What is a medication risk assessment?
A structured evaluation of the potential harms, interactions, and safety concerns associated with a claimant's medications.
Published: 3 April 2026 | Updated: 3 April 2026
Definition
A medication risk assessment is a systematic evaluation conducted by a pharmacist to identify potential safety concerns related to a claimant's medications. The assessment examines drug interactions, contraindications, adverse effects, dosing concerns, and other factors that could lead to medication-related harm.
Unlike a general medication review, which focuses on appropriateness and optimisation across the board, a medication risk assessment is specifically focused on identifying risks. It answers the question: "What could go wrong with this medication regimen, and how likely is it?"
Why Medication Risk Assessments Matter in Insurance Claims
Medication-related harm is a significant source of claims complications. As an insurer, you have a duty of care to identify and address known medication risks. A medication risk assessment:
- Identifies potential medication-related harms before they occur
- Provides evidence that you have exercised due diligence in medication safety
- Documents baseline risk so that if an adverse event occurs, you can demonstrate you were monitoring
- Supports intervention to prevent avoidable harm
- Reduces your exposure to claims of negligent medication management
- Informs claims management decisions about what level of monitoring is needed
Components of a Medication Risk Assessment
Drug Interactions
The assessment evaluates all potential interactions between the claimant's medications. Some interactions are minor; others are serious and potentially life-threatening. The assessment identifies the severity and likelihood of each interaction.
Contraindications
Certain medications should not be used in patients with specific conditions. The assessment checks whether any medications are contraindicated given the claimant's medical history.
Adverse Effects
The assessment identifies the potential adverse effects of each medication and evaluates whether symptoms the claimant is experiencing might actually be medication side effects rather than disease symptoms.
Dosing Concerns
The assessment evaluates whether doses are appropriate for the claimant's age, weight, kidney function, and other factors. Doses that are too high increase adverse effect risk; doses that are too low may be ineffective.
Renal and Hepatic Function
Many medications are metabolised by the kidneys or liver. If the claimant has reduced kidney or liver function, medications may accumulate to toxic levels. The assessment evaluates this risk.
Medication Appropriateness in Specific Populations
Certain medications carry particular risks in older people, in pregnant women, in people with specific conditions, or in people taking other medications. The assessment considers these population-specific risks.
Risk Rating Systems
Medication risk assessments typically rate identified risks by severity and likelihood:
| Risk Level | Severity | Likelihood | Action Required |
|---|---|---|---|
| Low | Minor adverse effects or outcomes | Unlikely | Routine monitoring |
| Moderate | Significant adverse effect or suboptimal outcome | Possible | Targeted monitoring, consider intervention |
| High | Serious adverse effect or major harm | Likely or significant if occurs | Urgent intervention, specialist review |
| Critical | Life-threatening or severe disability | Significant risk | Immediate action, medication change if possible |
Common Medication Risks
Some medication risks are particularly common in insurance claims:
Fall Risk
Many medications increase fall risk, particularly in older claimants. Sedating medications, those affecting blood pressure, and certain pain relievers can increase falls. Falls lead to serious injuries, hospitalisations, and complications.
Bleeding Risk
Medications such as anticoagulants and antiplatelet drugs increase bleeding risk. If the claimant is on multiple such medications or has conditions that increase bleeding risk further, the cumulative risk is substantial.
Kidney Injury
Some medications (particularly certain antibiotics, NSAIDs, and ACE inhibitors) can damage the kidneys, especially in claimants with existing kidney disease or taking multiple nephrotoxic medications.
Liver Damage
Some medications can damage the liver, particularly if the claimant is on multiple potentially hepatotoxic drugs or has pre-existing liver disease.
Drug Interactions with Serious Consequences
Some drug interactions can cause serious harm. For example, certain combinations of pain relief and anticoagulant medications dramatically increase bleeding risk.
Medication Risk Assessment Process
Pharmacist reviews claimant's medications, medical conditions, and relevant pathology. Identifies potential drug interactions, contraindications, adverse effect risks, dosing concerns. Rates each risk by severity and likelihood. Recommends monitoring or interventions. Documents findings in clear report with actionable recommendations.
Red Flags for Medication Risk
Certain situations warrant immediate medication risk assessment:
- Claimant on high-risk medication classes (anticoagulants, antipsychotics, certain pain relievers)
- Recent medication-related adverse event or hospitalisation
- Claimant with reduced kidney or liver function on medications that require dose adjustment
- Polypharmacy (five or more medications) without recent review
- Multiple prescribers without evidence of coordination
- Unexplained symptoms that could be medication-related
- Claimant reports confusion about medications or difficulty managing regimen
What an Assessment Report Includes
A medication risk assessment report typically includes:
- Summary of claimant's medications and relevant medical history
- List of identified medication risks, rated by severity and likelihood
- Clinical rationale for each identified risk
- Recommended monitoring or interventions for each risk
- Overall risk profile and recommended level of oversight
- Specific recommendations for medication changes if urgent risks are identified
Acting on Risk Assessment Findings
Once a risk assessment is completed, your claims team should:
- Critical risks: Immediately contact the prescriber or claimant to discuss urgent medication changes
- High risks: Establish a monitoring plan and targeted interventions to reduce risk
- Moderate risks: Incorporate into routine claims oversight; monitor for any development
- Document: File the assessment and all actions taken in response
- Re-assess: If medications change, reassess to ensure previously identified risks are addressed
Does your claimant need a medication risk assessment?
IMM provides comprehensive medication risk assessments designed to identify potential harms and support your claims team in proactive risk management. Our assessments are practical, actionable, and focused on real-world risks in the insurance environment.
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