When you receive a prescription, you might notice the abbreviation “DAW” printed on the label or form. This term often appears without much explanation, leading to confusion for many patients regarding its meaning and implications for their medication.
Understanding “Dispense As Written”
“DAW” stands for “Dispense As Written,” serving as a specific instruction from your healthcare provider to the pharmacist. This directive guides whether a generic equivalent can be provided instead of the specific brand-name medication prescribed. Its purpose is to ensure the pharmacy dispenses the exact drug indicated by the prescriber, even if a therapeutically equivalent generic version is available. This instruction overrides the typical practice of generic substitution, which is often favored for cost savings. Pharmacists are obligated to follow this direction, selecting the brand-name medication even if a generic option exists.
The Various DAW Codes
“Dispense As Written” is not a single instruction but rather a system of standardized codes, each conveying a distinct reason for dispensing a particular product. These codes are primarily standardized by the National Council for Prescription Drug Programs (NCPDP), an organization that develops standards for the electronic exchange of healthcare information.
- DAW 0: No Product Selection Indicated. Generic substitution is permitted and often preferred.
- DAW 1: Substitution Not Allowed by Prescriber. The healthcare provider specifically requires the brand-name version.
- DAW 2: Substitution Allowed – Patient Requested Product Dispensed. A generic was available, but the patient chose the brand-name drug.
- DAW 3: Substitution Allowed – Pharmacist Selected Product Dispensed. The pharmacist chose to dispense the brand-name drug despite generic availability.
- DAW 4: Substitution Allowed – Generic Drug Not in Stock. The pharmacy does not have the generic in its inventory.
- DAW 5: Substitution Allowed – Brand Drug Dispensed as a Generic. The brand product is used but priced as a generic.
- DAW 6: Override. Rarely used and often reserved for future applications.
- DAW 7: Substitution Not Allowed – Brand Drug Mandated by Law/Regulation. A specific law or regulation prevents generic substitution.
- DAW 8: Substitution Allowed – Generic Drug Not Available in Marketplace. A generic equivalent is not manufactured or is experiencing a shortage.
- DAW A: Addresses multi-payer brand/reference product formulary conflicts, particularly when one payer requires the brand while another prefers the generic.
Reasons for a DAW Designation
A healthcare provider may choose to include a DAW designation on a prescription for several reasons, often centering on medical necessity. For certain medications, particularly those with a narrow therapeutic index, slight variations in how the body absorbs or processes the drug could significantly impact its effectiveness or safety. In such cases, the prescriber might specify a brand-name drug to ensure consistent therapeutic outcomes, as inactive ingredients or manufacturing processes can vary slightly between brand and generic versions, potentially affecting drug delivery. Additionally, a patient might have a known allergy to an inactive ingredient found in generic formulations but not in the brand-name product.
Patient preference can also play a role in a DAW designation. Sometimes, a patient has had a positive experience with a specific brand-name medication and requests it, even if a generic is available. While prescribers may consider these requests, this decision can sometimes lead to higher costs.
A prescriber’s clinical judgment or prior experience with a particular brand-name drug may also lead them to believe it is the most suitable option for a patient’s condition. This preference can stem from familiarity with the drug’s performance or specific patient responses observed in their practice.
What DAW Means for You and Your Pharmacy
The presence of a DAW code on your prescription has practical implications for both you and the pharmacy. For patients, the most immediate impact often relates to cost. Brand-name medications are typically more expensive than their generic counterparts, and a DAW designation, especially DAW 1 (prescriber requested brand), means you may incur higher out-of-pocket expenses. Insurance coverage can also be affected, as some plans may not cover brand-name drugs if a generic equivalent is available, potentially leaving you responsible for the full cost or a significant portion of it.
For the dispensing pharmacy, a DAW code is a clear directive that must be followed. This impacts the pharmacy’s inventory management and dispensing procedures, as they must stock or order the specific brand-name drug rather than opting for a generic alternative. A pharmacist generally cannot override a DAW code without explicit approval from the prescribing physician, particularly for codes like DAW 1. Adhering to these codes is also crucial for proper billing and reimbursement from insurance providers, as incorrect DAW usage can lead to claim rejections or reduced payments to the pharmacy.