Pharmacy
WorkSafe Agents can pay the reasonable costs of medications and pharmacy items for work-related injuries or illnesses in accordance with section 99 of the Accident Compensation Act 1985 (the Act).
Agents regularly review requests for payment of medication and other pharmacy items to ensure they are:
- appropriate for a worker’s work-related injury or illness
- requested by a medical practitioner or dentist
- provided by a registered pharmacist
- provided in line with the Pharmaceutical Benefits Scheme (PBS), where clinically appropriate and available, and
- registered (not listed) in the Australian Register of Therapeutic Goods.
Frequently Asked Questions
- Who can provide medications and pharmacy items to injured workers?
- How much can WorkSafe pay?
- What medications WorkSafe can pay for?
- What medications WorkSafe cannot pay for?
- Complementary medications and over the counter medications
- Non-drug pharmacy item
- Restrictions on funding and supply of medications
- Policies on specific medications
- WorkSafe invoicing requirements
Who can provide medications and pharmacy items to injured workers?
WorkSafe can pay for medications and other pharmacy items dispensed by pharmacists who are:
- registered with WorkSafe to provide pharmacy services, and
- registered with the Pharmacy Registration Board of Victoria, or the equivalent in other States/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. Updated details should be faxed to the Provider Registration Branch of WorkSafe on 9641 1767. A letter with the new provider number will be mailed to the Pharmacy.
How much can WorkSafe pay?
All injured workers with a Medicare card are entitled to PBS prescribed medications. All medications should be prescribed under the Pharmaceutical Benefits Scheme (PBS) when clinically appropriate and available.
WorkSafe can pay for the reasonable costs of medications and pharmacy items:
-
PBS prescription items
WorkSafe can pay all patient contribution charges set out in the PBS, including therapeutic premiums. WorkSafe can also pay for the brand premiums if a product with a brand premium has been prescribed and the prescriber has indicated on the prescription that brand substitution is not permitted.
-
Private / non-PBS prescription items with wholesale price less than $100
WorkSafe can pay up to a mark-up of 60% of the wholesale price plus a $7.50 dispensing fee ($11.70 for Schedule 8 medications)
-
Private / non-PBS items with wholesale price $100 and over
WorkSafe can pay up to a mark-up of 25% of the wholesale price plus a $7.50 dispensing fee ($11.70 for Schedule 8 medications);
-
Over the counter (OTC) items and non-medication items
WorkSafe can pay up to a mark-up of 50% of the wholesale price.
What medications WorkSafe can pay for
WorkSafe can pay for the reasonable costs of medications which 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 PBS where clinically appropriate and available, and
-
registered (as opposed to listed) in the Australian Register of Therapeutic Goods.
What medications WorkSafe cannot pay for?
WorkSafe cannot pay for medications that:
- do not relate to a work-related injury or illness
If you have any queries please contact WorkSafe Agent managing the worker’s claim.
-
are not provided on the request of a registered medical practitioner or registered dentist
-
are not provided by a registered pharmacist
-
are not provided at a reasonable cost
-
are recommended by a health care professional other than a registered medical practitioner or registered dentist
-
are prescribed as part of a clinical trial
-
were required prior to the work injury or illness, and
-
are not invoiced according to WorkSafe invoicing requirements.
Complementary Medications and Over The Counter Medications
WorkSafe can pay for the reasonable cost of complementary and over the counter medications which are required as a result of a work-related injury or illness and are:
- registered (as opposed to listed) in the Australian Register of Therapeutic Goods, and
- supplied by a registered pharmacist.
To assess the reasonable cost of a request for complementary medications and over the counter medications, a written clinical rationale from a registered medical practitioner or dentist may be requested by the Agent.
Non-Drug Pharmacy Items
WorkSafe can pay for the reasonable costs of non drug pharmacy items such as curative apparatus, appliances or materials, including such items as equipment, dressings, bandages, supports and syringes/needles which are:
- required as a result of a work-related injury or illness, and
- supplied by a registered pharmacist.
To assess the reasonable cost of a request for non drug pharmacy items, a written clinical rationale from a registered medical practitioner or dentist may be requested by the Agent.
Restrictions on Funding and Supply of Medications
WorkSafe will require that the prescribing medical practitioner or dentist must provide a written clinical rationale to the Agent, for prior approval of:
- Schedule 8 medication not listed on the PBS or not prescribed under the PBS
- medication supplied in quantities exceeding the manufacturer’s maximum therapeutic dose, and
-
bulk supply of a medication e.g. for overseas travel.
Specific Medications
WorkSafe has a number of specific medication policies which have been developed in line with community standards and current best practice, including:
- Drugs of dependence (Schedule 8 and Schedule 4 medications)
- erectile dysfunction medications
- glucosamine, and
- topical non-steroidal anti-inflammatory drug (NSAIDs) creams and gels.
WorkSafe Invoicing Requirements
Registering with WorkSafe
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. Updated details should be faxed to the Provider Registration Branch of WorkSafe on fax no. 9641 1767. A letter with the new provider number will be mailed to the Pharmacy.
Invoice requirements
Pharmacy invoices for payment of medications and other pharmacy items, must contain the information specified in the table below.
A copy of an original script and a copy of a duplicate original script are the same. Either can be accepted as documentation for private items
|
Information required |
PBS script |
Private/ Non-PBS |
OTC medication |
Non-medication |
|
For each INVOICE, the following information is required |
||||
|
Pharmacist name, address & WorkSafe provider number |
√ |
√ |
√ |
√ |
|
Worker’s name, address and claim number |
√ |
√ |
√ |
√ |
|
Invoice number, date and total amount |
√ |
√ |
√ |
√ |
|
Valid GST invoice |
Not applicable |
Not applicable |
Where charged |
Where charged |
|
For each ITEM on an invoice the following information is required |
||||
|
Medication item status (PBS or private/non-PBS or OTC) |
√ |
√ |
√ |
Not applicable |
|
Copy of original prescription (and repeat authorisation form, where applicable) |
Not applicable |
√ |
Not applicable |
Not applicable |
|
Script number |
√ |
√ |
Not applicable |
Not applicable |
|
Date dispensed or supplied |
√ |
√ |
√ |
√ |
|
Brand name or non medication description |
√ |
√ |
√ |
√ |
|
Medication form |
√ |
√ |
√ |
Not applicable |
|
Medication strength |
√ |
√ |
√ |
Not applicable |
|
Quantity dispensed or supplied |
√ |
√ |
√ |
√ |
|
Price |
√ |
√ |
√ |
√ |
Forms & Publications
- Information about WorkCover for Healthcare Professionals
- Medications and Pharmacy Items - Information for Workers
- Information for Medical Practitioners & Dentists - Prescribing medications and pharmacy items for workers
- Disclosing health information about WorkCover patients - A guide for healthcare professionals
