Can a Pharmacy Do a Medication Review?

Understanding the difference between community pharmacy reviews and independent insurance medication reviews

Published 4 April 2026

The Short Answer: Yes, But There Are Important Differences

Pharmacies can conduct medication reviews, but the type of review matters significantly for your workers compensation claims management. There are two fundamentally different types of pharmacy medication reviews: community pharmacy reviews (government-subsidised programs like Home Medicines Review) and independent medication reviews conducted for insurance purposes. They serve different audiences, have different scopes, and different levels of independence. Understanding these differences is critical when deciding whether a community pharmacy review is appropriate for your claims or whether you need an independent, insurance-focused assessment.

Community Pharmacy Medication Reviews

Australia has several government-subsidised medication review programs that community pharmacies can conduct. These are valuable tools for primary care but have important limitations in the workers compensation context.

Home Medicines Review (HMR)

HMR is a government-subsidised program where a pharmacist visits a claimant's home to conduct a broad review of all medications. The GP initiates the referral. The pharmacist meets with the patient, reviews medication use and compliance, and provides patient-focused advice on medication management. The review is documented in a report back to the referring GP. HMR is designed to improve patient understanding of medications and to flag medication issues for the GP to address.

MedsCheck

MedsCheck is a simpler, clinic-based medication check (rather than a full review) provided by community pharmacies. It is focused on adherence and medication education. It is less comprehensive than HMR and is designed as a screening tool to identify whether a more detailed review is needed.

Residential Medication Management Review (RMMR)

RMMR is similar to HMR but for people living in aged care facilities. It is relevant only to claims involving aged care residency.

Why Community Pharmacy Reviews Are Problematic for Insurance Claims

While community pharmacy reviews serve important functions in primary care, they are not suitable as the primary clinical tool for workers compensation claims management. Here is why:

Lack of Independence

Community pharmacies have a commercial interest in maintaining the patient's ongoing pharmacy use and in encouraging regular prescription dispensing. This creates a potential conflict of interest: a pharmacy might be reluctant to recommend medication cessation or cost reduction if it means fewer scripts to dispense. While individual pharmacists are well-intentioned, the business model creates an incentive structure that is misaligned with claims management objectives.

Independent medication review services have no commercial interest in prescription volume. A pharmacist conducting an independent review is free to recommend deprescribing, medication consolidation, or cost reduction without any business impact. This independence is fundamental to the objectivity of the assessment.

Limited Scope

Community pharmacy reviews (HMR, MedsCheck) are designed to be relatively quick, general reviews focused on patient education and compliance. They do not typically include the depth of clinical file review, specialist engagement, or prescriber consultation that is necessary for comprehensive insurance claims management. They are screening tools, not definitive clinical assessments.

Patient-Focused, Not Insurer-Focused

Community pharmacy reviews are designed for the patient and their GP. The report and recommendations are formatted for patient education, not for claims management decision-making. The information you receive is not tailored to the questions you need answered: Is this medication necessary for the worker's recovery? Is it a barrier to return to work? What are the cost implications?

No Prescriber Engagement

Community pharmacy reviews report back to the referring GP but do not typically include active engagement with specialists or detailed discussion of recommendations with treating practitioners. Independent medication reviews, by contrast, include direct pharmacist-to-prescriber engagement as a core component, significantly increasing the likelihood of implementation.

No Insurance-Specific Reporting

Community pharmacy reviews are not designed to address insurance-specific issues such as medication necessity within the context of a workers compensation claim, cost implications for the insurer, or link to return-to-work objectives. A report designed for a patient and their GP does not provide the information you need for claims management.

Independent Medication Reviews for Insurance

Independent medication reviews conducted specifically for insurance purposes are fundamentally different. They are designed by insurers and claims managers to address insurance-specific questions: What is the medication-related risk in this claim? Are all medications necessary? What are the cost implications? Are medications a barrier to return to work? What does the clinical evidence support?

Key features of independent insurance reviews

• Clinical independence: Conducted by pharmacists with no commercial interest in prescription volume
• Comprehensive scope: Deep clinical file review, specialist engagement, and detailed analysis
• Insurer-focused reporting: Reports written for claims managers, addressing insurance-specific questions
• Prescriber engagement: Active discussion with GPs and specialists to increase likelihood of implementation
• Claims management context: Assessment explicitly considers the worker's injury, recovery objectives, and return-to-work timeline
• Cost analysis: Clear quantification of cost implications and savings opportunities

Direct Comparison: Community vs Independent Reviews

The Critical Importance of Independence in Insurance Pharmacy Reviews

Independence is the core principle that distinguishes insurance medication reviews from community pharmacy reviews. Why does independence matter so much?

