted synthetic DMARDs permitted. Conclusion: The findings highlight substantial variability in healthcare set-ups for biologic/targeted synthetic DMARD use in psoriatic arthritis and axial spondyloarthritis across Europe and their association with socioeconomic status and drug costs. These insights provide a basis for rheumatology societies, policymakers, and stakeholders to evaluate and potentially optimize healthcare policies.engAccess to health careAxial spondyloarthritisBiologic therapyHealth policyPsoriatic arthritisSocioeconomic health disparitiesjournal article10.1016/j.healthpol.2025.1053111872-6054