I really get angry when I see a DAW-1 on a prescription. To me, a DAW-1 without a good reason is like saying “Hey pharmacist bitch, do what I say right now because I’m the doctor and I know whats best in drug-land”. Bzzt, welcome to AngryPharmacyLand.
For those who don’t work in medicine, a DAW-1 means “Dispense as Written code 1” (There are a bunch of DAW codes to signify different things like “Generic not available”, “Brand dispensed as generic”, etc). However a DAW-1 is doctor speak for “I want this Rx to be exactly how I want it, I don’t want any changes/substitutions made”.
Now some doctors are confused. Lets indulge ourselves into what a DAW-1 means from a pharmacist standpoint. You see, DAW-1 (to us) is meant to be used when a doctor wishes a BRAND NAME medication used instead of a FDA approved generic. Most (if not all) states allow the pharmacist to auto-substitute a generic when the Dr writes the brand name on the pad. This is great because I’d rather have doctors write Maxide instead of triamterene/HCTZ. Brand names are shorter and (especially with birth control) a whole lot easier to deal with.
If a Doctor gets a wild hair up his/her ass and wants trade name Maxide (HAHAH!), they would write Maxide (DAW-1) while checking and initialing the little box by where they sign their name (which NO doctor can seem to get right) to prove that they indeed want the brand name dispensed instead of the generic substitution. This also can be noted by putting “DNS” for “Do Not Substitute”. Again, the checking & initialing the little “Do Not Substitute” is beyond an MD education. If you cannot get this right, then obviously there should be some question as if the DAW-1 is education driven, or some big-titted drug-rep driven.
Whats funny, is when doctors (but mostly PA/NP’s) put DAW-1 on EVERYTHING thinking that it means something. Diovan (DAW-1), Lipitor (DAW-1), Zyvox (DAW-1). Now you (and only you) may feel like you are doing the world a favor by putting DAW-1 on a bunch of Rx’s for brand-name-only products, but you’re just looking like an idiot to us pharmacists. You may think you are actually doing something via the DAW-1 code, but I hate to tell you, most states do not allow us to substitute completely different drugs, only a brand name drug to its FDA-approved generic. So you are telling us DO NOT SUBSTITUTE a generic for a drug you wrote that has no generic out. Way to go! You’re a winner!
Wait, you think that the patients insurance company will give 2 fucks about your DAW-1? Hate to tell you, but for all they care you can take that DAW-1, roll up really right and shove it straight up your ass. 99% of the insurance companies laugh at your DAW-1 and make your ass fill out prior-auth paperwork in lieu of putting DAW-1 on the Rx. Even if they do take the DAW-1 code, they just make the patient pay full price (or just flat out refuse to cover the medication). Now the patient gets no medication because you are too hooked on the pharma-pot-pie to “settle” for a generic (and the patient cant afford the brand name). A winner is you! Thats patient care right there! Remember, patient care does not start with you, it doesn’t start with me, it starts with whoever is footing the bill. Who pays for the drug makes the rules for the drug (unless your patient wishes to pay for it, but we all know the F in Pharmacy stands for “Free”).
All kidding aside, I’ve seen loads of doctors do DAW-1’s for really stupid shit (like psycho endocrinologists for Glucophage, Glucovance, Amaryl, Glyburide, etc) only to have the patient be SO noncompliant that I could fill the vial up with cow-shit and get more therapeutic response than your DAW-1’d drugs. Is it my job to make sure they take their medications? Sure, I blow them shit when they are 2 weeks late getting it filled, but I’m not their fucking nanny. Teachers are also notorious for wanting trade-name stuff because they “deserve it” (and know SO MUCH MORE THAN WE DO).
Really, if you prescribers in the audience really want to get your point across with this DAW-1 bullshit, you are better off telling us WHY the generics cant be used or WHY the formulary cannot be used (brittle blood levels with warfarin/tegretol). It’ll make it seem less bossy than DAW-1 (bitch!), but maybe (just maybe) we can save you a ton of time by faxing you the proper forms to sign or point you where to get that prior auth. Give us more “here is why I want this” vs “I just want this because I can”.
So what do we do when a patient brings in a DAW-1 Rx that the patient cannot afford, and the doctor refuses to change it to something else? The patient is now put into a position where he/she feels they need this super-expensive medicine that their “Obviously” intelligent doctor wants for them. Never mind the fact that the pharmacist has about 3 alternatives up his sleeves that might not work quite as well as what the reps spout, however its affordable and wont take food off of the patients table.
Here is something else to consider. Patient brings in a prescription for Drug-X that is DAW-1 for some reason. Patient cannot afford the $200 cost and the doctor (being an ass) refuses to change it to something else that costs less. Now the patient either forgoes treatment because the doctor wants THIS and ONLY THIS (even though a $12 generic might not work as well, but its better than nothing) or forgoes buying Xmas presents for their children or some other Quality of Life lowering factor due to the $200 they dropped for this drug. Or worst case they just go without and get nothing. Pisses me off when I call the doctor asking to change, and him/her (or one of their front end ‘staff’) says “Nope, we’re not going to change”. My response is “Good idea, the patient can’t afford this, so now they will take nothing.” Asshats.
There is /always/ some sort of drug alternative in medicine. Sure it may not work as well or be exactly what you are looking for, but having the patient not take/cant afford the medication due to some drug-rep telling you that “this is new and better” when you had been using drug x for the last 20 years before it went generic last week is (to me) bad medicine.