Opioid policy

The TAC Medical Excess may apply to these services

Policy

The TAC can pay the reasonable costs of opioid medication where required as a result of a transport accident injury under section 60 of the Transport Accident Act 1986 (the Act) following the provision of a written request from a medical practitioner.

The TAC will periodically review a client’s entitlement to opioid medication to ensure that the treatment and services remain reasonable for the transport accident injury and are payable under the Act.

Background

The TAC supports the prescription of opioid medication for short term use on prescription in line with the Department of Health and Human Services’ Health Information website Information for Health Professionals and Safe Prescribing and Supply of Opioid Medicines guidelines.

Opioids are medications that are synthesised or semi-synthesised, which act similarly to naturally occurring opiates. Opiates encompass drugs naturally derived from the opium poppy.

Opioids are often prescribed to relieve moderate to severe pain and have the potential for dependence and harm.

Opioids in certain circumstances can be more effective than nonsteroidal anti-inflammatory drugs and other non-opioids in providing pain relief, especially in acute pain settings where pain signals are too severe to be controlled by other drug groups.

Opioids differ to other drug groups in that they work on pain receptors located in the brain and spinal cord, where other drug groups generally work more directly on injured body tissue.

The Department of Health Victoria have published an opioid analgesics guide for medical and health services providers that advises that opioids should only be prescribed where pain is not controlled adequately with non-opioid analgesic drugs in the following contexts:

  • Pain related to the treatment of cancer
  • In a palliative setting; or
  • Selected cases of acute pain (time limited to less than 1 week).

For more information, please refer to the Victorian Department of Health website: https://www2.health.vic.gov.au/Api/downloadmedia/%7B87A38EEF-9588-4ACF-84CD-A63F9EDCE00F%7D

This policy must be read in conjunction with the following:

Definitions

In this policy, opioids refer to all synthetic and semi-synthetic opioids as well as all natural opiates.

Guidelines

What can the TAC pay for in relation to opioid medication?

The TAC can pay the reasonable costs of opioid medication:

What information does the TAC require to consider paying for opioid medication?

The TAC can pay the reasonable costs of opioid medication up to 3 months post discharge from hospital.  Where a medical practitioner is prescribing opioid medication outside of this period the TAC require the following information from the prescribing practitioner:

  • clinical justification for the continuing opiate use
  • a brief outline of pharmacological treatment to date
  • a list of medications currently being taken by the client including frequency and dose (including sedatives)
  • outcomes with regards to the client’s pain levels and functions; and
  • a management plan for future opioid use or cessation

To expedite payment of accounts, the TAC encourages prior approval be sought by the client's treating practitioner.

For a client with a severe injury, opioid medication prescription can be discussed as part of the Independence planning process with their treating team and TAC coordinator.

When will the TAC respond to a request?

The TAC will respond to written treatment and service requests as set out in the TAC Service Charter.

To assist the TAC to make a decision regarding a request for opioid medication, a request may be reviewed by the TAC Clinical Panel. The Clinical Panel may contact the requesting medical practitioner to seek further information and/or discuss the proposed treatment prior to making a recommendation to the TAC regarding the request. The TAC will respond to the request when they have received the Clinical Panel’s recommendation.

What are the TAC’s invoice requirements?

Please refer to:

What fees are payable for opioid medications?

Please refer to the How to invoice the TAC (for Pharmacists) information page.

In relation to opioid medication, what won’t the TAC pay for?

The TAC will not pay for:

  • treatment or services for a person other than the client
  • vitamins or minerals that have been listed (as opposed to registered) on the ARTG except for those listed in the Vitamins, Minerals and Complimentary Medications policy
  • treatment or services where there is no clinical justification
  • treatment, services or equipment where there is no published evidence in a recent peer-reviewed journal article that the treatment, service or equipment is safe and effective. Refer to the Non-Established, New or Emerging Treatment and Services policy
  • Schedule 4 or Schedule 8 drugs that have not been prescribed and used in the manner required by the Drugs and Poisons Regulation Group (DPRG) in Victoria or the corresponding body in another state or territory.
  • treatment or services provided outside the Commonwealth of Australia
  • telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
  • pharmacy medications provided more than two years prior to the request for funding except where the request for payment is made within three years of the transport accident.  Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.