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

Abstract

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) nonspecific 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 productspecific biologic research. The contents of the manuscript have been presented as a poster at the 2019 AMCP Managed Care and Specialty Pharmacy Annual Meeting 2019. The research was sponsored by the Biologic and Biosimilars Collective Intelligence Consortium (BBCIC), a nonprofit, scientific public service initiative.

Barriers and facilitators to conduct high‐quality, large‐scale safety and comparative effectiveness research: The Biologics and Biosimilars Collective Intelligence Consortium experience

“…BBCIC conducted a study evaluating the extent to which biosimilars were coded in medical claims with National Drug Codes (NDCs) and HCPCS modifiers. 11 This investigation extended outside the Sentinel Common Data Model as these variables are not captured in the current format.…”

“…Prior to April 2018, biosimilars of the same reference product were assigned with the same healthcare common procedure coding system (HCPCS) code, with modifiers added to identify manufacturers. BBCIC conducted a study evaluating the extent to which biosimilars were coded in medical claims with National Drug Codes (NDCs) and HCPCS modifiers . This investigation extended outside the Sentinel Common Data Model as these variables are not captured in the current format.…”