Prescription forms often contain various acronyms and codes that dictate how a medication is filled. One significant instruction a pharmacist receives is the “Dispense As Written” (DAW) designation. This code specifies whether the pharmacist must dispense the brand-name medication or if a generic equivalent is permissible. The instruction is part of the electronic claim submitted to the insurance company, confirming the exact product provided to the patient. Understanding this acronym is key for patients to know why they received a specific version of their drug or why the cost differed from expectations.
Understanding Dispense As Written
DAW is a standard code used to manage generic substitution in the pharmacy and insurance industries. It clarifies the prescriber’s intent regarding the brand-name drug versus its generic counterpart. Substitution is permitted for a multi-source drug, which is a brand-name medication that has a chemically equivalent generic version available. The DAW code ensures the dispensing decision aligns with the wishes of the prescriber, the patient, or the insurance plan requirements.
When a generic drug is approved by the Food and Drug Administration (FDA), it is deemed bioequivalent to the brand-name product, meaning it contains the same active ingredient and works the same way in the body. Since generic versions are much less expensive, most systems favor substitution unless a specific reason prevents it. The DAW code guides the pharmacist in overriding the default preference for generic substitution. Without a specific DAW code, the prescription is generally filled with the lowest-cost option, assuming a generic is available.
Decoding the Specific DAW Numbers
DAW codes are numerical values that instruct the pharmacist on the required dispensing action. The most common code is DAW 0, which indicates no product selection is specified, allowing the pharmacist to dispense a generic drug if one exists. This default code suggests substitution is permitted and encouraged. Conversely, DAW 1 means “Substitution Not Allowed by Prescriber,” requiring the pharmacist to dispense the specific brand-name drug written on the prescription.
DAW 2 covers the scenario where substitution is allowed, but the patient requested the brand-name product. This code acknowledges the patient’s choice to receive the more expensive brand drug, even when a generic equivalent is medically acceptable. Other codes cover specific logistical or regulatory issues encountered by the pharmacy.
Other Common DAW Codes
- DAW 4 is used if a “Generic Drug is Not in Stock” at the pharmacy, requiring the brand drug to be dispensed instead.
- DAW 5 is applied when “Substitution is Allowed, but the Brand Drug is Dispensed as a Generic,” often occurring if the pharmacy bills the payer at the generic price due to contract mandates.
- DAW 8 signals that the brand was necessary because the generic was temporarily unavailable in the entire marketplace (not being manufactured or distributed).
- DAW 9 is typically a catch-all code for “Other” situations, or when the payer or formulary requests the brand drug for specific administrative reasons.
Roles in Determining DAW Status
The determination of the DAW code can originate from three parties: the prescriber, the patient, or the pharmacist. The prescriber initiates the process and is the only party who can mandate the brand name using DAW 1. This is often done by writing “Dispense As Written” or “Brand Medically Necessary” on the prescription. This instruction is based on their clinical judgment, asserting the brand formulation is required over the generic.
The patient plays a role when they specifically request the brand-name product at the pharmacy counter, leading to the use of DAW 2. This patient choice overrides the default generic substitution policy, even if the prescriber did not mandate the brand. The pharmacist holds the default position of using DAW 0, allowing for generic substitution, but they also use codes like DAW 4 or DAW 8 based on inventory or market availability. State laws govern the exact language and procedures required for a prescriber to prevent substitution.
Impact on Patient Cost and Insurance
The DAW code directly influences the financial burden on the patient and the insurance company’s coverage decision. When the default DAW 0 is used and a generic is dispensed, the patient’s co-pay is the lowest tier, reflecting the price difference between brand and generic medications. Selecting a brand-name drug with an available generic—often through DAW 1 or DAW 2—can trigger a substantial increase in the patient’s out-of-pocket cost.
Insurance plans frequently impose a financial penalty, or a “DAW penalty,” when a brand drug is chosen over an acceptable generic equivalent. This penalty means the patient must pay the generic co-pay plus the cost difference between the brand and generic drugs. If a prescriber uses DAW 1, the insurance company may require a “Brand Medically Necessary” prior authorization to cover the drug at the higher brand-name rate. Without this authorization, or when DAW 2 is used, the patient often assumes the extra cost, as the plan incentivizes the use of cheaper, bioequivalent generic options.