These guidelines should be read in conjunction with our General provider guidelines, Medical practitioner guidelines and Non-Established, New or Emerging Treatments and Services policy.
Who can prescribe medication?
Medication can be:
- Requested or prescribed by a medical practitioner or dentist who is registered under the Health Practitioner Regulation National Law.
- Dispensed by a pharmacist who is registered under the Health Practitioner Regulation National Law (e.g. AHPRA) to practice in the pharmacy profession (other than as a student).
What we can pay for
Within the first 90 days of a client’s accident, we can help pay for medication without the need for you or the client to contact us for approval first. The medication must be recommended by a health professional, related to the client’s accident injuries and delivered in line with the Clinical Framework.
If the client receives treatment beyond 90 days after their transport accident, we will review their medication to ensure it’s reasonable, clinically justified, outcome focused and in line with the Clinical Framework. We'll ask you and our client for information during these reviews and may temporarily stop funding medication if we don’t receive it.
Reviews help us understand our client’s injuries, treatment needs, their goals and how to best support them get their lives back on track. After a review we’ll let you and our client know the decision regarding further medication.
If our client has not received treatment in 6 months they will need to seek approval from us before we will pay for further treatment. Ask our client for a copy of their approval if you haven’t seen them in 6 months.
We can help pay for:
- Medication prescribed in accordance with the Pharmaceutical Benefits Scheme (PBS) and registered (not listed) on the Australian Register of Therapeutic Goods (ARTG), including:
- 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.
- 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.
- Bacterial vaccinations (pneumococcal, meningococcal and haemophilus B) and the influenza vaccine for clients who have had a splenectomy or have a severe pulmonary condition as a result of their transport accident.
- Privately prescribed medications that are clinically appropriate for the accident-related injury or illness, where there is no readily available alternative on the PBS.
- “Off label” medication that is supported by National Health & Medical Research Council level 1 or 2 evidence.
We can help pay for over the counter items that are recommended by a medical practitioner or dentist, such as:
- Vitamins, minerals and complementary medications that are listed (as opposed to registered) on the ARTG:
- Vitamin C – in the form of ascorbic acid where required by a client with bladder complications and who is taking Hiprex as a urinary antisepsis.
- Vitamin C and iron – required by a client who has donated their own blood for use in an impending operation.
- Vitamin C and zinc – for up to 6 weeks, for a client who has poor wound healing.
- Zinc – required by a client who has a zinc deficiency as a result of the transport accident.
- Vitamin E cream – to treat scarring for up to two years post-accident.
- Glucosamine – in oral form to treat osteoarthritis affecting non-spinal joint.
- Hypericum (St John’s Wort) – to replace PBS and/or private script medications for the treatment of accident related depressive disorders.
- Vaccinium Macrocarpon (Cranberry product) – for the prevention of urinary tract infections in accident-related neuropathic bladders.
- Scar concealing products.
- Dose administration aids and the reasonable weekly refill cost.
- Topical non-steroidal anti-inflammatory drugs, such as gels, creams and sprays – for a period of six weeks, immediately after an accident or following surgery.
- Infant formula products recommended by a medical practitioner and required as a result of a transport accident injury.
- Sunscreen, where required, to counteract the effects of sun-sensitive medications or for patients with skin grafting and burn injuries.
Other things to note
For accidents that occurred prior to 14 February 2018 a medical excess may apply. Visit the medical excess page to see if it applies to your patient.
Patients with a severe injury
If your patient has a severe injury, the discussion, referral and approval of services may form part of the independence planning process between the patient's treating team and our TAC coordinator.
If your patient already has an individualised funding package, pharmaceutical services may be included as part of that.
Requests for information
We may contact you to seek further information and/or discuss your patient’s treatment plan.
How much we can pay
We can pay for services in line with our Pharmacist guidelines.
If your fee is higher than our fee, you may choose to charge the client the difference in the form of a gap payment.
What we cannot pay for
We cannot pay for:
- services that are included as part of a hospital inpatient bed fee
- herbal remedies
- sunscreen, unless specified above
For more information
Access our policy for Pharmacy and medication expenses.