What Happens at a Medication Review?

A detailed guide to the independent medication review process for workers compensation claims

Published 4 April 2026

Overview: The Medication Review Process

When you refer a claimant for an independent medication review, the pharmacist follows a structured clinical assessment process. This guide explains what happens at each stage, what the pharmacist assesses, what you receive, and how long each step takes.

Stage 1: Referral and Initial Information

The process begins when you submit a referral request to the medication review provider. You supply the claimant's details, current medications, relevant clinical history, and any specific questions you want addressed. This initial information helps the pharmacist understand the claim context and plan the review scope.

What you provide at referral

• Claimant name, date of birth, claim number, and injury type
• Current medication list with doses and frequencies
• Relevant clinical history and co-morbidities
• Recent medical reports or clinical summaries
• Specific clinical questions you want the pharmacist to address (e.g., "assess benzodiazepine use", "optimise pain management", "identify cost reduction opportunities")
• Treating practitioners' contact details (GP, specialists, pharmacists)

Referral timelines

Most providers respond to referrals within 2-3 business days. They confirm receipt, clarify any missing information, and begin the process of collecting clinical files.

Stage 2: Clinical File Collection

Before the pharmacist can assess medications, they need comprehensive clinical information. The provider requests files from the claimant's treating practitioners, including:

• General practitioner records (most recent consultations, prescriptions, pathology results)
• Specialist reports (orthopedic, neurology, psychiatry, or other relevant specialists)
• Hospital discharge summaries (if hospitalised during the claim)
• Rehabilitation reports (physiotherapy, occupational therapy, vocational rehabilitation)
• Recent pathology results (kidney function, liver function, lipids, blood glucose)
• Imaging reports (if relevant to clinical assessment)

Timeline for file collection

File collection typically takes 1-2 weeks. Once the provider makes formal requests to practitioners, most respond within 7-10 days. If files are not available or delayed, the pharmacist may proceed with available information and note the limitations in the report.

Stage 3: Pharmacist Analysis

Once the pharmacist has gathered clinical files and medication information, they conduct a detailed clinical analysis. Here is what happens during this stage:

Medication Appropriateness Assessment

The pharmacist examines each medication to determine whether it is appropriate for the claimant's condition, age, and clinical context. They reference evidence-based guidelines such as Therapeutic Guidelines, TGA product information, PBS criteria, and relevant clinical literature. For older people, they may apply the Beers Criteria (which identifies potentially inappropriate medications in people over 65). For psychotropic medications, they reference RANZCP and other specialist guidelines.

Drug Interaction and Contraindication Screening

The pharmacist uses specialist software and clinical knowledge to identify drug interactions (where one medication affects the action of another), contraindications (where a medication should not be used given the claimant's conditions), and duplicate therapy (where the claimant is taking more than one medication from the same class). These are documented and assessed for clinical significance.

Therapeutic Duplication Analysis

It is not uncommon for claimants to be on multiple medications from the same class, particularly with pain management (multiple opioids) or mental health (multiple antidepressants or benzodiazepines). The pharmacist identifies these duplications and assesses whether consolidation is possible.

Dosing and Administration Review

The pharmacist checks that all doses are within therapeutic ranges, appropriate for the claimant's age and renal/hepatic function, and that administration methods are practical. For example, if a claimant has difficulty swallowing, an oral tablet may need to be changed to a liquid formulation.

Adherence and Side Effects Assessment

If the pharmacist conducts a claimant consultation, they discuss adherence (is the claimant actually taking the medications as prescribed?), side effects (are there adverse effects that might be reduced by dose adjustment or medication change?), and functional impact (are medications contributing to barriers to return to work?).

Cost and Access Analysis

The pharmacist reviews whether all medications are cost-effective, whether generic alternatives are available, whether PBS restrictions are being met, and whether costs can be reduced without compromising clinical outcomes.

Evidence Base and Current Literature

The pharmacist considers current clinical evidence and guidelines to assess whether medications align with best-practice prescribing. For example, if a claimant is on a medication that evidence suggests should only be used short-term, the pharmacist notes this and recommends appropriate deprescribing.

Timeline for pharmacist analysis

The analysis phase typically takes 5-10 working days, depending on the number of medications, complexity of interactions, and the time required for any claimant consultations. Simple cases may be analysed more quickly; complex polypharmacy cases may take longer.

Stage 4: Prescriber Engagement

A critical component of any quality medication review is direct engagement with the claimant's prescribers. The pharmacist contacts the GP, specialists, and other treating practitioners to discuss findings and recommendations. This engagement serves several purposes:

Why prescriber engagement matters

• Understanding clinical rationale: The pharmacist asks practitioners to explain the clinical reasoning behind prescriptions. This helps clarify whether medications are truly necessary or whether circumstances have changed since they were initiated.
• Identifying hidden clinical context: Practitioners may have clinical information not documented in files (e.g., a specialist's preference, a previous adverse event with an alternative, psychosocial factors affecting prescribing).
• Increasing likelihood of implementation: When a prescriber discusses recommendations with the pharmacist directly, they are far more likely to implement them. Research shows implementation rates of 65-85% when prescribers are engaged, compared to much lower rates when they simply receive a written report.
• Enabling practical adjustments: The pharmacist may identify a recommendation that is clinically sound but practically difficult in the practitioner's context. Discussion allows for pragmatic solutions.

