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. 2020 Jul;29(7):778-785.
doi: 10.1002/pds.4934. Epub 2019 Dec 4.

Capture of biologic and biosimilar dispensings in a consortium of U.S.-based claims databases: Utilization of national drug codes and Healthcare Common Procedure Coding System modifiers in medical claims

Jie Zhang  1 , Kevin Haynes  1 , Aaron B Mendelsohn  2 , James Marshall  2 , Charles E Barr  3 , Cara McDermott  3 , Jeffrey Brown  2 , Annemarie Kline  4 , James Kenney  5 , Katelyn J King  6 , Cynthia Holmes  7 , Kai Yeung  8 , John Barron  1 , Huifeng Yun  9 , Catherine M Lockhart  3
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Capture of biologic and biosimilar dispensings in a consortium of U.S.-based claims databases: Utilization of national drug codes and Healthcare Common Procedure Coding System modifiers in medical claims

Jie Zhang et al. Pharmacoepidemiol Drug Saf. 2020 Jul.

Abstract

Purpose: To assess the capture of biologics (originator and biosimilar) in the Biologics and Biosimilars Collective Intelligence Consortium (BBCIC) Distributed Research Network (DRN), with a focus on medical claim National Drug Code (NDC), a new data field, and Healthcare Common Procedure Coding System (HCPCS) modifier.

Methods: We conducted a repeated cross-sectional study among patients with medical and pharmacy benefits enrolled in insurance plans participating in the BBCIC DRN between 1 January 2013 and 30 September 2017. We calculated the proportion of medical claims with ≥1 NDC and identified select biologics using four different approaches: (a) specific HCPCS alone, (b) specific HCPCS and NDC, (c) non-specific HCPCS with NDC, and (d) HCPCS with modifiers (applicable to biosimilars). Numbers of dispensings were calculated for each biologic by approach and select patient and claim characteristics.

Results: More than 1.5 million eligible participants contributed approximately 4 million person-years of data, including 1.2 billion medical claims. The proportion of medical claims with ≥1 NDC increased from 1.2% in 2013 to 3.0% in 2017. Medical claim NDCs identified 39% and 28% of vedolizumab dispensed in 2014 and 2015 and 30% of Epogen/Procrit dispensed overall. Out of 26,381 filgrastim biosimilar dispensings identified, 51% had a HCPCS modifier and 12% had a medical claim NDC for Zarxio. HCPCS modifiers and medical claim NDCs were present for 38% and 3% of all infliximab biosimilars dispensed (total n = 1,244).

Conclusions: Medical claim NDC and HCPCS modifier improves identification of select biologics without product-specific HCPCS code, thereby facilitating product-specific biologic research.

Keywords: Medical Claim National Drug Code; biologics; biosimilars; healthcare common procedure coding system modifiers; pharmacoepidemiology.

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References

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