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 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.
Please note that ACC will not reimburse costs for:
- prescribed items that are not prescription medicines, restricted medicines, pharmacy-only medicines or controlled drugs.
- pharmaceuticals that you have purchased without a prescription.
- administration charges that may be charged by your doctor or pharmacy.
Important:
ACC may, at any time, ask your doctor whether, and how, the prescribed medications are helping you recover from your injury.
Prescription medicine for which you need prior approval
If you would like ACC to contribute to the cost of non-subsidised medication, your doctor or specialist must first get special approval from ACC.
Non-subsidised pharmaceuticals include any medicine that is not paid for by Pharmac.
To do this, ask your doctor to send us a completed ACC1171 Request for funding from ACC for non-subsidised pharmaceuticals (DOC 145KB).
On the form, your doctor or specialist must explain how the non-subsidised medication will help treat your injury, and why other subsidised medication is unsuitable.
Special approvals are given for a limited time only. Further approvals will be considered following the receipt of a new application.
What do I need to do to get help?
- Complete ACC249 Request for reimbursement of pharmaceutical costs form.
- Attach originals of all pharmacy receipts or invoices showing the medicine costs that are related to your covered injury.
- Ensure you 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. - Provide a personalised deposit slip or letter/statement from your bank (with your name and account number printed on it) so we can direct credit your bank account with the amount that we reimburse.
Pharmacy receipts and invoices
ACC requires original pharmacy receipts and invoices. If you have lost these, you can get duplicates from your pharmacy.
ACC will not accept till receipts, EFTPOS or credit card receipts, pharmacy statements, 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)
- the value of the government subsidy (should be zero value, if there is no government subsidy).
How am I eligible?
You are eligible if your claim has been accepted by ACC and your doctor or other treatment provider* has prescribed medication to help you recover from your injury.
* Only treatment providers who have a legal authority to prescribe.
What happens next?
Subsidised pharmaceuticals:
ACC will process requests for reimbursement after checking:
- the item is prescribed by an authorised treatment provider
- the item is a pharmaceutical, as defined in section 6 of the Accident Compensation (AC) Act 2001
- the item has been prescribed to treat a covered injury, and
- the pharmacy receipt is valid.
Non-subsidised pharmaceuticals:
ACC will also check additional information, such as:
- if a completed ACC1171 form has been received from your doctor
- information about your injury
- assessments provided by your doctor or treatment provider
- other information about the pharmaceutical.
Your treatment provider will help provide this specialised information and ACC will gather existing claim-related information from their systems.
If your request for reimbursement is accepted, we will write to you to tell you. The amount reimbursed 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?
For more information, see PHARMAC – Pharmaceutical Management Agency (external site).
Related legislation
Accident Compensation (AC) Act 2001
- Section 6: Interpretation (external website)
- Schedule 1, Clause 3: When Corporation is liable to pay or contribute to cost of ancillary services related to treatment (external website)
Last updated: 1 April 2010