What is medication optimisation?

Understanding how to improve medication regimens for better outcomes

Published 2026-04-03

Medication optimisation is the process of improving a person's medication regimen to maximize therapeutic benefit while minimizing side effects, drug interactions, and cost. It's not about finding the "perfect" medication. It's about ensuring each medication is necessary, appropriate, effective, and well-tolerated.

For insurers, medication optimisation is one of the most powerful tools for improving claim outcomes and reducing costs. Let's explore what it means and how it supports better claims management.

What medication optimisation involves

Medication optimisation is a systematic process that includes:

• Review: Comprehensive assessment of all current medications, doses, and regimens
• Assessment: Evaluation of whether each medication is necessary, appropriate, and effective for the patient's conditions
• Adjustment: Changes to medication doses, schedules, or selection to improve outcomes
• Monitoring: Tracking whether changes improve the patient's health and function
• Coordination: Ensuring all prescribers and the patient understand the optimized regimen and implement changes consistently

This isn't about making drastic changes. It's about ensuring the regimen is carefully matched to the patient's actual needs.

Common optimisation strategies

Deprescribing: Carefully stopping medications that are no longer necessary or beneficial. Many patients accumulate medications over time; deprescribing removes those that don't add value.

Dose adjustment: Modifying doses to achieve better balance between benefit and side effects. Sometimes lower doses work as well with fewer side effects.

Therapeutic substitution: Replacing one medication with a more appropriate alternative that has fewer side effects or better efficacy.

Interaction management: Adjusting medications that interact with each other to reduce adverse effects.

Timing optimization: Changing when medications are taken to improve effectiveness or reduce side effects (e.g., taking sedating medications at night rather than morning).

Adherence support: Implementing tools like DAAs or education to ensure medications are taken correctly.

Why medication optimisation matters in claims

Optimised medication regimens directly improve claim outcomes:

• Better symptom control: Right medication at right dose is more effective than wrong medication or wrong dose
• Fewer side effects: Optimised regimens minimize adverse effects that derail recovery
• Improved function: When medications aren't causing side effects, claimant function improves
• Faster return to work: Better medication management accelerates recovery and work capacity
• Lower cost: Fewer unnecessary medications, fewer complications, faster claim resolution
• Better engagement: Claimants appreciate when medications are actually helping and working with their recovery

Who should optimize medications?

Medication optimisation is most beneficial for claimants with:

• Multiple medications (three or more)
• Medications prescribed by multiple providers without coordination
• Side effects limiting function or recovery
• Medications that don't seem to be helping
• Complex medical histories with multiple comorbidities
• Claims that aren't progressing despite time and treatment

How to implement medication optimisation in your claims

Step 1: Identify candidates

Which of your claimants would benefit from medication optimisation? Complex claims with multiple medications are good candidates.

Step 2: Refer for pharmacy review

Refer the claimant to a pharmacist with instruction to review the entire medication regimen and recommend optimisation.

Step 3: Review recommendations

Pharmacist will recommend specific optimisation strategies. Review these and discuss with the claimant and treating providers.

Step 4: Implement changes

Work with treating providers to implement recommended changes. This might involve medication stops, dose adjustments, or substitutions.

Step 5: Monitor outcomes

Track whether optimisation is working. Is function improving? Are side effects decreasing? Is the claimant moving toward return to work?

Keys to successful optimisation

Patient buy-in: The claimant needs to understand why changes are being made and what benefits to expect. Explain the rationale for each change.

Provider collaboration: Treating providers need to understand and support the optimisation plan. Involve them in decisions rather than imposing changes.

Gradual changes: Don't make too many medication changes simultaneously. Gradual adjustment allows you to assess what's working.

Ongoing monitoring: Don't optimize once and then ignore. Monitor outcomes and adjust further if needed.

Clear communication: Everyone involved (claimant, providers, you) needs clear understanding of the optimisation plan and their role in implementing it.

Real-world example

Your claimant has a work-related back injury. They're prescribed oxycodone 40mg daily for pain. They also take sertraline for mood, diazepam for muscle relaxation, and zopiclone for sleep. They report fatigue, cognitive difficulty, and depression despite being on all these medications.

Medication optimisation would involve:

• Reduce oxycodone gradually while implementing non-medication pain management (physical therapy, exercise)
• Optimize sertraline dose and consider whether it's being given time to work
• Stop or reduce diazepam (muscle relaxants have limited benefit and significant side effects)
• Substitute zopiclone with non-medication sleep strategies or, if medication needed, a non-sedating option
• Monitor how claimant responds to these changes

Result: The claimant feels cognitively clear, fatigue improves, function increases, and they're able to return to work three months sooner than expected.

That's medication optimisation.