Date: 11/24/09
Beginning January 1, 2010, Horizon Blue Cross Blue Shield of New Jersey will introduce new Dispense as Written (DAW) system edits to help your clients optimize their pharmacy benefits while ensuring their employees receive the safest and most effective treatments. There are two types of DAW rules:
• DAW 1 - substitution not allowed by provider. The prescriber writes “Dispense as Written” on a prescription, indicating that a generic equivalent should not be substituted for the brand.
• DAW 2 - patients requested dispensed product. An employee is requesting the brand and that he or she does not want the generic equivalent. The DAW system edits will encourage prescribers and your clients’ employees to use cost-effective generic medications when available. For DAW1 prescriptions for drugs and products subject to prior authorization, medical necessity for the brand must be demonstrated before the lower copayment will apply. If medical necessity is not demonstrated, or if the employee has requested the more costly brand drug (DAW2), the employee will be responsible for the difference between the cost of the brand drug and the medically necessary generic equivalent, plus the usual generic copayment. DAW system edits are designed to increase members’ awareness of health care costs and their role in controlling them. FDA-approved generic medicines cost consumers 30 percent to 80 percent less than brands. More specifically, every 1 percent increase in overall generic dispensing rate can reduce plan costs by 1 percent. Beginning January 1, 2010, DAW 1 system edits will commence for all fully-insured clients with prescription benefits that include prior authorization requirements, while DAW 2 is in effect for all fully-insured groups, with or without prior authorization requirements. In addition, Horizon BCBSNJ will introduce the new Advantage Formulary, which will encourage the use of generic drugs first in nine therapeutic classes. If you have any questions about these changes or their impact on your clients, please contact your sales representative. Saving your clients and their employees on their prescription drug costs is just another way we’re Making Healthcare Work.
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