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13 Cards in this Set
- Front
- Back
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The Maximum Allowable Cost is usually (greater than or less than) the Usual and Customary (U&C) price.
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less than
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What is meant by Maximum Allowable Cost or MAC?
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the maximum price per tablet (or other dispensing unit) an insurer or PBM will pay for a given product
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What is meant by U&C or UCR?
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the maximum amount of payment for a given prescription, determined by the insurer to be a usual and customary (and reasonable) price
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What does the DAW code 0 indicate?
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No DAW
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What does the DAW code 1 indicate?
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DAW handwritten on the prescription by the prescriber
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What does the DAW code 2 indicate?
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Patient requested brand
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What does the DAW code 3 indicate?
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Pharmacist selected brand
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What does the DAW code 4 indicate?
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Generic not in stock
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What does the DAW code 5 indicate?
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Brand name dispensed but priced as generic
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What does the DAW code 6 indicate?
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N/A
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What does the DAW code 7 indicate?
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Substitution not allowed; brand mandated by law
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What does the DAW code 8 indicate?
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Generic not available
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What does it mean when "Refills Not Covered" is the reason for a rejected claim?
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The patient has a mail order pharmacy for maintenance medications.
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