What is deprescribing?
The systematic process of reducing medication doses or discontinuing unnecessary medications under medical supervision.
Published: 3 April 2026 | Updated: 3 April 2026
Definition and Purpose
Deprescribing is the evidence-based, systematic process of reducing or discontinuing medications that are no longer needed, are causing harm, or where the risks outweigh the benefits. Unlike simply stopping a medication abruptly, deprescribing is a structured clinical process that considers whether gradual dose reduction is necessary, what monitoring is required, and how to support the claimant through the transition.
Deprescribing is not the opposite of good prescribing; it's an essential part of good medication management. When medications become unnecessary or harmful, continuing them is not evidence-based practice. Deprescribing returns medications to those that are clearly beneficial.
Why Deprescribing Matters in Insurance Claims
Deprescribing directly impacts your claims in several ways:
- Reduces medication costs by eliminating unnecessary drugs
- Reduces adverse effects and medication-related complications
- Simplifies regimens, improving adherence and outcomes
- Reduces hospitalisation and complications from drug interactions
- Improves claimant quality of life by reducing medication burden
- Supports rehabilitation by reducing medications that impair function
A single deprescribing success, such as safely discontinuing a medication costing $50 per month, saves $600 annually. When applied across multiple claimants and medications, deprescribing programs can reduce medication expenditure significantly.
Common Candidates for Deprescribing
Medications frequently identified as candidates for deprescribing include:
- Medications without clear current indication: Medications started for acute problems that have resolved but were never discontinued
- Duplicate medications: Multiple medications from the same class, where one would suffice
- Medications causing adverse effects: Side effects that outweigh the clinical benefit
- Low-dose preventive medications: Some preventive medications may be candidates for deprescribing depending on the claimant's situation
- Medications appropriate for short-term use: Medications such as sedatives or strong pain relievers that should not be used long-term but have been continued
- Medications where therapeutic goals have changed: For example, aggressive cholesterol-lowering in a very elderly claimant with short life expectancy
Deprescribing Approaches
Abrupt Discontinuation
Some medications can be safely stopped immediately without risk of withdrawal or rebound effects. Examples include many antibiotics, antifungals, or medications that are clearly no longer needed. This is the simplest approach.
Dose Reduction
Some medications require gradual dose reduction to minimise withdrawal effects or allow the body to adjust. Benzodiazepines and some antidepressants, for example, often require gradual tapering over weeks or months.
Substitution
Sometimes deprescribing involves substituting a medication with a simpler or safer alternative rather than direct discontinuation. For example, switching from a high-dose medication to a lower-dose alternative, or switching from an older medication with more side effects to a newer option.
Structured Withdrawal Protocol
Some medications require specific withdrawal protocols. For example, certain antipsychotics or beta-blockers have established tapering protocols to minimise withdrawal effects. A pharmacist or doctor would follow these protocols.
Deprescribing Process
Identify candidate for deprescribing. Discuss risks and benefits with claimant and treating doctor. Agree on deprescribing approach (abrupt, gradual, substitution). Implement with monitoring. Assess outcomes at agreed intervals. Document all changes and results.
Deprescribing Safety Considerations
Deprescribing must be done carefully to avoid harm. Key safety considerations include:
- Appropriate medications only: Only medications that are genuinely unnecessary or harmful should be deprescribed
- Medical supervision: Deprescribing should be planned with the treating doctor or pharmacist, not done by the claimant alone
- Withdrawal risks: Some medications require gradual tapering to avoid withdrawal symptoms
- Rebound effects: Some medications may cause rebound symptoms if stopped abruptly, requiring gradual reduction
- Monitoring: The claimant should be monitored after deprescribing to ensure the intended benefit is achieved
- Communication: All prescribers should be aware of deprescribing plans to ensure new medications are not prescribed to replace those being discontinued
Red Flags: When NOT to Deprescribe
Some medications should not be deprescribed and require continuation despite being burdensome:
- Medications for serious life-threatening conditions where discontinuation would be dangerous
- Medications where sudden withdrawal would cause significant harm or rebound effects
- Medications where the claimant would face substantial disability if discontinued
- Medications that have taken significant time to optimise and are now providing clear benefit
| Medication Class | Deprescribing Ease | Cautions |
|---|---|---|
| Preventive medications (e.g. statins) | Often easy | Depends on clinical context |
| Benzodiazepines | Difficult | Requires gradual tapering, withdrawal risk |
| Antidepressants | Moderate | Discontinuation syndrome possible, gradual taper preferred |
| Beta-blockers | Moderate | Rebound hypertension possible, gradual taper needed |
| Duplicate medications | Usually easy | Minimal risk if one is adequate |
| Medications without indication | Usually easy | Minimal risk if no longer needed |
Deprescribing in Your Claims
As an insurer, you can support deprescribing by:
- Flagging medications for deprescribing consideration in pharmacy reviews
- Requesting pharmacist input when medication costs are high but benefits are unclear
- Supporting claimants and treating doctors who are considering deprescribing
- Monitoring outcomes after deprescribing to ensure no negative consequences
- Communicating clearly with all treating doctors about deprescribing plans
- Documenting deprescribing decisions and their rationale in the file
Examples of Deprescribing in Insurance Claims
Consider these real-world examples:
- A claimant on four antihypertensive medications, BP well-controlled for years. Pharmacist recommends gradually reducing to three medications. Blood pressure remains controlled, cost reduced by 25%, fewer side effects.
- A claimant prescribed a sedative for acute post-injury anxiety five years ago, still taking it daily despite no anxiety symptoms. Deprescribed over four weeks, improved daytime function, eliminated hangover effect.
- A claimant on both a traditional and newer antidepressant without clear indication for both. Discontinuing one maintains mood stability and reduces medication cost and burden.
Is your claimant a candidate for deprescribing?
IMM specialises in identifying and safely implementing deprescribing opportunities in insurance claims. Our pharmacists develop individualised deprescribing plans, support safe medication reduction, and monitor outcomes to ensure deprescribing delivers the intended benefits.
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