Workers compensation · CTP · Income protection

Medication risk on injury claims, resolved.

The pharmacist on every claim team

Pharmily is a pharmacist-led service built for personal injury claims. We give insurers, treating doctors and injured people a clear, independent answer on medication, then work with the GP to fix it.

Refer a claim Try the claim check

24 hrsto triage and confirm every referral

5 daystarget turnaround for a pharmacy review

1named pharmacist per claim, start to finish

Fixedfees, approved by you before any work starts

Services

Every medication question on a claim, in one place.

Opinion

Pharmacy review

An independent opinion on whether medicines are reasonably necessary, what the risks are and what should change.

Learn more Ongoing

Medication management

We work with the treating doctor over weeks to reduce high-risk medicines and support return to work.

Learn more Fast check

Medication history check

Not sure what the claimant is taking? A stepped check that maps prescribers, pharmacies and risks.

Learn more 12 weeks

Medicinal cannabis program

Structured oversight with clear goals and review points, or a supported taper when funding changes.

Learn more Early

Claimant counselling call

A short pharmacist call that explains side effects and safe use early in the claim, with a letter for the file.

Learn more Medico-legal

Expert pharmacy reports

Court-ready opinions for disputes, settlement negotiations and the Personal Injury Commission.

Learn more

Why a specialist

Community pharmacy skills, insurance context.

Medication risk builds over months of repeat scripts, several prescribers and little oversight. Resolving it takes a pharmacist who understands the clinical side and the claim: the reasonably necessary test, return to routine goals and what makes a decision defensible.

How we stay independent

Identifying risk

A report lists the problems
Funding is declined
The GP feels audited
The claim becomes a dispute

Resolving risk

A plan is agreed with the GP
High-risk medicines step down
The claimant thinks more clearly
Rehab and return to work move

How a referral runs

From referral to an agreed plan.

01
Referral
Claim number, your questions and approval.
02
Triage
We confirm the service and fee within 24 hours.
03
Interview
Telehealth consult with the claimant, with consent.
04
GP call
We agree the plan with the treating doctor.
05
Report
Your questions answered, GP response recorded.
06
Follow-up
Progress checked at 6–8 weeks.

First five referrals at a pilot rate.

With an outcome summary at eight weeks: GP implementation, dose changes and work capacity.

Start a pilot

Services

Built for personal injury claims, nothing else.

Every service is priced as a fixed fee and approved by you in writing before we start. Nothing extra is done without your approval.

Pharmacy review

From $7505 business days

An independent pharmacist opinion on medication appropriateness, risk and alternatives for one claim, written to support your funding and liability decisions.

When to refer

Unsure if medicines are reasonably necessary
Medicines may not relate to the accepted injury
Costs rising with no clinical improvement
Cannabis approved without treatment goals

What you get

Medication list mapped to the accepted injury
Opioid load (oMEDD), interactions and risks
Direct answers to your referral questions
GP consultation and response (full review)

Medication management

Quoted per claim8–26 weeks

Ongoing pharmacist oversight that works with the treating doctor to reduce medication risk and support recovery, stage by stage.

When to refer

Medicines are delaying recovery or return to work
Sedation, fog, falls or dependence risk
A risk was found but nobody is managing it

What you get

A staged plan agreed with the GP
Check-ins with the claimant and GP at each stage
Progress updates to you
An outcome summary at close

Medication history check

From $3503 business days

For claims where nobody is sure what the claimant is taking. The check only goes as far as the risk justifies.

Step 1RecordsCertificates, invoices and reports on file

Step 2Dispensing historyFrom the claimant's pharmacies, with consent

Step 3Risk mapPrescribers, pharmacies, medicines and flags in one page

Medicinal cannabis program

Quoted12 weeks · 3 reviews

Structured oversight for funded cannabis: goals set at the start, effect measured at each review, and a supported taper where treatment isn't working or funding rules change.

Week 0BaselineGoals, interactions with opioids and sedatives, driving risk

Week 6ReviewPain, sleep, function and side effects against goals

Week 12DecisionContinue with evidence, or taper with the prescriber

Claimant counselling call

From $15015 minutes

A short pharmacist call that explains how to use medicines safely and which side effects to report, followed by a one-page letter for the claim file.

Best timed

Around 4 weeks after injury
After hospital discharge
When opioids or sedatives are started or changed

What you get

A call in plain language, with an interpreter if needed
A confirmation letter for the file
Early warning of anything needing a review

Invoice audit

From $3503 business days

Pharmacy invoices checked by pharmacists who run pharmacies, so we know how billing works from the inside.

What we check

Private dispensing where the PBS applies
High private prices
Early or duplicate supply
Items unrelated to the accepted injury

What you get

Each issue with the SIRA rule it breaches
Estimated overspend
Suggested queries for the pharmacy or prescriber

Expert pharmacy reports

QuotedBy agreement

Medico-legal opinions prepared to the standard expected in disputes, settlement negotiations and proceedings before the Personal Injury Commission.

