April 25, 2017
Pharmacy staff should ensure the proper use of Dispense as Written (DAW) values when processing brand-name drugs that have a preferred status on the Texas Medicaid Preferred Drug List (PDL).
The VDP Pharmacy Provider Procedures Manual addresses the processing of brand name drugs when a generic is available. Brand name drugs that are listed as preferred on the Texas PDL do not require the prescribing provider to request brand medically necessary on the prescription with a DAW value of "1" for pharmacies to be reimbursed at the brand name price for traditional or managed care Medicaid.
Traditional Medicaid accepts other submitted DAW values other than "1". Pharmacy staff should refer to the client's managed care plan for the DAW values that plan accepts. Additionally, a pharmacy may substitute a brand name drug for the generic equivalent when written as the generic without requiring additional information from the prescriber.
Other multi-source brand name drugs not listed as preferred on the PDL, or brand name drugs not reviewed for PDL status, will require pharmacy staff to submit a "1" in the "DAW / Product Selection Code" field (4Ø8-D8). This value will override generic pricing. The prescriber is required to write either "Brand Necessary," "Brand Medically Necessary," "Brand Name Necessary," or "Brand Name Medically Necessary" on the prescription for submission of DAW value of '1".
Pharmacy staff with questions may call the VDP Pharmacy Benefits Access Help Desk.