Pharmacy providers must submit a value "1" in the "Dispense as Written (DAW) / Product Selection code" field (408-D8) when a prescribing provider wants a nonpreferred brand name dispensed and hand writes the phrase "Brand Necessary," "Brand Medically Necessary," "Brand Name Necessary," or "Brand Name Medically Necessary" across the face of the prescription. The value of “1” will reimburse at the normal calculated cost, including comparison to the submitted "Usual and Customary Charge" and "Gross Amount Due" fields. The value of “1” is not needed if the brand drug prescribed has preferred status on the Texas Medicaid Preferred Drug List.
If an e-prescription is received by a pharmacy with “dispense as written” indicated but without the free text message ("Brand Medically Necessary") or additional note, the pharmacy must contact the prescriber for a new prescription. Submit the claim once the pharmacy receives the e-prescription with both data elements.
Failure of the pharmacy to produce electronic records indicating the proper DAW and “Brand Medically Necessary” in the free-text message for the prescription will result in the claim subject to recoupment. All non-electronic “Brand Medically Prescriptions” (for controlled and non-controlled substances), must continue to comply with current policy and Texas State Board of Pharmacy (TSBP) rules.