Medication governance in VIC workers' compensation

WorkSafe Victoria requirements, legislative framework, and medication management best practices

Published: 2026-04-03

Introduction

Victoria's workers compensation system is administered by WorkSafe Victoria under the Accident Compensation Act 1985 (Vic). Within this framework, medication governance is essential for managing costs, ensuring appropriate treatment, and improving claimant outcomes. This article outlines the regulatory framework for medication management in Victoria's workers compensation scheme, WorkSafe guidance, and best practice approaches to medication governance.

The Victorian legislative framework

The Accident Compensation Act and Medical and Pharmaceutical Provisions

The Accident Compensation Act 1985 establishes workers compensation in Victoria. The Act requires that workers are entitled to medical and pharmaceutical treatment for compensable work injuries. The Regulations specify the scope of coverage and requirements for medical and pharmaceutical services. Critically, treatment must be reasonable and necessary for the treatment of the work-related injury.

WorkSafe guidelines and directions

WorkSafe Victoria provides guidelines and directions to insurers on claims management, including medication management. These guidelines set expectations for medication appropriateness, cost control, and safety. Insurers must comply with WorkSafe requirements and demonstrate good governance practices.

The role of the Treatment Co-ordinator

Under the Accident Compensation Act, insurers must appoint a Treatment Co-ordinator in certain circumstances. The Treatment Co-ordinator coordinates medical treatment and can approve or decline treatment. This includes medications. Treatment Co-ordinators must balance providing appropriate treatment with managing costs.

Key medication governance issues in Victoria

Medication appropriateness and work-relatedness

A primary governance issue is ensuring medications are appropriate for and related to the compensable work injury. Disputes arise when medications appear to treat conditions not related to the work injury, or when prescribed medications are not first-line or are unusually costly. Pharmacist review helps clarify the relationship between medications and the work injury.

High-cost medication management

Victoria's workers compensation scheme must manage high-cost medications carefully. Specialty medications (biologics, targeted therapies) can represent substantial claims costs. Governance frameworks should include processes for reviewing high-cost medications, identifying lower-cost alternatives, and ensuring prior approval before high-cost medications are initiated.

Chronic pain and opioid management

Long-term opioid use in workers compensation claims is a significant governance issue. Current evidence supports deprescribing or minimisation of opioid use where possible. Best practice involves structured pain management programs that may include deprescribing opioids and transitioning to non-opioid alternatives.

Medication safety and adverse events

Claims must include adequate monitoring for medication adverse effects and therapeutic efficacy. Inadequate monitoring can lead to preventable adverse events and extended claims. Pharmacist review identifies monitoring gaps and recommends changes.

WorkSafe-endorsed best practices

Medication governance frameworks for Victorian insurers

Prior approval processes

Effective governance includes clear prior approval processes for high-cost medications, off-label use, and medications outside the scope of workers compensation coverage. Prior approval ensures medication decisions are made collaboratively and disputes are prevented.

Therapeutic guidelines alignment

Best practice involves ensuring prescribed medications align with the Therapeutic Guidelines. Where prescribing deviates, documentation of clinical justification strengthens governance and demonstrates reasonable decision-making.

Monitoring and escalation procedures

Claims should include regular monitoring of medication regimens. Automated alerts for high-cost medications, long-term opioids, or other red flags trigger escalation and review, enabling proactive management.

Dispute resolution processes

Clear processes for resolving medication-related disputes reduce friction. Pharmacist expertise is valuable for neutral assessment of disputed medications and supporting fair resolution.

Special considerations in Victoria

Permanent Disability Scheme

Victoria's Permanent Disability Scheme has specific requirements for medical and pharmaceutical treatment. Ongoing medications in the Scheme must be assessed as reasonable and necessary. Pharmacist review supports assessment of whether ongoing medications are appropriate under the Scheme.

Journey Management Plans

Treatment Co-ordinators often develop Journey Management Plans for complex claims. These plans should include clear medication management objectives, monitoring protocols, and deprescribing goals where appropriate.

Conclusion

Medication governance in Victoria's workers compensation scheme requires balancing appropriate treatment access with cost management and safety. WorkSafe guidance supports pharmacist-led medication review, early intervention, therapeutic guideline alignment, and structured deprescribing. By implementing best practice medication governance frameworks, Victorian insurers can improve outcomes, manage costs, and reduce medication-related risks. Pharmacist-led review is a key tool in achieving WorkSafe-endorsed medication governance objectives.