What is a pharmacy review?
A professional assessment of your claimant's medications to identify risks, optimise therapy, and reduce costs.
Published: 3 April 2026 | Updated: 3 April 2026
Definition and Purpose
A pharmacy review is a structured clinical assessment of a claimant's medications, performed by a qualified pharmacist, to evaluate whether their current therapy is appropriate, safe, and effective. You refer for a pharmacy review when you need independent expert analysis of medication management within a claim.
In the context of insurance claims, a pharmacy review serves several key functions:
- Identifying potentially harmful or redundant medications
- Assessing whether medications are being used appropriately for the claimant's conditions
- Detecting drug interactions, duplications, or contraindications
- Recommending medication changes to improve outcomes and reduce costs
- Providing expert opinion to support claim management decisions
Who Performs a Pharmacy Review?
Pharmacy reviews are conducted by accredited pharmacists with specialised training in medication management and clinical pharmacy. In Australia, these professionals hold relevant qualifications and registration with the Pharmacy Board of Australia. They have expertise in identifying medication-related issues and making evidence-based recommendations.
At IMM, our pharmacists bring years of insurance claims experience, meaning they understand not just the clinical issues, but also the practical realities of managing medications within insurance frameworks.
Types of Pharmacy Reviews Available
There are several pharmacy review models you can access depending on your needs:
Home Medicines Review (HMR)
A face-to-face assessment in the claimant's home, typically funded under the National Medicines List (NML) in Australia. The pharmacist reviews medications in the home setting, observes how they're stored and used, and provides recommendations to the GP.
Residential Medication Management Review (RMMR)
For claimants in residential aged care, a facility-based review that examines medication management practices and recommends changes to medication therapy.
Independent Pharmacy Review
A specialist assessment conducted specifically for insurance purposes, often desk-based or conducted by telehealth, focused on identifying medication-related risks and costs within the claim.
What Gets Reviewed?
A thorough pharmacy review examines:
- All current medications, dosages, and frequencies
- Indications for each medication and whether they're still clinically appropriate
- Drug interactions and contraindications
- Potential adverse effects and tolerability
- Medication adherence and how well the claimant is managing their therapy
- Duplicate therapies or overlapping medications
- Medication cost relative to clinical benefit
- Opportunities to simplify the regimen or deprescribe unnecessary drugs
Typical Pharmacy Review Process
1. Pharmacist collects claimant's medical history, current medications, and clinical information.
2. Comprehensive analysis of medication therapy against clinical guidelines and evidence.
3. Identification of medication-related issues and risks.
4. Recommendations documented and communicated to the claimant's GP and your claims team.
5. Follow-up to monitor implementation of recommendations.
Why Insurers Use Pharmacy Reviews
Medication-related issues are a significant cost driver in insurance claims. Unnecessary polypharmacy, inappropriate dosing, drug interactions, and inadequately treated conditions all increase claims costs and harm claimant outcomes. A pharmacy review provides you with expert intelligence to:
- Reduce medication-related hospital admissions and adverse events
- Identify cost-saving opportunities without compromising care
- Support clinical decision-making with expert pharmacist input
- Demonstrate due diligence in medication management
- Improve claimant quality of life through optimised therapy
Pharmacy Reviews and Your Claims Team
When you refer for a pharmacy review, you receive a detailed report that translates clinical pharmacy language into actionable insights for your claims management. The report will typically include specific medication recommendations, risk flags, and evidence to support changes to therapy.
This clinical intelligence allows you to have informed conversations with the claimant's medical team about medication optimisation, deprescribing opportunities, or concerns about medication safety.
Need expert medication review for your claim?
IMM specialises in delivering pharmacist-led medication reviews that cut through complexity and deliver clear, actionable recommendations. We work across workers compensation, CTP, life insurance, and NDIS schemes, and we understand the insurance claims environment inside out.
Request a Medication Review
