The Medicaid Department updated the Medicaid Fee-for-Service Providers Dispense Brand Name Drug when Less Expensive than Generic Program. 

Effective 10/6/2022, the following changes will be made to the Dispense Brand Name Drug 

When Less Expensive Than the Generic Program: 

• Daytrana, Nexavar, Pradaxa and Ventolin HFA will be ADDED to the program
• ProAir HFA will be REMOVED from the program.

In conformance with State Education Law, which intends patients receive the lower cost drug 

alternative, brand name drugs included in this program: 

• Do not require ‘Dispense as Written’ (DAW) or ‘Brand Medically Necessary’ on the

prescription. 

• Have a generic copayment.
• Are paid at the Brand Name Drug reimbursement rate or usual and customary price,

whichever is lower (SMAC/FUL are not applied). 

• Do not require a new prescription if the drug is removed from this program.

IMPORTANT BILLING INFORMATION 

Pursuant to this program, prescription claims submitted to the Medicaid program do not require the submission of Dispense as Written/Product Selection Code of ‘1’; Pharmacies should submit DAW code 9 (Substitution Allowed by Prescriber but Plan Requests Brand). Pharmacies will receive a NCPDP (National Council for Prescription Drug Programs) reject response of “22” which means missing/invalid DAW code if other DAW codes are submitted. The only exception to this, is DAW code 1 and “Brand Medically Necessary” on the prescription. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.