DAW 8: Documentation When the Generic is Not Available

supporting documentation be placed on any prescription billed with a DAW code (DAW 0 does not require documentation). Supporting documentation when the prescriber, patient, or insurance require the brand name medication is simple and straightforward. However, what steps should be taken when dispensing a brand name due to the generic not being available?

DAW 8 is only used in situations where the prescriber is allowing a substitution, a generic product exists, but you are unable to order it due to a market shortage. PAAS recommends documenting the date and the fact the generic is not available in the marketplace on the prescription. Ideally, take the time to capture an image from your pharmacy wholesaler’s website showing the generic product unavailability on that date and retain the image in a way it can be easily obtained for an audit (e.g., file it with the hardcopy prescription). Alternatively, you can reference the invoice number from your wholesaler showing the product was ordered but not sent due to being out of stock. An auditor may never ask for this proof, but if they do, you may struggle years later when the claim is audited.

PAAS Tips:

• Always document the reason on the prescription any time a DAW other than 0 is used
• When billing DAW 8, document the market shortage and ideally maintain proof from your wholesaler of the generic being out of stock (e.g., screen capture, invoice, etc)
• For a detailed description of each DAW code, refer to DAW Codes Explained under Proactive Tips.
• Review the April 2024 Newsline article, 2024 Self-Audit Series #2: DAW Codes for best practices when billing DAW codes