Common questions

Is the medication reasonably necessary?
Is it related to the accepted injury?
What future medication costs are reasonable?

What you get

A report addressing your letter of instruction
Clinical reasoning and the evidence relied on
A declaration of independence

Claim check

Does this claim need a pharmacist?

Enter the opioids from the pharmacy invoices and tick what applies. The check calculates the daily opioid load, tests the claim against SIRA's review indications and suggests the right service.

Opioids on the invoices Example claim loaded

What else applies?

Review recommended

Daily opioid load 0 mg oMEDD

050100150+

Why

Suggested service Pharmacy review

A triage aid for case managers, not clinical advice. oMEDD uses standard ANZCA Faculty of Pain Medicine conversion factors; methadone is excluded. A Pharmily pharmacist confirms every finding.

Who we help

One medication plan everyone on the claim can work from.

Insurers commission our work, but the plan has to work for the doctor and the claimant too. Here's what each group gets.

Workers comp insurers & self-insurers

Defensible medication decisions

Clear answers on reasonably necessary
Risk resolved with the GP, not just reported
Shorter, less costly claims

CTP insurers

Motor accident claims

Reviews against the reasonable and necessary test
Support for treatment and care decisions
Early action on minor-injury claims that drift

Claims agents & administrators

Fits your workflow

Simple referral, 24-hour triage
Fixed fees approved up front
One named pharmacist per claim

Rehabilitation providers

Remove medication barriers

Sedation and fog that stall programs
Plans timed with graded return to work
A pharmacist to call when something changes

Lawyers

Expert opinion

Court-ready pharmacy reports
Future medication cost opinions
Independent of treating providers

Treating doctors & claimants

Support, not an audit

A colleague's view on a complex regimen
Practical tapering steps and review points
Claimants who feel clearer and safer

Outcomes

We measure what changes on the claim.

A report is only worth what happens next. Every referral is tracked against the same measures, and you receive them in writing.

Implementation

GP acted on the plan

Whether the treating doctor put each recommendation in place.

Opioid load

oMEDD before and after

The daily opioid dose at referral and at each follow-up.

Cessation

Medicines stopped

By class: opioids, benzodiazepines, z-drugs, gabapentinoids, cannabis.

Capacity

Work capacity

Changes on the certificate of capacity after the plan starts.

Cost

Medication spend

Monthly pharmacy cost to the claim, before and after.

Illustrative case

How the measures move on a claim like Daniel's

A fictional example, not a reported result. Every claim moves at its own pace, set by the claimant and their GP, so we measure progress by what changes, not by a fixed timeline.

At referral120

mg oMEDD, plus diazepam, pregabalin and THC. No work capacity.

Step 1120

Cannabis and diazepam stopped first. Less daytime drowsiness.

Step 260

Short-acting oxycodone removed. Starts active rehab.

Step 3≤40

Pregabalin reducing. Returning to suitable duties.

See the measures on your own claims.

Pilot referrals include an outcome summary at eight weeks.

Start a pilot

Sample report

What lands on the case manager's desk.

An excerpt from an illustrative pharmacy review. The claimant and details are fictional.

pharmıly

Pharmacy review · Full
Claimant: Daniel, 44 · L4/5 disc injury
Insurer: [claims service provider]

Summary of findings

The regimen is high risk, only partly reasonably necessary, and likely contributing to sedation and low mood. A staged reduction, agreed with the GP, is recommended.

Medication	Daily dose	For accepted injury?	Risk
Oxycodone/naloxone CR	20/10 mg bd	Yes, with reduction plan	Opioid
Oxycodone IR	5 mg × 8	Yes, with reduction plan	Opioid
Pregabalin	300 mg bd	Partly	With opioids
Diazepam	5 mg nocte	No	Benzodiazepine
THC cannabis oil	Titrated	No, as prescribed	Cannabis
Sertraline	100 mg mane	Liability question	Continue

Opioid load: 80 mg oxycodone × 1.5 = 120 mg oMEDD/day, with a benzodiazepine, a gabapentinoid and THC.
Capacity: drowsiness and forgetfulness reported by the rehab provider fit this combination.
Plan: stop cannabis, then diazepam, then short-acting oxycodone; step down pregabalin and long-acting oxycodone with pain specialist input.
GP response: agreed to stages 1–3; requested pain specialist input for stages 4–5.

Doses and steps are illustrative. Prescribing decisions remain with the treating doctor.

Pharmily Medication Reviews · ABN 91 714 383 681 · 0420 808 848Confidential · Prepared for the referring insurer

Insights

Plain-English guides for case managers.

Short reads on the medication questions that come up most on claims.

Regulation

When SIRA says a medication review is indicated

The review triggers in SIRA's better practice guide, and how to spot them on a file.

SIRA's guide to medication management in the NSW personal injury schemes lets insurers request an independent medication review, carried out by a pharmacist or doctor with the claimant and their GP. It lists when a review is indicated. The most common on files are:

Repeat scripts for opioids, benzodiazepines, z-drugs or medicinal cannabis
More than one opioid, or opioids combined with sedatives or antidepressants
More than one prescriber or pharmacy supplying high-risk medicines
High-risk medicines used for longer than two weeks
Comorbidities such as sleep apnoea, heart or lung disease, or psychiatric conditions

Read the full guide on the SIRA website.

