We previously wrote about the National Council for Prescription Drug Programs (NCPDP) introduction of  a new Dispense as Written (DAW) code, “DAW A,” defined as “Multi-payer Brand/Reference Product Formulary Conflict.” This code would be used in the event of a claim where there are two or more payers involved, and one payer (primary or secondary) will only cover the brand drug via DAW 9, while the other payer prefers that the generic product be dispensed.

At the NCPDP May 2025 Work Group, the membership voted to sunset the DAW A value. This decision was made with the expectation that payers should enhance their claim processing rules and make one of two decisions in this type of scenario: (1) Payer should pay their portion for the generic, even when the generic is not their preferred product, or (2) Payer should pay as the secondary plan on the brand claim when the primary payer rejects the brand. This simplification can be put into place without requiring pharmacies to make system and process adjustments that would have been required with DAW A.

The industry collectively determined that implementation of this new value would be a challenge to multiple stakeholders involved. When considering the widespread industry, it is more convenient for the secondary plans to either choose to pay their portion for the nonpreferred generic OR pay for the full brand reimbursement when the primary rejects the branded product that the secondary payer prefers. Note that state Medicaid plans are generally the secondary payers in these claim situations.

PHSL can assist payers with assessing the financial impacts of these scenarios to enable a data-driven approach to the implementation decision. Reach out to discuss your needs.