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DAW Codes (Dispense as Written) for Pharmacy

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What are DAW Codes?

DAW codes are used in pharmacy to indicate whether a generic drug or a brand-name drug should be dispensed to a patient when prescribed. They help communicate the prescriber’s intent, specifically regarding whether a substitution (such as a generic for a brand-name drug) is allowed.

DAW Codes

DAW 0: No product selection indicated (generic substitution allowed)
DAW 1: Substitution not allowed by the prescriber (brand name must be dispensed)
DAW 2: Substitution allowed, but the patient requests the brand name
DAW 3: Substitution allowed, pharmacist dispenses  brand name
DAW 4: Substitution allowed, but the pharmacist dispenses a generic drug
DAW 5: Substitution allowed, but the prescriber requests the brand name
DAW 6: Override (substitution is permitted but an override occurs)
DAW 7: Substitution not allowed due to state law
DAW 8: Substitution allowed – Generic Drug not available in Marketplace
DAW 9: Substitution allowed – Plan requests brand

Importance of DAW Codes in Pharmacy Practice:

Communication Tool: They help ensure that pharmacy staff understand the prescriber’s intent and provide the appropriate medication.

Cost Considerations: Understanding the DAW codes helps pharmacists manage medication costs for patients, potentially helping them save money through generic substitution when appropriate.

Patient Safety: By adhering to the DAW codes, pharmacists help maintain accurate medication therapy management and avoid medication errors.

DAW 0: No Product Selection Indicated

Meaning: The prescriber has not specified whether the brand name or generic drug should be dispensed. The pharmacy is allowed to substitute the brand-name drug with a generic version if one is available.

Scenario: A patient is prescribed a medication, but the prescriber leaves it up to the pharmacy to choose the drug form. The pharmacist can fill the prescription with a generic version of the medication if one exists.

Example: A prescription for lisinopril is written without specifying “brand” or “generic.” The pharmacist can choose either the brand-name Prinivil or the generic version.

DAW 1: Substitution Not Allowed by Prescriber

Meaning: The prescriber has explicitly stated that no substitution is allowed. This means the pharmacy must dispense the brand-name version of the drug, even if a generic alternative is available.

Scenario: A prescriber believes the patient requires a specific brand due to clinical reasons (e.g., past allergic reactions to generics, concerns about bioequivalence) or patient preference.

Example: A patient is prescribed Synthroid for hypothyroidism. The prescriber writes “Dispense as Written” (DAW 1) because they believe the brand-name Synthroid is most suitable for this patient, despite the availability of generic levothyroxine.

DAW 2: Substitution Allowed, Patient Requests Brand Name

Meaning: The prescriber has allowed a generic substitution, but the patient insists on receiving the brand-name medication. The pharmacist should honor the patient’s request and dispense the brand-name drug.

Scenario: A patient requests the brand-name drug, either due to personal preference, perceived effectiveness, or past experience with the brand. The pharmacist should respect this request, even if a generic is available.

Example: A patient is prescribed atorvastatin for cholesterol management. The prescriber writes the prescription with the option for a generic, but the patient specifically asks for the brand Lipitor, which the pharmacist can provide using DAW 2.

DAW 3: Substitution Allowed, Pharmacist Dispenses Brand Name

Meaning: The prescriber has authorized a generic substitution, but the pharmacist has chosen to dispense the brand-name drug instead. This may occur due to pharmacy policies, inventory issues, or availability concerns.

Scenario: The pharmacy has a stock shortage of the generic version, and the pharmacist decides to dispense the brand-name version in order to fulfill the prescription.

Example: A prescription for hydrochlorothiazide is written, and the generic version is authorized, but the pharmacist is out of stock of the generic. The pharmacist dispenses the brand-name Microzide and uses DAW 3.

DAW 4: Substitution Allowed, Pharmacist Dispenses Generic Drug

Meaning: The prescriber has allowed a generic substitution, and the pharmacist has chosen to dispense the generic version of the medication. This is the typical scenario when generic drugs are available and often the more cost-effective option for the patient.

