ACT News


Comcare targets benefit rorters

The public service workplace insurer has moved to crack down on profiteering from its generous pharmaceutical benefits and on workers' compensation claims being used to fund drug habits.

Comcare has overhauled its medications policies to regulate the supply of ''drugs of dependence'' and to stop pharmacists overcharging for taxpayer-funded drugs given to injured employees.

The new policy, which comes into effect on June 1, puts pharmacists on notice that Comcare will only pay for drugs that have been medically subscribed and used to treat ''compensable injuries''.

The policy, sent out to all pharmacists nationwide who have billed Comcare in the past 12 months, also warns that the agency will not pay for drugs supplied to individuals other than the injured worker, or for medicines taken without ''clinical justification''.

The insurer has also issued a new pricing schedule for drugs, aimed at putting an end to taxpayers paying ''whatever price the pharmacist has charged'', and warns chemists not to try to charge dispensing fees for selling over-the-counter medication.

Comcare, which covers 218,000 public servants and 167,000 private sector workers, recorded a $564 million loss in 2011-12 and faces an ongoing liability of $2.6 billion for outstanding claims.


''Medical and rehabilitation'' costs, including medications, grew by 18 per cent in 2011-12 to $120 million and the scheme has promised more policies to ensure it only pays for ''clinically justified treatment''.

A recent review by Melbourne barrister Peter Hanks has recommended 147 changes to rewrite Comcare's legislative framework in a bid to rein in the costs of the insurance scheme, including stricter rules on subsidised drugs and ''doctor shopping''.

Comcare pays for the ''reasonable cost of medications'' prescribed by a doctor for a ''compensable condition'' and claims for medical costs can span decades and continue to be paid well beyond the worker's retirement age.

The new policy caps the amount pharmacists can bill the scheme when dispensing drugs that are not covered by the Pharmaceutical Benefits Scheme, known as ''privately prescribed'' medications.

''Rather than paying whatever price the pharmacist has charged, Comcare will pay a maximum 25 per cent mark up on the wholesale price plus a dispensing fee,'' a Comcare spokesman told Fairfax. ''The policy ensures that Comcare pays an appropriate price for

private script medications and over-the-counter products which will be consistently applied across the scheme in a national context.

''Again, this is consistent with the Hanks recommendation to apply legislative instruments outlining prices for medical services within the scheme.''

Comcare has also introduced guidelines around the prescription and dispensing of ''Schedule 8'' medications including controversial drugs like oxycodone, stipulating that they must be dispensed through the PBS.

''Safe prescription of these medications is an important worker safety issue within our scheme,'' the spokesman said.

''It is important to note this was also highlighted within the Hanks review.

''Mr Hanks even went further in including a recommendation that workers nominate a treating practitioner when receiving Schedule 8 medications to ensure appropriate control and management.''


Comment are now closed