SIRA RTW Roadmap 2026-28: The Medication Gap

SIRA has a problem it has finally named publicly.

Psychological claims are 10% of NSW workers compensation claims. They consume 26% of total scheme costs. And the current approach, reactive, clinician-dependent, inconsistently applied, is not working.

The Return to Work [Roadmap 2026-28](https://www.sira.nsw.gov.au/news/new-roadmap-to-help-more-injured-workers-return-to-work) is SIRA's response. Three years. Four strategic priorities. A mandate for earlier intervention, stronger insurer accountability, and measurable RTW outcomes.

It is a significant document. And it is missing something important.

What the Roadmap Gets Right

The roadmap correctly identifies the core failure in the current system: intervention comes too late. By the time complex claims develop their full profile, the trajectory is set. Medication regimens are entrenched. Prescribing patterns are established. Reversing them is costly, time-consuming, and clinically difficult.

The roadmap's response is structural. Injury notification within 48 hours. Early engagement with rehabilitation providers. Person-centred planning from the first contact. These are not incremental changes. They represent a genuine shift in the scheme's operating model.

SIRA is also moving on accountability. The Recovery through Work Measurement Framework introduces lead and lag indicators, tools that measure insurer behaviour, not just outcomes. That is a material change in regulatory pressure.

The Gap the Roadmap Doesn't Close

The roadmap is silent on medication.

Not because medication is irrelevant to psychological claims. Because it is the least governed, most consequential variable in the whole system.

Three in four people still on high-risk drugs at 12 weeks remain on them at 52 weeks. One in five injured workers is prescribed opioids within the first three months. For psychological claims, add benzodiazepines, antidepressants, antipsychotics, and the full spectrum of psychotropic prescribing that accompanies serious injury.

That medication burden is not being governed. Not at intake. Not at 12 weeks. Not at 26 weeks. It accumulates, silently, inside claims that are already expensive and getting worse.

Where IMM Fits

IMM operates as an independent clinical governance layer. Our function is not to treat injured workers. It is to identify the medication risk that insurers cannot currently see, and produce defensible, actionable outputs that change prescribing trajectories.

Our prescriber implementation rate is 81%. That is the proportion of our recommendations that treating clinicians act on. It is not advisory. It is clinical governance that works.

The SIRA roadmap creates three specific insertion points where IMM and AllMeds align directly with scheme requirements:

• Day 20: [AllMeds risk screen](https://www.allmeds.ai/) at intake. Identifies high-risk medication trajectories before they compound.
• 12 weeks: Portfolio-wide AllMeds deployment across the insurer's book. Triggers IMM Pharmacy Reviews for high-risk cases.
• 26-27 weeks: Targeted IMM intervention for claims showing high or critical risk scores.

These timelines are not arbitrary. They correspond to the inflection points SIRA itself identifies as critical for disrupting chronic claim trajectories.

The Accountability Argument

The roadmap introduces insurer accountability metrics for the first time as a formal scheme requirement. Lead indicators. Documented governance. Auditable outputs.

IMM's reports are defensible and documented. AllMeds' risk intelligence is systematic and repeatable. Together, they produce the kind of structured, evidence-based outputs that satisfy a measurement framework.

Insurers managing NSW claims under the new roadmap need to demonstrate they are acting proactively on complex, high-cost cases. Medication governance is a demonstrable, documented form of that action.

The Roadmap Has Opened the Conversation

SIRA has identified the problem, set the timeline, and placed accountability on insurers to respond. The piece it has not provided is the mechanism for governing medication risk inside that framework.

That mechanism exists. It is operating in the scheme today.

If you manage claims in the NSW workers compensation system and want to understand how IMM and AllMeds fit within the SIRA roadmap framework, contact the IMM team to discuss your current approach.