Scenario: A pharmacist fills a prescription with a generic version of the drug, following the prescriber’s permission for substitution. This is standard practice when no specific preference for brand or generic is indicated.

Example: A patient is prescribed amoxicillin, and the prescriber allows substitution. The pharmacist dispenses the generic amoxicillin in place of the brand Amoxil and uses DAW 4.

DAW 5: Substitution Allowed, Prescriber Requests Brand Name

Meaning: The prescriber has authorized a generic substitution, but the prescriber specifically requests that the brand-name drug be dispensed. The pharmacist must respect the prescriber’s request and dispense the brand-name medication.

Scenario: The prescriber believes the patient should receive the brand name for clinical reasons, such as differences in formulation or patient response, even though a generic is available.

Example: A prescriber writes for gabapentin with instructions to dispense the brand Neurontin instead of the generic. The pharmacist will fill the prescription with Neurontin and use DAW 5.

DAW 6: Override

Meaning: An override is typically used when the standard substitution rules are not followed due to a special circumstance. This might be due to an insurance issue, clinical concern, or a situation where the normal substitution rules are not applicable.

Scenario: This code is used when a specific circumstance requires a deviation from standard substitution practices. It could involve an exception granted by the insurance company or a clinical reason requiring deviation from typical protocol.

Example: A patient’s insurance company has a policy requiring the dispensation of a particular brand, despite a generic being available. The pharmacist uses DAW 6 as an override to dispense the brand-name drug in compliance with insurance requirements.

DAW 7: Substitution Not Allowed by State Law

Meaning: Some states have laws that prevent substitution of generics for certain medications, even if the prescriber has allowed it. This code is used when state laws prohibit generic substitution.

Scenario: A state law requires that certain high-risk drugs be dispensed only as their brand-name counterparts, even when the prescriber would typically allow a generic substitution.

Example: In certain states, laws may prevent the substitution of a specific anticoagulant (e.g., warfarin) with a generic alternative. In such cases, DAW 7 would be used to indicate that substitution is not allowed by law.

DAW 8: Substitution Allowed – Generic Drug Not Available in Marketplace

Meaning: This code is used for circumstances not covered by the other DAW codes. It serves as a catch-all for situations where none of the standard DAW codes are applicable.

Scenario: A special situation or exception exists that does not fit into the other predefined DAW codes.

Example: A patient has a rare situation or a customized prescription where neither a generic nor the brand-name drug is available, and the pharmacist must choose another alternative. This situation would be documented with DAW 8.

DAW 9: Substitution allowed – Plan requests brand.

Meaning: DAW 9 means the prescriber has allowed generic substitution, but the insurance plan mandates that the brand-name drug be dispensed. This is often due to formulary preferences, rebate arrangements, or specific plan requirements.

Scenario: A patient brings in a prescription for a common medication like Concerta® (methylphenidate ER). The prescriber writes it allowing generic substitution. However, when the pharmacy bills the claim, the insurance rejects it unless the brand-name Concerta® is dispensed—because the plan has a rebate contract that favors the brand.

Example: Prescription: Methylphenidate ER 36 mg, substitution allowed. Insurance Response: Rejects the generic and requires brand Concerta to be covered. Pharmacist Action: Enters DAW 9 to indicate that although substitution is permitted by the prescriber, the insurance plan specifically requires the brand for reimbursement.

Importance of DAW Codes in Pharmacy Practice:

  • Communication Tool: They help ensure that pharmacy staff understand the prescriber’s intent and provide the appropriate medication.
  • Cost Considerations: Understanding the DAW codes helps pharmacists manage medication costs for patients, potentially helping them save money through generic substitution when appropriate.
  • Patient Safety: By adhering to the DAW codes, pharmacists help maintain accurate medication therapy management and avoid medication errors.

Where DAW Codes Are Used?

