Incentives contribute to the proper functioning of the broader contracts that regulate the relationships between health systems and professionals . Likewise, incentives are an important element of clinical governance understood as health services ’ management at the micro-level, aimed at achieving better health outcomes for patients . In Spain, monetary and non-monetary incentives are sometimes used in the health services, but not as frequently as in other countries . There are already several examples in European countries of initiatives searching the promotion of biosimilars through different sorts of incentives, but not in Spain . Hence, this paper is aimed at identifying the barriers that incentives to prescribe biosimilars might encounter in Spain, with particular interest in incentives in the framework of clinical governance . Both questions are intertwined . Barriers are presented from two perspectives . Firstly, based on the nature of the barrier: (i) the payment system for health professionals, (ii) budget rigidity and excessive bureaucracy, (iii) little autonomy in the management of human resources (iv) lack of clinical integration, (v) absence of a legal framework for clinical governance, and (vi) other governance-related barriers . The second perspective is based on the stakeholders involved: (i) gaps in knowledge among physicians, (ii) misinformation and distrust among patients, (iii) trade unions opposition to productivity-related payments, (iv) lack of a clear position by professional associations, and (v) misalignment of the goals pursued by some healthcare professionals and the goals of the public system . Finally, the authors advance several recommendations to overcome these barriers at the national level.