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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
Author(s) -
Zhang Jie,
Haynes Kevin,
Mendelsohn Aaron B.,
Marshall James,
Barr Charles E.,
McDermott Cara,
Brown Jeffrey,
Kline Annemarie,
Kenney James,
King Katelyn J.,
Holmes Cynthia,
Yeung Kai,
Barron John,
Yun Huifeng,
Lockhart Catherine M.
Publication year - 2020
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4934
Subject(s) - biosimilar , medicine , pharmacy , pharmacoepidemiology , diagnosis code , health care , database , family medicine , medical prescription , pharmacology , environmental health , computer science , population , economics , economic growth
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 improve s identification of select biologics without product‐specific HCPCS code, thereby facilitating product‐specific biologic research.