If a patient has MaineCare and DAW is not checked, when is generic substitution required?

The correct answer is focused on the requirement for generic substitution when a patient has MaineCare and 'Dispense As Written' (DAW) is not checked. In this context, generic substitution is typically mandated if it is deemed cost-effective by health services. This approach aligns with the principles of promoting cost efficiency in prescription drug spending, especially within programs like MaineCare, which aim to provide accessible healthcare while managing costs effectively.

When DAW is not checked, it signals that the prescriber has not prohibited the use of a generic equivalent. Therefore, if the generic option is available and is cost-effective, the pharmacy must refill the prescription with the generic medication to comply with the standards set forth by health services involved in the state Medicaid program. This policy supports patients by providing them with more affordable medication options.

Other scenarios, such as requiring the patient's specific request or needing to contact the prescriber, do not align with the standard practices for generic substitution under MaineCare. The emphasis is on cost-effectiveness initiated by health services to drive the decision for substitution, rather than on individual patient preference or direct communication with prescribers.