4.5.34.1 Pharmacy providers

Direct billing by a pharmacy

Workers may ask a registered pharmacy if they are willing to send invoices directly to the Agent.

If the pharmacist agrees to direct bill the Agent, the pharmacists must obtain the following from the worker:

claim number and Agent name
prescription for the items to be reimbursed and
a letter from the doctor or dentist confirming that the pharmacy item, over the counter item and/or complementary medication is for treatment of a work-related An injury/disease is work related if it arose out of or in the course of employment and the scope of employment. injury or illness.

WorkSafe recommends that pharmacists confirm with the Agent or worker whether liability has been accepted for the pharmacy item before agreeing to bill the Agent directly. It is advised that pharmacists keep a copy of the doctor's letter on file as proof that particular items are injury related.

Invoicing requirements

Before submitting an account refer to Requirements for invoicing the TAC and WorkSafe Victoria for information to include on accounts for dispensary medications.

Reimbursing a worker

A worker can pay for pharmacy items and then seek reimbursement by providing an itemised receipt as proof of purchase.

Pharmacy items:

on the Pharmaceutical Benefits Scheme (PBS) are reimbursed at the PBS rate
not on the PBS are reimbursed at the private medication rate.

See: Private schedule 8 medication with a PBS equivalent

4.5.34.2 Assess pharmacy requests & invoices

Step	Agent action
Receive request	Requests for pharmacy items must be made by a medical practitioner or registered dentist.
Review request	If items have been previously paid with no supporting information on file: send standard letter to the worker within 10 working days requesting justification and copy to the pharmacy (where appropriate) payment can be made in the first instance to allow the worker time to obtain medical justification. If items have not been previously paid: send standard letter to the worker within 10 working days payment is placed on hold until justification received. If justification is not received reject items.
Determine liability within 10 working days	Information is reviewed by: a suitably qualified person and/or medical advisor a Clinical Panel pharmacist for Schedule 8 medications. See: Costs WorkSafe pays \| Reasonable cost
Send letter	Accept liability If liability is accepted - send an approval letter within 10 working days to the worker. Reject liability If liability is denied - send a rejection letter to the worker within 10 working days with a copy to the pharmacy where appropriate. Note: Minimum Compliance Standards expects that all Medical and Like requests are addressed within 28 days. To assist the worker it is recommended that these requests are addressed within 10 days.

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