Mark Cuban

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There is a two-character code on nearly every prescription claim your plan pays.

It decides whether your plan or your member absorbs the difference between a brand drug and its generic: DAW code (Dispense As Written).

DAW 1 means the prescriber required the brand. DAW 2 means the member asked for it.

Most plan designs say the same thing: if the member chooses brand when a generic exists, the member pays the brand copay plus the difference. That is DAW 2.

DAW 1 is different. When the prescriber requires the brand, the plan usually absorbs the difference. That is the correct design and there are real clinical reasons for it.

The code is applied at the pharmacy counter, your plan does not set it and your PBM adjudicates it. In the reporting most plans receive, the DAW breakdown does not appear anywhere.

The field that decides who pays the brand premium is invisible to the party paying.

We ran 132 pharmacy benefit reviews last year at Prescription Benefit Solutions, with an average recovery of $469,000 per plan. A surprising share of that came from line items exactly this small, found by counting something nobody had counted.