Working with IMM: a guide for treating doctors

Practical guidance on collaborating with pharmacist-led medication reviews in insurance contexts

Published: 2026-04-03

Introduction

When an insurer engages IMM to conduct a medication review on one of your patients, it may feel like an external review of your clinical judgment. This guide is designed to clarify what a medication review entails, how to respond constructively, and how to use IMM recommendations to optimise your patient's medication regimen and treatment outcomes. Medication reviews by qualified pharmacists are a valuable resource for treating doctors, providing an independent clinical perspective that can improve medication management and patient safety.

What is a medication review and why insurers request them

A medication review is a comprehensive analysis of a patient's medication regimen conducted by a qualified pharmacist. The review assesses whether prescribed medications are indicated for the patient's conditions, whether dosing is appropriate, whether drug-drug interactions exist, whether monitoring is adequate, and whether the overall regimen is optimised for efficacy and safety. Insurers request medication reviews for insurance claimants to identify opportunities for cost optimisation, improve medication safety, and reduce medication-related adverse events.

Why insurers value medication reviews

Medication costs represent a significant portion of total claims costs in workers compensation, CTP, life insurance, and NDIS schemes. Medication-related adverse events extend claims duration and increase secondary costs. By conducting medication reviews, insurers can identify opportunities to optimise regimens, reduce high-cost medications, and prevent medication-related complications. This benefits both the insurer and the patient by improving health outcomes and reducing unnecessary medication costs.

The medication review process

How IMM conducts reviews

IMM's medication reviews begin with a comprehensive medical record review. Our pharmacists analyse the patient's diagnoses, comorbidities, laboratory results, and existing medications. We assess each medication against current clinical guidelines, identify potential drug-drug and drug-disease interactions, check for contraindications, and evaluate whether monitoring is adequate. We then prepare a detailed report with recommendations for optimisation.

What happens next

After the review is complete, IMM will typically provide you with a copy of the report and recommendations. In some cases, the pharmacist may contact you to discuss recommendations directly. The insurer will also review the recommendations and may contact you about implementing changes. This is an opportunity for collaborative dialogue about your patient's medication regimen.

Responding to medication review recommendations

Common types of medication review recommendations

Deprescribing and simplification

One common recommendation is deprescribing medications that are no longer indicated or that carry risk in the patient's circumstances. For example, long-acting benzodiazepines in older adults, or medications where the original indication has resolved. Deprescribing should be gradual to avoid withdrawal effects, and should include patient education and monitoring.

Medication switching or optimisation

The pharmacist may recommend switching from one medication to another within the same therapeutic class, or to a different class with better evidence or safety profile. For example, switching from an originator biologic to a clinically equivalent biosimilar to reduce costs, or switching from a first-generation antipsychotic with metabolic side effects to a newer agent.

Dose adjustment

For medications requiring dose adjustment in renal or hepatic impairment, or in older adults, the pharmacist may recommend dose changes. This is particularly important for medications with narrow therapeutic windows or significant adverse effects at high doses.

Drug interaction management

If significant drug-drug interactions are identified, the pharmacist may recommend adjusting dosing, adding monitoring, or switching one of the interacting medications. Some interactions can be managed through monitoring; others require medication changes.

Monitoring optimisation

For medications requiring regular laboratory monitoring, the pharmacist may recommend establishing or adjusting monitoring frequency to ensure adequate surveillance for adverse effects or therapeutic efficacy.

Situations where you may reasonably disagree

There are legitimate situations where you may not implement a pharmacist recommendation:

• Patient preference: Your patient may have strong preferences about medication regimen that differ from what the pharmacist recommends. Respecting patient autonomy may justify deviation from standard recommendations.
• Individual circumstances: Your patient's individual circumstances may justify deviation from guidelines. For example, a patient with contraindications to standard therapy may require non-standard regimens.
• Specialist knowledge: As the treating doctor, you have ongoing knowledge of your patient's clinical course, response to treatments, and individual circumstances that may not be fully captured in the review. Your clinical judgment is valuable and may justify different decisions.
• Recent guideline changes: Clinical guidelines evolve, and the medication review may have been based on guidelines that have since been updated. You may have knowledge of more recent evidence that changes the recommendation.

Using medication reviews to improve prescribing

Even when you don't implement every recommendation, medication reviews provide a valuable opportunity to reflect on your prescribing. Consider:

• Are there medications your patient is on that they no longer need?
• Are there drug-drug interactions you should be monitoring more closely?
• Is monitoring adequate for medications with potential adverse effects?
• Are there cost-effective alternatives to medications your patient is taking?
• Is your patient on medications that are inconsistent with current guidelines or evidence?

Using medication reviews as an opportunity for reflection and continuous improvement enhances your practice and benefits your patients.

Communicating with your patient

If medication changes are implemented based on the review, communicate clearly with your patient. Explain:

• Why the change is being made
• What benefits are expected
• What side effects or monitoring may be needed
• When to follow up with you to assess response
• What to do if adverse effects occur

Clear communication improves medication adherence and helps your patient understand and accept medication changes.

Conclusion

Medication reviews are a collaborative opportunity to optimise medication management for your patient. IMM's pharmacists work to provide evidence-based recommendations that improve medication safety, efficacy, and cost-effectiveness. While you may not implement every recommendation, engaging thoughtfully with the review and using it as an opportunity to reflect on prescribing enhances your practice and supports better patient outcomes. If you have questions about recommendations or would like to discuss them further, our pharmacists welcome dialogue with treating doctors.