DAW 1 Coding and Reimbursement Rates
Customize your policy alerts
Sign up for all kernfamilyhealthcare policy alerts
Know when kernfamilyhealthcare releases new policies or updates existing guidance.
Monitor payer policy activity
Defines how claims identified with Dispense as Written 1 (DAW 1) are reimbursed for multisource brand drugs and the role of prior authorization and member claim history; applies to pharmacy providers submitting claims for Kern Family Health Care members.
During a 180-day transition (retroactive to Jan 1, 2022) MSB claims with DAW 1 will be reimbursed at brand price if member has prior paid brand claim or active PA, and a PA Type Code of 1 is no longer required for brand pricing.
Effective July 1, 2022, a clinical prior authorization is required for reimbursement at the brand-name price; approved PAs pay at brand price for the PA duration.
There will be no edits on the use of any other DAW code.
Brand‑price Reimbursement Criteria
Brand-price reimbursement criteria for DAW 1 MSB claims
Covered when ALL of the following conditions are met:
ANY of the following
- Beneficiary has a paid claim for the same brand-name drug in claim history
- Beneficiary has an active prior authorization for the same brand-name drug
DAW Coding and Transition Period
| DAW 1 | Dispense as Written 1 — prescriber requested brand product |
Prior Authorization Requirements and Provider Guidance
Clinical prior authorization required for brand-price reimbursement (DAW 1 MSB)
Submit a clinical prior authorization (PA) to obtain reimbursement at the brand-name price for medically necessary brand-name multisource (MSB) drugs. During the 180-day transition (retroactive to Jan 1, 2022) a beneficiary’s paid claim for the same brand-name drug or an active PA in the member’s history also qualifies the claim to be paid at the brand price; effective July 1, 2022 a clinical PA must be submitted for brand-price reimbursement. Approved PAs pay at the brand-name price for the duration of the PA effective date.
- Transition rule (retroactive to Jan 1, 2022): paid claim for same brand or active PA in member history qualifies DAW 1 MSB claim for brand pricing. [[source cited]]
- If no prior paid claim or active PA exists during the transition, pharmacy or prescriber may submit a clinical PA justifying medical necessity; approved PA pays at brand price for the PA duration. [[source cited]]
- Post-transition (effective July 1, 2022): a clinical PA is required for reimbursement at the brand-name price; approved PAs pay at brand price for the PA duration. [[source cited]]
- Prior Authorization Type Code = 1 is no longer required for a medically necessary brand-name drug PA to pay at the brand-name price. [[source cited]]
Key Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.