Pharmacy insight for claims, medication risk and service improvement.
Medilens helps insurers answer medication questions in individual workers compensation claims, and helps organisations improve pharmacy services, governance and operations.
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Pharmacist Led
Defensible reports
Liability support
Medication management
CORE SERVICE - WORKERS COMP REVIEW PATHWAY
01
Is the insurer liable for the medication picture?
02
Are medicines helping recovery — or adding risk?
03
Is use reasonable, necessary and connected to the accepted injury?
Typical review time: 5–7 days
Insurers & Self insurers
Hospitals & pharmacies
Regulators & policymakers
Two ways Medilens supports healthcare organisations
We support insurers with independent medication assessments and healthcare organisations with pharmacy advisory services to improve safety, governance and operational performance.
The primary service: workers compensation medication review
Short, practical support for insurers when medication questions affect liability, recovery, duration, risk or claim direction.
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CORE SERVICE
Pharmacy Medication Analysis
Single-Claim Medication Review
We analyse one workers' comp claim to give you a definitive, unbiased answer on liability, future risk, and treatment necessity—so you can decide whether to approve, deny, or settle.
Liability
Is the insurer responsible?
Management
Are medicines helping?
WHAT INSURERS GET
A clear answer that can be used in a claim decision.
• Rationale for funding decisions
• Medication risks, necessity and appropriateness
• Practical recommendations: fund, question, optimise, monitor or escalate
Medication analysis follows the insurer’s decision pathway.
Claim referred
Is liability accepted?
No
Yes
A. Liability decision
Is use reasonable, necessary and connected to the accepted injury?
B. Medication management
Is medication helping recovery, or adding risk?
Output: rationale for funding decision
Output: fund, question, optimise, monitor or escalate
A
A. Liability decision
Is use reasonable, necessary and connected to the accepted injury?
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Output: rationale for funding decision
A. LIABILITY DECISION
Is the insurer liable for the current medication regimen?
For workers compensation and other insurance pathways, the first analysis helps teams understand whether current or proposed medication use is reasonable, necessary and connected to the accepted injury or claim context.
◉ Rationale for funding decisions
◉ Appropriateness, necessity and medication risk
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B. MEDICATION MANAGEMENT
Medication Isn't Working. Now What?
Once liability is accepted, medication management focuses on stalled recovery, long-term prescribing, multiple prescribers, complex regimens or medicines that are increasing risk without obvious improvement.
◉ Multiple prescribers or pharmacies
◉ No improvement despite prolonged treatment
When a medication review makes sense
Request a review if any of the following apply to a claim
Polypharmacy
(5+concurrent meds)
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Delayed recovery
Multiple prescribers
High-risk medicines
Conflicting plans
Liability uncertainty
Medication analysis: from referral to report.
This is the workflow for the core workers compensation medication assessment service — after the review trigger is identified and before advice is used in the claim decision.
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Refer case
Submit case details
Pharmacist review
5–7 business days
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Receive report
Ready to action
01
Understand the question
We identify whether the referral is about liability, ongoing management or both.
02
Analyse the current medication regimen
A pharmacist reviews clinical context, prescribing pattern, risk, expected benefit and decision relevance.
03
Return usable recommendations
The outcome is written to support action: fund, question, optimise, monitor or escalate.
SECONDARY SERVICE - ORGANISATION lEVEL ONLY
Pharmacy advisory beyond individual claims.
This sits apart from single-claim Medication Analysis. Use Advisory Services for pharmacy department strategy, operations, due diligence, audits, governance and service design across corporate, government, aged care or healthcare organisations.
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Strategic uplift and pharmacy operations
Insurance, legal and claims advisory
Medication safety and risk reviews