Freedom to recommend deprescribing

In workers compensation, one of the most valuable recommendations a pharmacist can make is deprescribing: stopping medications that are no longer necessary. A community pharmacy may be reluctant to recommend medication cessation because it means fewer scripts to dispense. An independent pharmacist recommends deprescribing whenever clinically appropriate, regardless of impact on prescription volume.

Freedom to recommend cost reduction

Independent pharmacists can recommend switching from high-cost branded medications to low-cost generics, consolidating duplicate therapies, or reducing total medication numbers. None of these recommendations hurt the independent pharmacist's business. Community pharmacies might be less inclined to suggest cost reductions that mean lower dispensing fees.

Freedom to identify conflicts of interest

An independent pharmacist can objectively assess whether prescriptions appear to be driven by practitioner habit, convenience, or financial incentive rather than clinical evidence. A pharmacist employed by or commercially aligned with a particular pharmacy may be less comfortable raising concerns about inappropriate prescribing if it might offend referring practitioners.

Objectivity in specialist engagement

When an independent pharmacist engages with prescribers, they do so purely to support evidence-based medication management. There is no business interest involved. This makes the conversation objective and focused purely on clinical evidence.

When Might a Community Pharmacy Review Be Useful?

While community pharmacy reviews are not suitable as your primary insurance medication review tool, they may have a role in complementing other work:

• Pre-review baseline: If a claimant is new to you and has never had a formal medication review, you could arrange an HMR through their GP before deciding whether an independent insurance review is needed. This may help identify obvious issues and provide baseline information.
• Patient engagement: An HMR can improve the patient's understanding of their medications and compliance, which supports the effectiveness of any recommendations from an independent review.
• Ongoing medication advice: For routine medication questions and patient education, the claimant's community pharmacy and GP remain important resources. Independent reviews complement rather than replace ongoing care relationships.

However, for core claims management decisions about medication necessity, cost, and RTW impact, you should rely on an independent insurance-focused medication review, not a community pharmacy review.

The Gap: Why Insurance Claims Need Independent Reviews

Many workers compensation claims involve complex medication management issues that require specialist assessment. These issues include:

• Polypharmacy and drug interactions that require deep clinical analysis
• High-risk medications (opioids, benzodiazepines, antipsychotics) that require specialist assessment
• Questions about medication necessity within the specific context of a workers compensation injury and recovery plan
• Medication-related barriers to return to work that need to be identified and addressed
• Cost optimization opportunities in long-tail claims
• Prescriber engagement and implementation of recommendations

A community pharmacy review, by design, is not equipped to address these specialist claims management issues. They serve a different purpose in the primary care system. For insurance claims, you need a review that is independent, comprehensive, and explicitly designed to support claims management decision-making.

Making the Decision: Do You Need an Independent Medication Review?

Consider an independent medication review for your workers compensation claim if any of these apply:

• The claimant is on 5 or more medications
• High-risk medications are involved (opioids, benzodiazepines, antipsychotics)
• Medication costs are rising or unexpectedly high
• Medications may be barriers to return to work or functional recovery
• You have questions about medication necessity or appropriateness
• The claim is complex, long-tail, or involves specialist input
• You are considering medication changes but want specialist advice before implementing

In these situations, an independent medication review conducted by a specialist insurance pharmacy provider will give you the depth of analysis, objectivity, and claims-focused insights you need.

What to Look for in an Independent Pharmacy Review Provider

Not all independent providers are equal. When selecting a provider, prioritise:

• Specialist credentials: Pharmacists with advanced qualifications in clinical pharmacy or related areas
• Insurance industry experience: Experience working with workers compensation, CTP, or other insurance schemes
• Prescriber engagement standard: Direct engagement with treating practitioners as part of the review process
• Insurer-focused reporting: Reports written for claims managers, not generic patient-focused templates
• Implementation support: Follow-up and support to ensure recommendations are implemented
• Track record: Reference checks and examples of reports demonstrating quality and depth