Here’s our policy on ‘DAW’ or ‘dispense as written’

BCN prescription drug programs
Blue Care Network will only cover the cost of a brand-name drug when the patient’s health care provider and BCN agree that the brand-name drug is medically necessary and that the generic drug was tried unsuccessfully or was not tolerated by the member.

Members need approval to receive tier 2 coverage for a DAW 1 indicator prescription. If the member doesn’t have approval, the member pays the difference between the cost of the generic and brand-name drug, plus the member’s brand-name copayment amount.

For DAW 2 indicator prescriptions, the member pays the difference between the cost of the generic and brand-name drug, plus the member’s brand-name copayment amount. BCN will reject all other DAW indicators, except DAW-5.

Blue Cross Blue Shield of Michigan follows the Michigan Public Health Code, which states that the prescribing health care provider must enter the initials “DAW” or the words “dispense as written” on the prescription in his or her own handwriting.

Our policy doesn’t allow payment for a multisource brand-name drug when the DAW indicator is preprinted or stamped, circled or checked off. DAW must also be appropriately noted on a phone order and initialed by the receiving pharmacist.

Each prescription stands on its own merit. This means that DAW indications on previous prescriptions don’t permit the dispensing of a brand-name drug when DAW isn’t present on another prescription for the same drug.

Member requesting a brand-name drug
If the member requests a brand-name drug, you must report a DAW 2 and inform the member that he or she will be responsible for the difference between the generic and the brand-name drug, plus any applicable copay amount. This is also true when the member requests a brand-name drug on the Maximum Allowable Cost program drug list and DAW is not indicated by the prescriber.

Audit
As stated above, preprinted DAW indicators aren’t acceptable. The pharmacists who dispense brand-name drugs for prescriptions with preprinted DAW indicators are entitled to the price of the generic drug only. When this error is found during an onsite audit, the pharmacy will incur a monetary sanction that amounts to the difference between the cost of the brand-name drug and the generic. This will be extrapolated. Auditors also routinely contact prescribing physicians to verify the authenticity of DAWs on prescriptions.

Electronically transmitted prescriptions
An electronic prescription allows the prescriber to instruct the pharmacist to dispense a brand-name drug product provided that the prescription includes both of the following:

The indication that no substitute is allowed, such as “dispense as written” or “DAW”
The indication that no substitute is allowed and that it is a unique element in the prescription

For more information
DAW may only be requested by the prescriber, not by the member, to justify reporting a dispensing indicator of “1.” If a member requests a brand-name drug when a generic alternative is available, a dispensing indicator of “2” should be reported.

You can find more information about DAW and the Maximum Allowable Cost program in the BCBSM/BCN Guide for Pharmacists.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding, documentation and prescriptions are done in accordance with applicable state and federal laws and regulations.

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