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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

    Basic Details

    To purpose was 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. 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). The number of dispensings was calculated for each biologic by approach and select patient and claim characteristics.


    Jie Zhang, Kevin Haynes, Aaron B. Mendelsohn, James Marshall, Charles E. Barr, Cara McDermott, Jeffrey Brown, Annemarie Kline, James Kenney, Katelyn J. King, Cynthia Holmes, Kai Yeung, John Barron, Huifeng Yun, Catherine M. Lockhart