"Dispense as written," or DAW, prescriptions cost the health care system up to $7.7 billion annually, according to a study by researchers at CVS Caremark Corp., Harvard University, and Brigham and Women's Hospital.

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CVS Caremark: 'DAW' prescriptions prove costly

March 25th, 2011

WOONSOCKET, R.I. – "Dispense as written," or DAW, prescriptions cost the health care system up to $7.7 billion annually, according to a study by researchers at CVS Caremark Corp., Harvard University, and Brigham and Women's Hospital.

CVS Caremark said Friday that about 5% of prescriptions submitted by its pharmacy benefit management (PBM) members in a 30-day period during 2009 included a DAW designation, in which doctors or patients demand the dispensing of a specific brand-name drug and not a generic drug alternative. Those requests also reduce the likelihood that patients actually fill new prescriptions for chronic conditions, researchers found.

In a study published this week in the American Journal of Medicine, the researchers demonstrated that DAW prescriptions have key implications for medication adherence. They found that when starting new therapy, chronically ill patients with DAW prescriptions were 50% to 60% less likely to fill the more expensive branded prescriptions than generics.

"Although dispense-as-written requests would seem to reflect a conscious decision by patients or their physicians to use a specific agent, the increased cost sharing that results for the patient may decrease the likelihood that patients actually fill their prescriptions," the researchers stated.

The study reviewed 5.6 million prescriptions adjudicated by CVS Caremark for 2 million patients from Jan. 1 to Jan. 31, 2009, finding that 2.7% of those prescriptions were designated DAW by doctors and 2% were requested DAW by patients.

Reseachers concluded that if safe, effective generic alternatives had been provided instead of those brand-specific prescriptions, patients would have saved $1.7 million and health plans would have spent $10.6 million less for the medications. Assuming a similar rate of DAW requests for the more than 3.6 billion prescriptions filled nationwide each year, patient costs could be reduced by $1.2 billion and overall health system costs could be lowered by $7.7 billion, they said.

"Previous to this study, little was known about the frequency with which doctors and patients request dispense as written prescriptions," study author Troy Brennan, executive vice president and chief medical officer at CVS Caremark, said in a statement. "Those who advocate for dispense as written and argue that the practice provides patients and physicians with greater choice will probably be surprised to learn that the practice increases costs and exacerbates nonadherence."

Study lead author William Shrank, M.D., MSHS, of Brigham and Women's Hospital and Harvard, noted that the research shows that DAW requests are costing the health care system billions of dollars. "The further irony is that patients with prescriptions specifying a certain brand seem less likely to fill their initial prescriptions, adding to the medication nonadherence problem," he added.

The study is part of CVS Caremark's three-year collaboration with Harvard University and Brigham and Women's Hospital to research pharmacy claims data to better understand patient behavior, particularly around medication adherence.

In January, CVS Caremark reported that another study by the collaboration found that although most physicians are comfortable with generic drugs, some still have negative perceptions about them, which affect their prescription choices. Researchers found that 23% of doctors have negative views of the effectiveness and quality of generics, and that may lead them to prescribe unnecessarily expensive medications.