Reframing pharmacy reviews

Pharmacy Reviews Reframed: Why Medication Oversight Is a Liability Issue, Not Just a Clinical One

For years, medication reviews have been positioned as a clinical safeguard. Important, but often seen as optional, reactive, and removed from core claim decision making.

That framing is outdated.

In workers’ compensation, CTP, and personal injury schemes, medications are one of the most powerful and least controlled drivers of claim duration, cost escalation, and delayed recovery. When left unchecked, prescribing practices quietly inflate reserves, distort liability decisions, and extend time off work.

At Independent Med Management (IMM), we believe pharmacy reviews should be viewed for what they really are: a liability containment tool.

The Hidden Cost of Medications in Claims

Most claims managers already understand the obvious risks. Opioids. Benzodiazepines. Polypharmacy. But the real exposure sits deeper:

• Medications prescribed outside the accepted injury
• Duplication across providers and jurisdictions
• Long term use of sedating or cognitively impairing drugs
• Off label prescribing with no functional benefit
• Interstate prescribing blind spots that bypass state based monitoring systems

Each of these factors directly affects recovery trajectory, work capacity, and claim defensibility. Yet they often go unidentified until the claim is already entrenched.

From Pharmacy Review to Liability Containment Report

IMM has deliberately reframed its pharmacy reviews previously known as "Primary Assessment Reports".

These reports are designed for claims decision makers, not just clinicians. They quantify exposure, clarify causation, and support defensible action.

Every report provides a clear snapshot of:

• Claim related versus non claim related medication use
• High risk prescribing patterns that affect safety and function
• Medication risks that may undermine treatment engagement or return to work
• Case-specific recommendations for next steps

This allows insurers to move from passive oversight to informed control.

Early Intervention Changes Everything

When medication risk is identified early, insurers gain leverage.

Small, timely interventions can prevent months or years of unnecessary exposure. A short pharmacist led review can:

• Support earlier treating doctor conversations
• Clarify what is and is not reasonably necessary
• Reduce reliance on escalations, IMEs, or legal intervention
• Improve functional recovery by reducing sedation and cognitive burden

In practical terms, this often means faster stabilisation and clearer decision pathways.

Designed for Claims Managers, Not Just Clinicians

IMM reports are structured to be usable at a glance:

• Clear risk flags across liability and safety
• Action focused recommendations with review triggers
• Documented accountability through treating doctor contact and follow up timelines

This ensures medication oversight becomes part of routine claim governance, not an afterthought.

The Strategic Shift Insurers Are Making

Forward thinking insurers are no longer asking whether medication reviews are helpful. They are asking how early they should be embedded.

By repositioning pharmacy reviews as liability containment tools, insurers gain:

• Better reserve confidence
• Reduced tail risk and claim duration
• Stronger alignment between treatment and recovery goals
• Defensible evidence for decision making
• Prevention of secondary liability concerns

Medication oversight is not about second guessing clinicians. It is about ensuring medications support recovery rather than silently working against it.

Independent Med Management exists to close that gap.