Substitutions

substitutions best practices ensure accurate substitution authorization using daw ✅ quality checks ensure accurate substitution authorization using daw as part of the medication prescribed segment, the ncpdp script standard includes the substitutions field, which allows the prescriber to identify whether the prescribed medication may be substituted for a therapeutic and bio equivalent medication product the dispense as written (daw) code is used to communicate the substitution authorization for each prescription use the substitutions field to indicate “dispense as written” codes ensure substitution information is not included in the note field unless it is required by law clinical relevance/rationale in most states, when a prescriber issues a prescription for a brand name drug, regulations allow the pharmacist to substitute an fda approved generic medication in its place however, a prescriber may override such rules by prescribing brand name/trade name drugs and requesting that they be "dispensed as written" pharmacists rely on the substitutions indicator to determine whether they are allowed to dispense a generic equivalent it is important that the information in this field be accurate and that prescribers are familiar with the appropriate use cases since generic medications are typically less expensive than their branded counterparts, there may be financial implications for the patient and/or pharmacy if incorrect or inconsistent information is transmitted best practices for technology partners ensure this field defaults to “0” to indicate substitution is allowed, thus saving the prescriber time during order entry the prescriber would need to actively select “1” to indicate a substitution is not allowed (i e , dispense as written) if they choose to order a brand name medication and have the patient receive the brand name medication ensure the e prescribing preferred name (epn) only indicates the brand/trade name best practices for prescribers some state programs (e g , medicaid) require the prescriber to include the phrase “brand medically necessary” for a brand prescription with no substitutions permitted the reasonforsubstitutioncodeused field is designed for this purpose and should be used, in addition to being entered in the note field do not indicate “dispense as written” (substitution = 1) for generic medications if the prescriber wants a brand name medication to be dispensed, select the brand name medication from the database and indicate “substitution not allowed (1) ”