Pharmacy policy

What WorkSafe will pay for

WorkSafe (either directly or through one of its authorised agents) can pay the reasonable costs of medications and other pharmacy items required as a result of work-related injury or illness, or if the worker* is entitled to provisional payments on a claim that includes a mental injury, in accordance with Victorian worker's compensation legislation.

*Eligible Victorian volunteers are also entitled to provisional payments.

Injured workers

All references to injured workers on this page may also apply to workers who are entitled to provisional payments.

This excludes items covered in the WorkSafe Equipment and related services policy (such as bandages).

WorkSafe can pay the reasonable costs of medications that are:

• required as a result of a work-related injury or illness
• requested by a registered medical practitioner or registered dentist
• provided by a registered pharmacist
• provided in accordance with the Pharmaceutical Benefits Scheme (PBS)

• non-steroidal anti-inflammatory drugs, such as gels, creams and sprays – for a period of six weeks immediately after an injury or following surgery
• drugs of dependence (schedule 8 medicines), schedule 3 and schedule 4 medicines that adhere to the relevant legal requirements relating to their prescribing, dispensing and clinical use including the service provision (clinical oversight and management of administering this medication) of opioid replacement therapy (ORT) an Long Acting Injectable Buprenorphine (LAIB) by a registered pharmacist
• erectile dysfunction medication in oral or injectable form, up to a maximum of 8 intermittent use tablets or injections per month, or low dosage daily use tablets
• ARTG registered medicine if it is a clinically appropriate treatment for the work related injury or illness if there is no readily available alternative

WorkSafe will review and consider pay the reasonable costs of the following:

• Non-PBS private prescribed medications (where they are clinically appropriate for the work related injury or illness and there is no readily available alternative on the PBS)
• ARTG listed complementary medicines including certain vitamins and minerals such as:
  • Vitamin C
  • Zinc
  • Vitamin E cream
  • Glucosamine
  • Hypericum (St John's Wort)
  • Vaccinium Macrocarpon (Cranberry product)

  WorKSafe Agents will be guided in their review of each listed complimentary medicine claim based on the clinical appropriateness of the treatment related to the injury or illness

• "off label" medications (unless it is supported by National Health & Medical Research Council (NH&MRC) level 1 or 2 evidence)

What WorkSafe will not pay for

WorkSafe cannot pay for medications that:

• are not clinically justified, safe and effective,
• are not reasonable, necessary or appropriate to treat the work related injury,
• have no NH&MRC level 1 or 2 evidence that the medication is safe and effective. Refer to the Non-established, new or emerging treatments and services policy,
• are recommended by a healthcare provider other than a registered medical practitioner or registered dentist, or
• are not invoiced according to WorkSafe's Pharmacy invoicing requirements.

How much WorkSafe will pay

WorkSafe will pay for treatment and services according to our fee schedule. If the pharmacist charges more than the WorkSafe rate, the worker may need to pay the difference.

WorkSafe will pay for pharmacy and over-the-counter items in line with the Pharmaceutical Benefits Scheme (PBS) where applicable. The Pharmaceutical Benefits Scheme (PBS) provides subsidised prescription medicines to residents of Australia.

Where a pharmacist charges above the PBS rate, or the over-the-counter item are not on the PBS, the worker may need to pay the difference, if it's not covered by Medicare or private health insurance. WorkSafe can also pay for the reasonable cost of private scripts dispensed by a pharmacy. If the cost of your private script exceeds the WorkSafe rate, the worker may need to pay the difference. For pricing and invoicing requirements please see Requirements for invoicing WorkSafe Victoria policy.

Definitions

Pharmacists

A pharmacist will prepare medication, dispense or fill prescriptions and provide advice about the medicines the worker is taking.

Medicines and pharmacy supplies can only be provided by a registered pharmacist, and can treat the work-related injury in a number of ways. Supplies may include:

• prescription medications, and/or
• other pharmacy items dispensed by pharmacists, such as bandages.

Controlled medicines

Medications may have risks associated with them. In Australia, there are systems in place to minimise these risks, including regulations on how and when certain medications are prescribed and administered. Some medications if misused or overused have a high risk potential for harm, dependence and accidental death from poisoning. Controlled medications are subject to strict controls under the law and include medications such as sedatives and opioid analgesics.

When prescribed a controlled medication, it is important to pay close attention to any instructions from the doctor and pharmacist, to minimise the risks associated with taking a medication of this type. WorkSafe encourage workers to seek further information from their medical practitioner or pharmacist.

SafeScript

SafeScript monitors all prescriptions for identified high risk medicines regardless of whether they receive a PBS subsidy or are private, non-PBS prescriptions.

Doctors, nurse practitioners and pharmacists have access to SafeScript to view records of all high-risk medicines that have been supplied to patients under their care. This enables health professionals to make safer and more informed clinical decisions, and facilitates the co-ordination of treatment and communication by giving them visibility of all clinicians involved in the prescription of identified high risk medications.

Authorised Department of Health staff access SafeScript as part of their regulatory role in ensuring the safe supply of medicines in the community. WorkSafe and their agents do not have access to SafeScript records of injured workers.

Sedatives

WorkSafe can pay the reasonable costs of sedatives prescribed for short-term use of up to 4 weeks.

Clinical justification is required in order for WorkSafe to consider paying the reasonable costs of:

• sedatives prescribed beyond 4 weeks,
• privately prescribed sedatives available on the PBS, or
• two or more prescribed sedatives to be taken in the same 24 hour

Who can provide medication and pharmacy items to injured workers?

WorkSafe can pay for medication and other pharmacy items dispensed by pharmacists who are:

• registered with WorkSafe to provide pharmacy services, and
• registered with the Pharmacy Board of Victoria, or the equivalent in other Australian states or territories.

Pharmacies are required to register with WorkSafe to obtain a WorkSafe provider number to enable payment of invoices.

If the pharmacy name or address details change, a new provider number will need to be allocated. To update provider name or address details with WorkSafe, providers must email the new details to: [email protected]

Following the processing of the change in details, correspondence confirming the new provider number will be emailed back via the email address from which the request was received.

If WorkSafe gives notice to a provider advising them that they are suspended from providing services to WorkSafe clients, WorkSafe will notify the Australian Health Practitioner Regulation Agency or other relevant professional body that regulates the provider, and Medicare Australia, of the suspension and the grounds on which the suspension has been issued.