Prescriptions for Preferred Brands with Non-preferred Generic Alternatives

The issue communicated from NCTracks on 8/1/2016 where preferred brands with non-preferred generic alternatives were pricing with the NADAC generic cost basis instead of the NADAC brand cost basis has been resolved and the impacted claims have been reprocessed by NCTracks.

Brand preferred/generic non-preferred prescriptions will reimburse at the NADAC brand cost basis when submitted using a DAW code of 1 or 8 (or 7 for NTI drugs). The use of DAW code 9 for brand preferred/generic non-preferred prescriptions will not allow these prescriptions to be correctly reimbursed and will result in an underpayment.

DMA is aware of concerns over the use of DAW codes 1 and 8 for brand preferred/generic non-preferred prescriptions and has identified a solution that will not require brand preferred/generic non-preferred prescriptions to be submitted with a DAW code in order for these prescriptions to be correctly reimbursed. This solution is currently being developed and tested by CSRA, the vendor responsible for maintaining NCTracks, and has been given a priority status. Further information will be provided once the solution is scheduled for implementation into NCTracks.

Until the final solution is implemented into NCTracks, pharmacy providers may submit their claims for brand preferred/generic non-preferred prescriptions using a DAW code 1 or 8 (or 7 for NTI drugs) as stated above. Pharmacy providers may also wait until the final solution is implemented into NCTracks when the use of a DAW code will not be required and resubmit their claims where underpayment has occurred at that time.