MEDICATION ASSESSMENT
Medication evidence for the liability decision.
Medication Assessment helps claims teams determine whether prescribed medicines are clinically justified, claim-related, and supported by defensible evidence before an insurer commits to ongoing medication costs.
Includes Medication Cost Analysis, where our pharmacists assess medication pricing against the Australian Pharmaceutical Benefits Scheme (PBS) to identify pricing discrepancies and provide guidance on fair and reasonable costs
ASSESSMENT REVIEW
Clinical justification
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Risk and interaction review
Defensible recommendations
Medication Cost Analysis
CLAIMS DECISIONING WORKFLOW
First question: is the insurer liable for the medication?
Medication Assessment is designed for the first point in the claims workflow: clarifying whether the prescribed medicine is connected to the accepted injury or condition, appropriate for the circumstances, and reasonable for the insurer to fund.
1
Liability decision
The insurer needs to understand whether the medication is justified and connected to the claim before accepting responsibility for payment.
2
Medication Assessment
MediLens reviews the clinical context, medicines, risks, interactions, and available evidence to provide an independent assessment for claims decision-making.
3
Defensible recommendation
The review gives claims teams a practical position on justification, risk, and next steps so the decision can be explained and applied consistently.
WHY THIS ASSESSMENT MATTERS
Care based evaluation prior to billing.
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1. Clinical justification
Determine whether prescribed medications are clinically justified for the accepted injury or condition.
2. Risk & interaction review
Identify potential risks, interactions, duplication, or polypharmacy issues before costs become ongoing.
3. Actionable guidance
Explore alternative treatment pathways and next steps for safer, more effective recovery.
REVIEW TRIGGERS
When a medication
assessment is recommended
A medication assessment is valuable whenever claims teams need confidence, clarity, or independent guidance on medication use. Typical scenarios include:
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Managing complex or high-risk regimens — especially when multiple prescribers or overlapping therapies are involved.
Determining appropriateness — confirming that prescribed medicines are necessary and justified.
Clarifying treatment alignment — ensuring medications are connected to the accepted injury and treatment goals.
Assessing specific therapies — such as medicinal cannabis where objectives or expected outcomes are unclear.
Resolving conflicting opinions — when different treating providers offer opposing guidance.
Evaluating costs and value — ensuring medication spending aligns with therapeutic benefit.
Identifying potential risks — including interactions, polypharmacy, or factors that may delay recovery.
Pre-IME review — for cases requiring assessment before escalation to an Independent Medical Examination.
SERVICE INCLUSION
A clear, decision-ready review of the case.
Each assessment provides a thorough review of the medication picture, delivered in a way claims teams can understand, explain, and act on.
Comprehensive report
A pharmacist-prepared record of current regimens, medication history, interactions, concerns, and reasoning.
Actionable recommendations
Practical guidance that helps optimise medication use, reduce risk, and support confident claim decision-making.
Recovery-focused advice
Recommendations that support safer recovery, treatment alignment, therapeutic value, and appropriate next steps.