Audit Risk: Billing DAW 1 Unnecessarily

In a time where every aspect of prescriptions is scrutinized, PAAS National® wants to ensure you don’t forget simple filling and billing practices; in this case, using DAW 1 appropriately. PBMs can flag pharmacies who use a high volume of DAWs (other than zero), increasing your pharmacy’s audit risk. A simple way to decrease the amount of non-DAW 0 claims that are being adjudicated is to …

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not use DAW 1 for single-source brand products, reference products without an interchangeable biosimilar, and medical supplies (e.g., test strips, lancets, and glucose meters).

This includes situations where the prescription comes to your pharmacy indicating “Dispense as Written” per prescriber. The best practice in those scenarios would be to contact the prescriber and inform them a DAW 1 is not appropriate since there is no product on the market deemed to be substitutable. Subsequently, make a full clinical note on the hardcopy with the date, name and title of the person you spoke with, a recap of the conversation, and your initials.

If there are questions regarding proper DAW use, refer to the DAW Codes Explained tool, which can be found under the “Proactive Tips” section on the PAAS Portal.

PAAS Tips:

  • The two most common Reference Product biologics with an interchangeable biosimilar on the market are Lantus® and Humira®

Meredith Thiede, PharmD