How to Prevent Substitution Guide

State Specific Laws on Drug Product Selection
This information is a summary based on the Drug Product Selection Laws Section of the 2012 Survey of Pharmacy Law done by the National Association of Boards of Pharmacy. This only serves as guide/reference, for patients along with their healthcare provides, to understand and navigate the regulations regarding drug substitution, more commonly referred to by many as Dispense as Written (DAW). Please note that Individual state law is subject to change and may allow other ways to indicate no substitution.

State	Generic Substitution		How to Prevent Substitution	Patient Consent
	Permissive - State law permits the pharmacists to substitute a generic version of the prescribed drug.	Mandatory - State law mandatorily require the pharmacist to substitute a generic version of the prescribed drug.		Yes - Includes states where consent is required and those that require the patient to be notified/informed of substitution
Alabama	√		Prescriber must sign the appropriate on signature line of two-line prescription.	Yes
Alaska	√		Prescriber must handwrite “Brand Necessary”	Yes
Arizona	√		Prescriber must expressly indicate that substitution is not allowed	Yes
Arkansas	√		Prescriber must handwrite “Brand Necessary”	Yes
California	√		Prescriber must handwrite or orally state “Do Not Substitute” or similar words or initial the “Do Not Substitute” box	Yes
Colorado	√		Prescriber must handwrite “Dispense as Written” or initial the “Dispense as Written” pre-printed box	Yes
Connecticut	√		Prescriber must handwrite “DAW,” “Dispense as Written,” or “Medically Necessary”	Yes
Delaware	√		Prescriber must handwrite “DAW” or “Dispense as Written”	Yes
District of Columbia	√		Prescriber must expressly indicate that substitution is not allowed	Yes
Florida		√	Prescriber must expressly indicate that substitution is not allowed	Yes
Georgia	√		Prescriber must handwrite “Brand Necessary” or “Brand Medically Necessary”	Yes
Guam	√		Prescriber/Licensed Practitioner must handwrite "No Substitution" or "No sub"	No, Patient may request the brand name to be dispensed, but prescriber must authorize generic
Hawaii	√		Prescriber must handwrite “brand necessary” or “brand medically necessary”	Yes
Idaho	√		Prescriber must mark “May not substitute” or check brand only box	Yes
Illinois	√		Prescriber must mark “May not substitute”	No, Except for anti-epileptic drugs
Indiana	√		Prescriber must sign the appropriate on signature line of two-line prescription.	Yes, patient must be informed/notified
Iowa	√		Prescriber must expressly indicate that substitution is not allowed	Yes
Kansas	√		Prescriber must sign the appropriate on signature line of two-line prescription or must expressly indicate that substitution is not allowed	Yes, patient must be informed/notified
Kentucky		√	Prescriber must handwrite “Brand Medically Necessary” (Medicaid) or expressly indicate that substitution is not allowed or “Do Not Substitute”	Yes
Louisiana	√		Prescriber must check box on prescription	Yes
Maine	√		Prescriber must expressly indicate that substitution is not allowed or check box on prescription	Yes
Maryland	√		Prescriber must handwrite “Brand Medically Necessary” (Medicaid), or expressly indicate that substitution is not allowed	Yes
Massachusetts		√	Prescriber must indicate “No Substitution”	No
Michigan	√		Prescriber must handwrite “DAW” or “Dispense as Written”	No
Minnesota		√	Prescriber must handwrite “DAW” or “Dispense as Written”	Yes
Mississippi		√	Prescriber must sign the appropriate on signature line of two-line prescription.	Yes
Missouri	√		Prescriber must sign the appropriate on signature line of two-line prescription.	Yes
Montana	√		Prescriber must handwrite “Brand Name Medically Necessary,” or printed if electronically generated.	Yes
Nebraska	√		Prescriber must expressly indicate that substitution is not allowed	Yes
Nevada		√	Prescriber must handwrite “Dispense as Written”	No
New Hampshire	√		Prescriber must handwrite, orally state, or include on the face of electronically transmitted prescription, “medically necessary”	Yes
New Jersey		√	Prescriber must sign the appropriate on signature line of two-line prescription.	No
New Mexico	√		Prescriber must handwrite “No Substitution” or “No Sub.”	No
New York		√	Prescriber must handwrite “Brand Medically Necessary” (Medicaid) or indicate "DAW or “Dispense as Written” in the designated box	Yes
North Carolina	√		Prescriber must sign the appropriate on signature line of two-line prescription or expressly indicate that substitution is not allowed	Yes, For narrow therapeutic drugs only
North Dakota	√		Prescriber must handwrite “Brand Medically Necessary”	Yes
Ohio	√		Prescriber must handwrite “DAW” or “Dispense as Written	Yes
Oklahoma	-	-	Unlawful for pharmacists to substitute without the authority of prescriber or purchaser	Unlawful for pharmacists to substitute without authority of prescriber or purchaser
Oregon	√		Prescriber may specify in writing, telephone communication or by electronic transmission that there shall be no substitution	No
Pennsylvania		√	Prescriber must handwrite “Brand Necessary” or “Brand Medically Necessary”	Yes
Puerto Rico		√	Prescriber must handwrite “Do not interchange”	Yes
Rhode Island		√	Prescriber must handwrite “Brand Necessary” or “Brand Medically Necessary” or patient may request, in writing, that the brand name be dispensed	No
South Carolina	√		Prescriber must sign the appropriate on signature line of two-line prescription.	Yes
South Dakota	√		Prescriber must handwrite “Brand Necessary”	Yes
Tennessee	√		Prescriber must handwrite “Brand name medically necessary,” “dispense as written,” “medically necessary,” “brand name,” “no generic,” or any abbreviation of this language or circle preprinted “dispense as written”	No
Texas	√		Prescriber must handwrite “Brand Necessary” or “brand medically necessary”	Yes
Utah	√		Prescriber must expressly indicate that substitution is not allowed or check pre-printed “Do Not Substitute” box	Yes
Vermont	√		Prescriber must handwrite “brand necessary,” “no substitution,” "dispense as written" or "DAW" plus a statement that the generic equivalent has not been effective or is reasonably certain it will not be effective or is reasonably certain to cause adverse reactions	Yes
Virginia	√		Prescriber must handwrite “Brand Medically Necessary”	Yes
Washington		√	Prescriber must sign the appropriate on signature line of two-line prescription.	No, Patient may request the brand name to be dispensed, but prescriber must authorize generic
West Virginia		√	Prescriber must expressly indicate that substitution is not allowed or handwrite “Medically Necessary,” "brand necessary," or "brand medically necessary"	Yes
Wisconsin	√		Prescriber must expressly indicate that substitution is not allowed	Yes
Wyoming	√		Prescriber must expressly indicate that substitution is not allowed	No

References

National Association of Boards of Pharmacy. Survey of Pharmacy Law—2012. Mount Prospect, IL: National Association of Boards of Pharmacy; 2011.

Wockhardt USA (2010), State-Specific Regulations for Writing Dispense as Written (DAW).

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