If a generic drug is available but a patient requests the brand name, how should it be billed?

When a patient requests the brand-name version of a drug despite the availability of a generic alternative, it should be billed using a specific Dispense As Written (DAW) code. In this scenario, the appropriate code is DAW 1. This code indicates that the patient has requested the brand-name drug and that the generic alternative is not acceptable to them.

DAW 1 signifies that the patient insists on receiving the brand-name drug, which directly influences how the claim is processed by insurance companies. This is crucial for proper billing because using the correct DAW code can affect reimbursement rates and the approval of the claim, ensuring that the pharmacy gets compensated appropriately for dispensing the brand product as requested by the patient.

While alternative DAW codes exist, they serve different purposes: DAW 0 indicates that the generic can be dispensed, DAW 2 indicates the physician requested the brand but allows for substitution, and DAW 3 signifies that a pharmacist chose to dispense the brand name instead of the generic. In this case, since the patient solely requested the brand over the available generic, DAW 1 is the correct choice.