What to do when RTPM flags reveal a claimant is using multiple prescribers

Practical scenario: Your RTPM data shows your claimant is seeing four different doctors for pain management. Here's your step-by-step guide to assessment and response.

Published 3 April 2026

The scenario: multiple prescribers in RTPM data

You've requested an RTPM-based medication review for your claimant. The report comes back showing that over the past six months, your claimant has obtained opioid and benzodiazepine prescriptions from four different doctors in your state. There's no evidence that these prescribers know about each other's involvement. Your claimant didn't mention these multiple doctors when interviewed. This is a red flag. Now what?

Step 1: Get the clinical context from the medication review report

The medication review report should tell you more than just "multiple prescribers." A good report will analyse whether the medicines prescribed by each doctor are appropriate for the injury, whether there are duplications or dangerous interactions, and whether the pattern suggests coordinated care or fragmented care. Use this context to guide your next steps.

Questions to ask the medication review specialist:

• Are the prescribers all prescribing for the same condition (pain) or different conditions?
• Are there overlapping prescriptions or clear hand-offs between prescribers?
• Are the doses consistent with evidence-based guidelines?
• Is there evidence that any prescriber is aware of the others?
• Does the prescribing pattern suggest doctor shopping or legitimate complex care?

Step 2: Contact your claimant directly

Ask your claimant directly about the multiple prescribers. Their explanation will help you understand whether this is legitimate or problematic:

Legitimate explanations might include:

• "My GP refers me to a pain specialist, and the specialist also arranges for a psychologist and a rheumatologist. They're all coordinating treatment for my injury."
• "I moved house and changed GPs. The first doctor started my pain medication, and my new doctor continued it."
• "I see a specialist in a different town for specific treatment."

Red flag explanations include:

• "I didn't realise I was seeing different doctors" (suggests lack of awareness or honesty)
• Inability to explain why multiple doctors were involved
• Inconsistent or evasive responses about treatment intent

Step 3: Refer for specialist medication coordination

Whether the multiple prescribers situation is legitimate or problematic, recommend medication coordination. This involves:

1. Your claimant identifying a primary GP or pain specialist who will coordinate all medication management
2. All other prescribers copying correspondence to the primary coordinator
3. A structured referral for IMM to contact each prescriber and coordinate treatment plans
4. RTPM review 6-8 weeks later to verify that coordination is occurring

Step 4: Document and communicate with treating team

Send a letter to your claimant, copying their medical team, stating that medication coordination is required. This document should specify that all future prescriptions must be coordinated through a named primary prescriber and that regular RTPM monitoring will occur. This creates accountability and makes it clear that uncoordinated prescribing will not be accepted.

Step 5: Establish monitoring schedule

Don't assume coordination has happened. Refer for follow-up RTPM review in 6-8 weeks to verify that multiple prescribers have ceased and that treatment is now coordinated through a single primary prescriber. If multiple prescribers persist after this communication, you have a different problem that may warrant more significant claim intervention.

When multiple prescribers indicates serious concern

If your claimant continues accessing multiple uncoordinated prescribers despite your communication, or if the pattern clearly suggests doctor shopping (seeking high-dose opioids or benzodiazepines from multiple sources), consider these options:

• Refer the matter to your claims manager or medical advisor for escalation
• Consider whether continued medication funding is appropriate without coordination
• If you suspect fraud or serious misconduct, refer to appropriate authorities
• Consult legal advice about impact on claim liability

The bottom line for multiple prescriber scenarios

Multiple prescribers in RTPM data is a red flag that requires action. But it's not automatically disqualifying. Your job is to understand why multiple prescribers are involved, to implement coordination, and to monitor whether coordination is actually occurring. This protects your claimant's health and your claim's integrity.