What support can I get?

Prescription costs

If your doctor prescribes medication to help with your recovery and rehabilitation, ACC may be able to contribute towards your prescription costs.

What help can I get?

We can help with prescription costs if your claim has been accepted by ACC and the prescribed item:

  • is needed to help treat your injury
  • is classified as a prescription medicine, restricted medicine, pharmacy-only medicine or controlled drug
  • is prescribed by a treatment provider who has legal authority to prescribe
  • has been purchased from a licensed New Zealand pharmacy, including online pharmacies.

    Note:
    Examples of New Zealand licensed online pharmacies are Pharmacy Direct and Allergy Pharmacy.

    Before buying online, check that the online pharmacy is licensed to operate in New Zealand by phoning the Ministry of Health (external link) on (04) 496 25 79 or email pharmacylicence@moh.govt.nz.

What ACC doesn’t reimburse costs for

ACC doesn’t reimburse costs for:

  • prescribed items that are not prescription medicines, restricted medicines, pharmacy-only medicines or controlled drugs
  • medicines that you have purchased without a prescription
  • administration charges that may be charged by your doctor or pharmacy
  • medicines purchased from pharmacies, including online pharmacies, which are not licensed in New Zealand
  • medicine delivery costs.

Medicines for which you need funding approval

If you would like ACC to contribute to the cost of non-subsidised medication, your doctor or specialist must first get funding approval from ACC.

Non-subsidised pharmaceuticals include any medicine that is not fully paid for by the Pharmaceutical Management Agency (PHARMAC).

To do this:

  1. Ask your doctor to send us a completed ACC1171 Request for pharmaceutical funding (DOC 277K)
  2. Your doctor or specialist must explain on the form:
  • how the non-subsidised medication will help treat your injury, and why other subsidised medication is unsuitable
  • what the rehabilitation goals are and how these will be measured
  • your previous medicines and a list of current medicines.

Your claims manager will use this information, best practice literature and your rehabilitation progress to date, to assess whether it is appropriate to fund the non-subsidised medicines.

We’ll write to you to tell you if your request for funding is accepted, how long we approve funding for and the cost we will pay. If your request is declined, we’ll tell you why.

Funding approvals are given for a limited time only and for a limited cost contribution. You may need to pay a co-payment if your pharmacy charges you a higher cost than what ACC is paying.

Renewal approvals will be considered following the receipt of a new application.

If you are unhappy with the decision, you can ask for a review. See What if I have problems with a claim?

Important:
ACC applies the same process when deciding whether to reimburse any medicine costs.

Before agreeing to pay for medicine costs, ACC will check:

  • information about your injury and current conditions(s)
  • assessments provided by your doctor or treatment provider
  • other information about the pharmaceuticals and how they are helping you recover from your injury
  • your rehabilitation progress to date.

How do I get my prescription costs reimbursed?

Paying your pharmacy directly

ACC may pay your pharmacy directly for any pharmaceuticals costs we approve funding for. You will not have to claim back any prescription costs. Contact your case manager to set up pharmacy direct billing if you want ACC to pay your pharmacy directly.

Claim back and be reimbursed

If ACC doesn’t pay your pharmacy directly, you can claim back some of your prescription costs in the following way:

  1. Complete the ACC249 Request for reimbursement of pharmaceutical costs (DOC 192K).
  2. Attach originals of all pharmacy receipts or invoices to the form and highlight the medicine costs that are related to your covered injury.
  3. Fill in all parts of the form, including each pharmaceutical’s name, cost, and the injury for which it was prescribed.

    Important:
    Make sure that you sign the form and give us your bank account number so that we can pay the amount we reimburse into your bank account.
  4. Pharmacy receipts and invoices.

ACC requires original dispensary receipts and invoices. If you have lost these, you can get duplicates from your pharmacy. If you send us scanned copies of these you will need to keep the original dispensary receipts for six months, in case we need the originals.

ACC will not accept till receipts, EFTPOS or credit card receipts, pharmacy statements or box labels and faxed or photocopied invoices.

Please ensure the receipt or invoice shows the following information:

  • name of client
  • name of pharmacy
  • date of dispensing
  • name of pharmaceutical(s)
  • name of prescriber, eg doctor
  • prescription number
  • amount charged for the pharmaceutical(s).

What happens next?

ACC will process requests for reimbursement after checking the:

  • pharmaceutical is prescribed by an authorised treatment provider
  • item is a pharmaceutical, as defined in section 6 of the Accident Compensation (AC) Act 2001
  • item has been prescribed to treat a covered injury
  • costs are appropriate
  • pharmacy receipt is valid
  • information about your injury and current condition
  • assessments provided by your doctor or treatment provider
  • other information about the pharmaceuticals and how they are helping you recover from your injury
  • rehabilitation progress to date.

The amount ACC agrees to reimburse will be paid into your bank account. If your request for reimbursement is declined, we will tell you why.

Note:
If you are unhappy with the decision, you can ask for a review. See What if I have problems with a claim?

Related legislation

Accident Compensation (AC) Act 2001:

External Information

For more information on pharmaceutical funding in New Zealand, see PHARMAC – Pharmaceutical Management Agency (external link). ACC contributes to this via a funding agreement with the Crown.

Updated: 25 August 2015

Reviewed: 8 November 2014