I am finishing up a week of vacation but I didn’t want to miss a week on the blog. Plus, a little alone time was much needed.
We have established that the Orange Book is a fun read, but you can bypass it by using DAW codes. DAW or Dispense as Written codes are codes that specify that a particular brand or manufacturer must be dispensed without substitutions.
There are two DAW codes that I believe are most important for our food allergy discussions/issues: DAW 1 and DAW 2.
DAW 1 means that the prescriber has specified that the BRAND medication only (not the “A” rated, therapeutically equivalent, generic) must be dispensed. Laws vary from state to state but, in general, the prescriber must write DAW or Dispense as Written or Brand Medically Necessary or Brand Necessary on the prescription. At this point the pharmacy is ONLY allowed to dispense that particular product, no substitutions permitted.
This can be good and bad.
If the brand product or a specific manufacturer is not covered on your insurance, the pharmacist cannot legally switch to the generic. The pharmacist must call the prescriber and get permission to give the generic product. This will take time. The pharmacy staff may have to leave a message and, depending on how busy the prescriber’s office is, may not receive a return call for several hours to several days.
The specific medication desired may require a Prior Authorization. A Prior Authorization is when the prescriber must call the insurance company, explain why the patient must have a certain medication, and often give diagnoses.This usually happens due to cost issues. Sometimes, the insurance company wants a patient to have tried several cheaper options before allowing a more expensive medication to be covered.
For example: Brand Singulair may require a Prior Authorization since a less expensive, “A”rated generic called montelukast is available.
Some insurances will assign different copays based on DAW 1 vs DAW 2; DAW 1 being cheaper. Additionally, in instances such as with epinephrine auto-injectors, a “B” rated auto-injector cannot be substituted as with the special circumstances discussed at the end of The Orange Book post.
Example: Adrenaclick written as Brand Medically Necessary CANNOT be substituted with Lineage’s epinephrine auto-injector under any circumstance of which I am aware without the prescriber removing the DAW 1 indication.
Another way that DAW 1 can be awesome in the food allergy world is by specifying a particular manufacturer.
As we have discussed in Pharmacy Basics: NDC numbers and Package Inserts, inactive ingredients often contain food items. If you have found a manufacturer that makes a product without your particular food allergens, stick with it.
As always, review the package insert before purchasing the medication. Inactive ingredients change just like the recipes for the food we eat. We must review the inactive ingredients each time the medication is picked up.
DAW 2 is simply the patient, patient’s guardian, or patient’s representative requesting a specific brand or manufacturer of medication.
This still may require a Prior Authorization, it may not be covered at all depending on your insurance formulary, and it will not be a less expensive copay but it may be the same copay as prescriptions specified as DAW 1.
However, with DAW 2, if one of those problems arise, you can decide that it’s not worth the copay price or the wait that may be required for a Prior Authorization to be processed.You can say “Never mind, give me the generic.” No need to call the prescriber.
At that point, you can have the pharmacist help you find another compatible manufacturer, if one exists. This will take time, please be patient. If the pharmacist cannot find a suitable alternative, she may need to call the prescriber to see if a medication change is appropriate.
Plus, you may request the brand medication or a particular manufacturer at any time, even if it’s the third refill.
Once the pharmacy staff processes the medication, they should be able to tell you how much it costs, if it requires a “Prior Auth” (as we call it), or if it is just simply not covered.
For more information on DAW codes go here: http://www.pharmacy-tech-resources.com/Dispense-As-Written-Codes.html
In the next few weeks, I will be posting an epinephrine auto-injector comparison chart and Pharmacy Basics: Vocabulary. Please comment below on any particular phrases or vocabulary you would like explained.
Don’t worry, there won’t be a quiz at the end.