Medication in the workers compensation scheme
Medication prescribed by a nominated treating doctor (NTD) or medical specialist for the management of your compensable injury may be paid for or reimbursed as part of your claim.
Medications paid for as part of a claim:
- must be for the treatment of the compensable injury (as noted on your certificate of capacity or in medical reports provided to your claims service provider)
- must be prescribed by a qualified medical practitioner (such as your NTD or psychiatrist)
- must be supplied by a registered pharmacist
- where possible, prescribed and supplied through the Pharmaceutical Benefits Scheme (PBS), unless the medication is not available on the PBS or there are extenuating circumstances.
Tip: When you are prescribed medications, request that your NTD adds the medication to your Certificate of Capacity to ensure all parties are aware of the new addition to your treatment plan.
Two ways to pay for claim-related medication
- Reimbursement: you pay and request reimbursement from the claims service provider (CSP).
- Direct billing by the pharmacist: the pharmacist sends the invoice directly to your claims team.
Reimbursements
You can pay for medication and request to be reimbursed by submitting the required documents below via email or post to your case manager.
- For prescription medication: a dispensary computer-generated tax receipt for PBS and private (non-PBS) medications supplied for treatment of your compensable injury.
- For over-the-counter medications and equipment: a pharmacy receipt or cash register receipt for over-the-counter or equipment items supplied for the treatment of your compensable injury.
In addition, providing a copy of the prescription will assist with prompt reimbursement.
Direct billing by the pharmacist (preferred method)
You can request that a pharmacy account be set up for medications approved for your compensable injury. This will allow for medications to be supplied to you with payment made directly to the pharmacist by the insurer.
The pharmacist should provide the insurer with the following information:
- a dispensary computer-generated tax invoice for PBS and private (non-PBS) medications supplied for treatment of the compensable injury
- the statement of account for over-the-counter medication and equipment items supplied for treatment of your compensable injury.
Where the item type is not clearly identifiable on the invoice or statement, this may be handwritten:
- OTC – over the counter
- PBS – Pharmaceutical Benefits Scheme
- PRIV – private (non-PBS) medication.
Invoices provided by your pharmacist should include the following:
| Pharmacy details | Your details | Medication details |
|---|---|---|
|
Pharmacy name and street address Dispensing pharmacist's name ABN Invoice number and date Total amount charged |
Family name and given name(s) Address Claim number (or date of birth and date of injury). |
Date of service (date dispensed) PBS item code (for PBS dispensed medications) A copy of the original script for medications that are available on the PBS but are dispensed privately (non-PBS), and a copy of the repeat prescription where applicable Full description of the medication (including script number, generic name, form) Quantity of medication dispensed Strength of the medication dispensed Prescriber name/address/prescriber number Amount charged per item |
Travel Expenses
As part of your claim, you are entitled to receive travel expenses that cover the journey to and from medical appointments that are related to your workplace injury. The maximum amount payable for private motor vehicle transport is $0.55 per kilometre.
For public transport, you will need to keep a copy of your receipt. Your claims service provider can send you a travel expense form where you can keep a record of the distances covered.
