DAW Codes
What does "DAW" stand for?
Dispense As Written
What does the term "Third Party Payer" refer to?
Insurance companies or place of employment that pays for the patient's services.
Name the 3 main government sponsored insurance providers.
Medicare (over 65 and some disabled persons)
Medicaid (or MediCal in California)
TriCare (Military/Veteran)
Who are the "three parties" involved the insurance claims processing.
1. Patient or person receiving services
2. Person or company that provides the services (Doctor or pharmacy, etc)
3. Group that pays for all or part of the services (Insurance)
Which DAW code is used when the prescriber wants the patient to use the brand name medication (not generic).
DAW 2
A cost-sharing requirement of most insurance policies, under which it is the responsibility of the insured to make a payment of a specified amount (e.g., $20) at the time of treatment or purchase of a prescription.
Copayment
Name of the insurace that provides coverage for employees injured in the workplace.
Worker's Compensation
Specializes in the management of the prescription portion of a managed health care plan. PBMs contract with participating pharmacies, process claims, control costs, and manage the various elements of the pharmacy benefit, including formularies and utilization review.
What does DAW 0 stand for?
No particular product selection is indicated. Prescriber and Patient accept the generic substitution or there is no generic substitution.
A specific amount of money that must be paid yearly before the policy benefits begin.
Deductible
The "part" of Medicare that pays for prescription medications.
Medicare Part D
What is a prescription "formulary".
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits
What does DAW 7 stand for?
When a state mandates a brand name medication be used instead of a generic medication.
The monthly cost associated with having an insurance plan through an employer or private insurance.
Insurance Premium
A type of insurance that requires you to have a referral from another provider to see specialists.
HMO (Health Maintenance Organization)
What 4 numbers off the patient's insurance card will you need to process an insurance claim?
1. Patient ID Number
2. Rx Group Number
3. PCN Number
4. BIN Number
Which DAW code is used when the generic is not in stock at the pharmacy so a brand name is dispensed?
DAW 4
A set of numbers or letters (or combination of both) that identifies specific benefits plan for the member.
Group Number
The "part" of Medicare that pays for medical equipment, xrays or lab services.
Medicare Part B
A requirement that specific medications be covered only if approved by the third party-payer. Usually prescribers or pharmacists but certify that the medication is medically necessary and superior to less costly alternatives before approval is given.
Prior Authorization