1. Pharmacy Claim Submissions

DAW codes are entered in the pharmacy software system when submitting a claim to third-party payers like:
  • Insurance companies
  • Medicaid/Medicare
  • Pharmacy Benefit Managers (PBMs)

2. Reimbursement Determination

They help determine:
  • Whether the claim should be paid for brand or generic
  • If the pharmacy will get reimbursed properly
  • Whether a copay adjustment is needed based on drug selection

3. Audit and Compliance Records

DAW codes are used to justify dispensing decisions during insurance audits. Using the correct DAW code ensures the pharmacy complies with:
  • State laws
  • Insurance contract terms
  • Manufacturer rebate agreements (in some cases)

Practice Questions on DAW Codes (Most Predictable in Exams)

Question 1: What does DAW Code 0 indicate?

A) Brand name is medically necessary
B) Substitution allowed; no product selection indicated
C) Patient requested brand name
D) Generic substitution prohibited by law

Answer: B

Explanation: DAW 0 is the default code used when substitution is allowed, and neither the prescriber nor patient has indicated a preference for brand or generic.

Question 2: A prescription is written as “brand medically necessary.” Which DAW code should be used?

A) DAW 0
B) DAW 1
C) DAW 2
D) DAW 9

Answer: B

Explanation: DAW 1 is used when the prescriber specifically indicates that the brand-name drug must be dispensed and no substitution is allowed.

Question 3: If a patient requests the brand-name drug even though a generic is available and allowed by the prescriber, which DAW code applies?

A) DAW 0
B) DAW 1
C) DAW 2
D) DAW 3

Answer: C

Explanation: DAW 2 is used when substitution is permitted, but the patient prefers the brand-name product over the generic.

Question 4: Which DAW code is typically used when the pharmacist fills a prescription with the generic version without any specific product selection instructions?

A) DAW 1
B) DAW 2
C) DAW 0
D) DAW 9

Answer: C

Explanation: DAW 0 is used when no product selection is indicated, allowing for generic substitution.

Question 5: Which DAW code may result in higher out-of-pocket costs for the patient due to their preference?

A) DAW 0
B) DAW 1
C) DAW 2
D) DAW 9

Answer: C

Explanation: DAW 2 often leads to higher copays or full costs since the patient requests the brand drug when a generic is available and allowed.

Question 6: Which DAW code reflects a legal or medical requirement for the brand name to be dispensed?

A) DAW 2
B) DAW 0
C) DAW 9
D) DAW 1

Answer: D

Explanation: DAW 1 indicates that the prescriber requires the brand drug due to medical necessity, often enforced by law or insurance rules.

Question 7: A prescription for Lipitor is written without any special instructions. The pharmacy attempts to dispense generic atorvastatin, but the patient’s insurance plan requires the branded Lipitor due to formulary limitations.

Which DAW code is most appropriate to use?

A) DAW 0
B) DAW 1
C) DAW 2
D) DAW 9

Answer: D

Explanation: DAW 9 is used when the plan (payer) requires brand-name dispensing even though generic is available. This code reflects third-party formulary mandates.

Question 8: A doctor writes a prescription for amlodipine with no indication of brand necessity. The pharmacy offers the generic, but the patient insists on receiving Norvasc, the brand version.

Which DAW code should be applied?

A) DAW 0
B) DAW 1
C) DAW 2
D) DAW 3

Answer: C

Explanation: DAW 2 applies when substitution is allowed, but the patient requests the brand-name product, which may result in higher costs.

Question 9: A prescriber writes "Brand Medically Necessary" on a prescription for Synthroid. The pharmacy must dispense the brand despite generic levothyroxine being available.

What DAW code fits this scenario?

A) DAW 1
B) DAW 0
C) DAW 2
D) DAW 3

Answer: A

Explanation: DAW 1 is used when the prescriber specifically requires the brand medication due to medical necessity or efficacy concerns.

Question 10: A prescription for lisinopril is received without any special notation. The pharmacy dispenses the available generic, and the patient accepts it without objection.

Which DAW code should be applied in this case?

A) DAW 1
B) DAW 0
C) DAW 2
D) DAW 9

Answer: B

Explanation: DAW 0 is used when substitution is allowed, and neither the prescriber nor patient has specified a preference, which is the most common case.
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