Format

Send to

Choose Destination
Pharmacoepidemiol Drug Saf. 2019 Dec 4. doi: 10.1002/pds.4934. [Epub ahead of print]

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 information

1
HealthCore, Inc., Wilmington, DE, USA.
2
Harvard Pilgrim Health Care Institute, Boston, MA, USA.
3
Biologics and Biosimilars Collective Intelligence Consortium, Alexandria, VA, USA.
4
Aetna, Informatics, Hartford, CT, USA.
5
JTKENNEY, LLC, Waltham, MA, USA.
6
Harvard School of Public Health, Boston, MA, USA.
7
AbbVie, Global Medical Affairs, Healthcare Solutions, Chicago, IL, USA.
8
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
9
University of Alabama at Birmingham, Birmingham, AL, USA.

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

PMID:
31802568
DOI:
10.1002/pds.4934

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center