Medication Review Guide for Case Managers

Use pharmacy reviews to optimise claimant medications and improve outcomes

Published: 3 April 2026 | Updated: 3 April 2026

Why You Need to Understand Medication Reviews

As a case manager, you're responsible for the overall wellbeing and rehabilitation progress of your claimants. Medications profoundly affect both. A medicine that eliminates pain might also cause drowsiness, impairing rehabilitation participation. An antidepressant might improve mood but cause weight gain and metabolic problems. You see these effects firsthand; claimants tell you about side effects, compliance struggles, and functional limitations.

Pharmacy reviews give you expert insight into medication strategy and options. They help you understand whether medications are working as intended, whether side effects are necessary trade-offs or avoidable, and whether alternative approaches might serve your claimant better. This knowledge makes you a more effective advocate for your claimant's wellbeing and recovery.

How Medication Reviews Work

A medication review is a comprehensive assessment of your claimant's medicines, performed by a specialist pharmacist. Here's what happens:

What a Pharmacy Review Can Tell You

A good pharmacy review report answers these key questions:

• Is this medicine necessary? Does it address a real problem, or can it be stopped?
• Is the dose right? Too low; too high; just right?
• Are medications interacting? Could medicines be cancelling each other out or causing problems together?
• Why is my claimant experiencing side effects? Which medication is causing them; can we switch to something better?
• Is my claimant actually taking medications as prescribed? What barriers to compliance exist; how can we fix them?
• Are medications supporting or hindering rehabilitation? Can we adjust the regimen to improve functional capacity?
• What should happen next? Continue, adjust, change, or stop each medication?

When to Request a Pharmacy Review

You don't need a pharmacy review for every claimant. Request one when any of these apply:

• Your claimant is on four or more medications
• Multiple doctors are prescribing without clear coordination
• Your claimant reports side effects affecting daily function or rehabilitation
• Recovery isn't progressing as expected; medications may be limiting rehabilitation
• Your claimant struggles to comply with medication regimen
• High-risk medicines present: opioids, benzodiazepines, anticoagulants
• You're unsure whether medications are appropriate for the injury or condition
• Long-term claim; concerned about medication dependency or escalation

Understanding the Pharmacy Review Report

The report will include clinical language, but good reports are written for insurance professionals. Here's what to look for:

Executive Summary

This section distils key findings into simple language. Read this first. It tells you what problems the pharmacist identified and what the main recommendations are.

Medication-by-Medication Assessment

Each medicine is evaluated for appropriateness, dose, and interactions. Look for medications flagged as "not indicated" or "consider deprescribing." These are candidates for stopping.

Drug Interactions

This section identifies whether medicines are interfering with each other. Some interactions are serious; others are minor. The report should explain the clinical significance.

Recommendations

This is the actionable part. Recommendations might include: continue this medicine; reduce the dose; try this alternative; stop this medicine; coordinate prescribing with these doctors. These are not orders; they're expert suggestions for you and your claimant's doctor to consider.

Deprescribing Strategies

If medications should be stopped, the report provides a plan: which medicine first, how fast to reduce, what to watch for, when to involve the doctor. Deprescribing often needs to happen slowly.

Using the Pharmacy Review Report in Case Management

Once you receive the report, here's how to use it:

Talking to Your Claimant About Medication Reviews

Some claimants are hesitant about medication reviews. They worry you're trying to take away medicines they depend on. Here's how to frame it:

Red Flags That Suggest Medication Problems

As a case manager, you often see signs of medication problems before doctors do. Watch for:

• Drowsiness or sedation affecting rehabilitation engagement
• Dizziness or balance problems increasing reinjury risk
• Mood changes; anxiety or depression worsening despite medication
• Claimant reports "I don't like how this medicine makes me feel"
• Dosages escalating without corresponding improvement
• Multiple prescribers; no one coordinating the full regimen
• Claimant sometimes taking medicines; sometimes not; confused about why
• Side effects causing new problems: weight gain, constipation, difficulty concentrating

When you see these signs, a pharmacy review can help understand what's happening and identify better options.

Working with the Pharmacy Review Report Long-Term

For long-term claims, periodic pharmacy reviews are valuable. Annual check-ins ensure medications remain appropriate as your claimant's condition evolves. Changes that made sense 18 months ago might not be appropriate now. Regular review keeps the regimen optimised and prevents entrenchment of unnecessary medicines.

Questions to Ask Your Claimant About Medications

As a case manager, you can gather useful information through conversation:

• "How are your medications working for you?"
• "Any side effects bothering you?"
• "Do you take them exactly as prescribed? Any problems with that?"
• "Do you feel any of these medicines aren't helping?"
• "Are you sleeping OK? Any dizziness or drowsiness?"
• "How's your mood? Any anxiety or depression?"
• "Do you understand what each medicine is for?"

These conversations provide valuable context for a pharmacy review and help your claimant feel heard.