In what situation is a pharmacist NOT required to substitute a generic for a branded drug?

A pharmacist is not required to substitute a generic for a branded drug when the physician indicates "DAW," or "Dispense As Written," on the prescription. This instruction from the prescriber signifies their explicit preference for the brand-name medication over any generic alternatives. The "DAW" notation indicates to the pharmacist that the prescriber believes the branded version is necessary for the patient's treatment, whether due to reasons such as efficacy, tolerability, or specific patient needs.

In cases where a patient requests a generic or where the generic is more expensive, there may still be circumstances in which the pharmacist can or should provide a generic option, depending on the prescription's specifics and insurance coverage. Similarly, third-party payment may affect costs and choices but does not override a physician's directive. Understanding the implications of a "DAW" order is crucial in pharmacy practice, as it helps ensure that the prescriber’s intent and patient care considerations are prioritized.