4.5.34.4 Drugs of dependence
Drugs of dependence are some Schedule 4 medications plus all Schedule 8 medications. These medications have a therapeutic benefit but can be addictive and may result in significant negative health and social consequences if misused.
Policy
Refer to the Pharmacy policy for more information.
See: health.vic.gov.au
Private schedule 8 medication with a PBS equivalent
A THP Treating Health Practitioner must provide written clinical rationale to prescribe private schedule 8 medication if there is a PBS equivalent.
Only the first invoice may be paid for a worker or a pharmacy without a WorkSafe exception being granted.
Refer to the Pharmacy policy for more information.
Note: If a worker is not eligible for Medicare, see: Worker ineligible for Medicare.
Clinical rationale of private schedule 8 medications
The Agent must refer the clinical rationale for the prescription of private Schedule 8 medication to a Medical Advisor via a Novus task for review.
Service provision of Opioid Replacement Therapy (ORT) and Long Acting Injectable Buprenorphine (LAIB)
Service provision includes the clinical oversight and management of administering these medications.
Agent can use the following codes, depending on the method and duration of administration of ORT:
-
DAILYORT: for service of providing daily ORT only (replaces DAILYDSP)
-
WEEKLAIB: to enact $25 weekly payment for dispensing/associated pharmacy supply of the medication, and delivery of the LAIB to the medical clinic/injecting medical practitioner
-
INJLAIB: an additional $20 for injection administered by a qualified/registered pharmacist (with $25 WEEKLAIB payment = $45 per week)
On receipt of an invoice, an Agent may seek further information from an injured worker’s medical practitioner or pharmacist if required.
Worker ineligible for Medicare
The PBS gives Medicare card holders subsidised access to prescription medicine and provides measures to support safe drug use.
Medicare Australia rules outline that a PBS prescription can be written for a patient receiving compensation if they are an eligible Australian resident and hold a valid current Medicare card. Where a worker is not eligible for a Medicare card, they are not entitled to receive medication under the PBS.
Worker ineligible for Medicare
If a worker advises the Agent that they are not eligible for Medicare:
- WorkSafe can consider paying for the private prescription of Schedule 8 medication outside of the PBS
- check eligibility for Medicare - review the information available on the Medicare website .
Agent is satisfied that the worker is not eligible for Medicare
Where the Agent is satisfied the worker is not eligible for Medicare based on the information provided on Medicare Australia’s website, the Agent should:
- approve the private prescription of the Schedule 8 medication, up to six months only
WorkSafe expects that Agents periodically review a worker’s eligibility for Medicare.
Agent is not satisfied that the worker is not eligible for Medicare
Where the Agent is not satisfied that the worker is not eligible for Medicare, the Agent should:
- send a letter to the worker requesting they provide the reasons they believe they are ineligible for Medicare in writing