NSW Government State Insurance Regulatory Authority (SIRA) published the Better Practice Guide: Medication Management in July 2020. The Better Practice Guide highlights the issue of medication use within the personal injury scheme as well as providing clear guidelines on how insurance companies are able to identify issues and implement change.
Key areas of recommendation in the guidelines:
- High Risk medications
- Pharmaceutical Benefits Scheme (PBS)
- Medication Review
- Standardised pharmacy invoicing
High Risk mediations include opioids, benzodiazepines medicinal cannabis, injectable narcotics and medication-assisted treatment of opioid dependency. The Better Practice Guide recommends a pharmacy review on claims where these medications are present, as well as claims where there are potential comorbidities or multiple dispensing pharmacies, or doctors present on the claim. Our team of accredited pharmacists can conduct comprehensive reviews on personal injury claims, which we have been doing since 2016.
To ensure optimal health outcomes for injured people, as well as providing benefit to the insurer, Claims Pharmacy can supply claim related medications to individuals. As per the SIRA Guidelines, “the prescription and supply of medications in the NSW personal injury schemes should be provided under the PBS where clinically appropriate and available”. Medications listed on the PBS and supplied by Claims Pharmacy are always charged to the insurer at a Government subsidized price. SIRA outlines the importance of standardised invoicing within the personal injury scheme, to further facilitate claim management.
Claims Pharmacy are hopeful that the SIRA Better Practice Guide for Medication Management will assist us in reducing drug dependency of injured people, improve their overall recovery time, uncover scheme based insights, drive behaviour change, provide support for the healthcare system and ultimately, provide protection for those who need it most.