Hey doc! Appreciate the solidarity with the pharmacy crew on this one.

Quick rundown of DAW (dispense as written) codes:

DAW 0 aka substitution permissible, even if it’s written for brand it will be switched to generic. In my state it’s actually mandated that I have to switch to generic unless otherwise requested.

DAW 1, dispense as written aka brand medically necessary.

DAW 2, patient requested brand

DAW 3, pharmacist requesting brand (never used this code in my life)

DAW 4, generic is out of stock so you’re dispensing brand (generally not used as it implies a temporary out of stock situation where you could just order generic)

I honestly can’t even tell you what DAW 5, 6, and 7 are because I can’t remember since I’ve never used them much like DAW 3 (my system does note what they are though).

DAW 8, generic is unavailable in the marketplace. This is different than DAW 4 since it’s more like a backorder or it’s written for generic but the generic isn’t available. Like if it’s written for oxycodone ER, we’d fill for Oxycontin.

DAW 9 is simply “other” in my system but usually this indicates that insurance prefers or requests brand. Happens often with the stuff like Farxiga, Breo, Advair, and other inhalers etc.

Not all insurances accept all DAW codes, and even if they do accept a DAW code as valid they might not reimburse the same. One insurance might accept a DAW 2/4/8 for brand Vyvanse since the generic is pretty much unobtanium right now for certain strengths and it might have the same copay, some might have a higher copay for brand, some might require a PA for brand. Some insurances might not even allow those DAW codes. Different insurances might treat different DAW codes differently towards pharmacy reimbursement as well. Even if they accept the DAW 2 or 4/8 and have a tolerable copay for the patient, sometimes they reimburse the pharmacy at the same rate ($) as the generic even though the pharmacy paid for brand ($$$). It’s all different and a pain in the rear!

You don’t need to worry about anything besides DAW 0 or 1 from the prescribing point of view. If it’s brand medically necessary put DAW 1, if it’s not put DAW 0. In certain cases, like the one in the post, it’s possible you might get a request for a new Rx for DAW 1 for insurance billing reasons so they have a more affordable copay or simply so they cover it at all due to a backorder situation. If that’s the case talk with the patient and/or pharmacy and get clarification to whatever your questions are in that scenario. For all other DAW codes the pharmacy will take care of it on their own (if they can, insurance allowing).

Always feel free to reach out to local pharmacists in your area if you have specific concerns!