Medication risk

Side effects that look like new injuries

Why low mood, fog and fatigue on a claim may be coming from the medicine cabinet.

Opioids, benzodiazepines, gabapentinoids and THC can all cause low mood, apathy, poor concentration and daytime sleepiness. Long-term opioids can also lower testosterone, which drains energy and mood.

These look exactly like the depression or cognitive problems a claim might go on to fund as a secondary psychological injury. Before accepting a new diagnosis, ask whether the timeline matches a medication change. A review can separate the two, and medication-driven symptoms often improve as doses come down.

PBS & pricing

Reading a pharmacy invoice in five minutes

What to look for before you approve the next pharmacy account.

PBS or private? Medicines should go through the PBS where clinically appropriate and available. Private supply needs a reason.
Private high-risk scripts need a written clinical rationale from the prescriber to the insurer.
Dates. Repeats filled early, or the same item twice in a week, are worth a query.
Relevance. Only medicines for the accepted injury are payable on the claim.
Required details. Invoices should show the PBS item code, prescriber, quantity, strength and price per item.

Cannabis

Planning for changes to cannabis funding

NSW has proposed limits on funding medicinal cannabis on workers comp claims. Here's how to prepare.

Proposed NSW regulations would stop medicinal cannabis being treated as reasonably necessary treatment on workers compensation claims. Check SIRA for the final position and start date before acting on any claim.

If funding ends, claimants already using cannabis will need a planned taper rather than an abrupt stop, and some will need their pain and sleep plan rebuilt. Identifying these claims early, and bringing the prescriber in, avoids disputes and gaps in care.

About Pharmily

The pharmacist on every claim team.

An injured claimant has a GP, a case manager, a rehab provider and an employer. The pharmacist is usually missing. Pharmily fills that gap, so everyone works from one safe medication plan.

Pharmily is led by Alan Ayoub, an accredited pharmacist who runs a Home Medicines Review practice and community pharmacies in Sydney, and works with GPs every week.

Our declaration

We do not dispense to, treat, or work for anyone on the claims we review.

Reviewing pharmacists never review claimants they supply or treat. That independence is why GPs act on our recommendations and why our reports hold up in disputes.

Questions

What case managers ask us.

Is a pharmacy review allowed on a workers comp claim?

Yes. SIRA's medication management guide says an insurer can request a medication review by a registered pharmacist or doctor, with the claimant and their doctor, resulting in an evidence-based medication plan.

Do you replace the GP?

No. The GP stays in charge of prescribing. We give an independent view of the whole medication picture and agree a plan with them.

How is the review paid?

By the insurer as a cost on the claim, after you approve the service and fee. The claimant never pays.

Can you review CTP and income protection claims?

Yes. The same review applies, answered against the test each scheme uses.

What do you need from us?

The claim number, your questions, pharmacy invoices or dispensing history, recent certificates of capacity and any medical or rehab reports you hold.

Which states do you cover?

Reviews are done by telehealth, so we can work on claims anywhere in Australia. We start in NSW.

Refer a claim

Send us the claim that's been bothering you.

Tell us about the claim. We'll confirm the service, fee and turnaround within 24 hours, before anything starts.

Pilot offer

Your first five complex referrals at a reduced rate, with an outcome summary at eight weeks.

referrals@pharmily.com.au

Call or text 0420 808 848

Call Text

Medication risk on injury claims, resolved.

Every medication question on a claim, in one place.

Pharmacy review

Medication management

Medication history check

Medicinal cannabis program

Claimant counselling call

Expert pharmacy reports

Community pharmacy skills, insurance context.

From referral to an agreed plan.

Referral

Triage

Interview

GP call

Report

Follow-up

First five referrals at a pilot rate.

Built for personal injury claims, nothing else.

Pharmacy review

When to refer

What you get

Medication management

When to refer

What you get

Medication history check

Medicinal cannabis program

Claimant counselling call

Best timed

What you get

Invoice audit

What we check

What you get

Expert pharmacy reports

Common questions

What you get

Does this claim need a pharmacist?

Opioids on the invoices Example claim loaded

What else applies?

One medication plan everyone on the claim can work from.

Defensible medication decisions

Motor accident claims

Fits your workflow

Remove medication barriers

Expert opinion

Support, not an audit

We measure what changes on the claim.

GP acted on the plan

oMEDD before and after

Medicines stopped

Work capacity

Medication spend

How the measures move on a claim like Daniel's

See the measures on your own claims.

What lands on the case manager's desk.

Summary of findings

Plain-English guides for case managers.

When SIRA says a medication review is indicated

Side effects that look like new injuries

Reading a pharmacy invoice in five minutes

Planning for changes to cannabis funding

The pharmacist on every claim team.

What case managers ask us.

Send us the claim that's been bothering you.