Prescriber contact

The pharmacist typically contacts prescribers by phone to discuss findings and recommendations. This conversation is documented and included in the final report. If contact is not possible by phone, the pharmacist may send a detailed letter outlining recommendations and requesting written response.

Timeline for prescriber engagement

Prescriber engagement typically takes 3-7 working days, depending on how quickly practitioners respond. If practitioners are difficult to reach, this may extend the timeline.

Stage 5: Report Preparation and Delivery

Once the pharmacist has completed their analysis and engaged with prescribers, they prepare a detailed report for you (the insurer or claims manager). Here is what a quality pharmacy review report contains:

Report structure and content

• Executive Summary: A concise overview of key findings, risk assessment, and main recommendations
• Claimant Background: Injury type, relevant clinical history, current medications
• Medication Analysis: Detailed assessment of each medication, including appropriateness, dose, interactions, and any concerns
• Key Findings: Summary of significant issues identified (e.g., drug interactions, duplicate therapy, medications not aligned with evidence, cost opportunities)
• Risk Assessment: Pharmacist's assessment of medication-related risks and their significance
• Recommendations: Specific, actionable recommendations for medication changes, including clinical justification for each
• Prescriber Response: Documentation of conversations with the claimant's treating practitioners, including their response to recommendations
• Implementation Guidance: Practical guidance on how to implement recommendations, including any transition periods or monitoring needed
• Cost Impact: Estimated savings from recommended changes (if applicable)

Timeline for report delivery

The complete report is typically delivered within 2-4 weeks of referral, depending on file collection speed and prescriber engagement. Simple cases may be completed faster; complex cases may take longer.

Stage 6: Implementation Support and Follow-Up

A quality medication review provider does not simply deliver a report and disappear. They provide follow-up support to ensure recommendations are implemented and outcomes are achieved.

Implementation support services

• Clarification of recommendations: If you have questions about any recommendations, the pharmacist is available to discuss and clarify
• Prescriber follow-up: If prescribers have not yet implemented recommendations, the provider may follow up to encourage adoption
• Compliance monitoring: At agreed intervals (e.g., 3-6 months), the provider may check whether recommendations have been implemented and gather feedback on outcomes
• Transition support: If implementing recommendations requires medication changes, the provider can guide the transition process to ensure safety

Timeline for follow-up

Follow-up support is typically provided for 3-6 months post-review. Some providers track outcomes continuously; others provide check-ins at specified intervals.

Total Timeline: From Referral to Final Report

Here is a typical timeline for a complete medication review:

What You Receive: Understanding the Report

The medication review report you receive is your primary tool for decision-making. Here is what to look for when reviewing it:

Executive Summary and Key Findings

Start here. The executive summary gives you the "headline" of the review. Key findings should clearly identify the most significant medication-related issues identified, whether they are clinical risks, cost opportunities, or barriers to RTW.

Medication-by-Medication Analysis

This section details the pharmacist's assessment of each medication. Look for clear justification of whether medications are appropriate and any recommendations for change.

Risk Assessment

The pharmacist should clearly state their assessment of medication-related risks. Is the claimant at risk of adverse drug interactions? Are dosages safe? Are medications contributing to barriers to recovery?

Recommendations and Justification

Recommendations should be specific, actionable, and well-justified. For example, rather than "reduce opioids", a quality recommendation states: "Consolidate morphine and oxycodone to a single long-acting opioid (morphine 60mg daily), as the claimant is currently on two opioids with overlapping action, and speciality pain medicine guidelines recommend monotherapy. This consolidation is clinically appropriate given the claimant's renal function and pain profile, and will reduce medication costs by AUD 300/month."

Prescriber Response

The report documents how prescribers responded to recommendations. Did they agree? Did they suggest modifications? Did they disagree? This documentation is valuable in understanding the likelihood of implementation and in identifying any clinical concerns about the recommendations.

Implementation Guidance

For any recommended changes, look for practical guidance. If deprescribing is recommended, is there guidance on tapering schedules? If a medication switch is recommended, is there information on transition timing and monitoring?

Timelines: What Affects Speed?

Several factors influence how quickly your pharmacy review is completed:

Factors that speed up reviews

• Readily available clinical files
• Clear, complete medication list at referral
• Responsive treating practitioners
• Straightforward polypharmacy (fewer than 10 medications)
• Few drug interactions or complications

Factors that slow down reviews

• Difficulty obtaining clinical files from practitioners
• Complex polypharmacy (15+ medications) requiring detailed analysis
• Difficult-to-reach treating practitioners
• Need for specialist consultation or additional clinical input
• Claimant unavailability for consultation

Communication and Questions

During the review process and after receipt of the report, you should feel comfortable asking questions:

• During review: If you have additional clinical information or specific questions that emerge after referral, contact the provider to add to the review scope
• After report: If any recommendation is unclear or you need further discussion with the pharmacist, request a call or written clarification
• Follow-up: If you want to track implementation outcomes, request a follow-up report at 3 or 6 months post-review