When billing insurance, which DAW code is submitted if a patient decides to choose a generic version?

The correct DAW code to submit when a patient chooses to use a generic version of a medication is DAW 0. This code indicates that the substitution of the generic for the brand-name drug is allowed and that the patient has opted for the generic version.

Using DAW 0 signifies that the prescriber has not specified that a brand-name drug must be dispensed and the patient is choosing the lower-cost generic alternative, which is the more common scenario when there are both brand-name and generic options available. This facilitates billing and reimbursement processes by allowing the pharmacy to bill the insurance for the generic medication, which typically has lower copayments and formulary pricing for patients.

In contrast, the other DAW codes have specific meanings that do not apply in this case. DAW 2 is used when a patient requests a specific brand-name drug and the pharmacy dispenses a brand drug instead of a generic, while DAW 3 is relevant when a physician has authorized the substitution, but the patient chooses the brand drug. DAW 4 is utilized when a generic is available but the patient specifically wants the brand-name drug, which does not align with the selection of a generic by the patient.