Myth: Multiple Prescriptions Mean Over-Treatment. The Clinical Reality.

Amar Lunagaria — Co-Founder & Chief Pharmacist, LienScripts | March 24, 2025 | 8 min read

Defense attorneys and adjusters routinely attack pharmacy lien bills by claiming that a patient's 5-7 medications represent over-treatment or 'padding.' This argument is clinically wrong. Here's why multi-drug PI regimens reflect appropriate medicine — and how to rebut the over-treatment claim.

Myth: Multiple Prescriptions Mean Over-Treatment. The Clinical Reality.

One of the most common attacks on pharmacy liens and medical treatment records in personal injury cases is the "over-treatment" argument: the patient has too many medications, the bills are inflated, the prescriptions are unnecessary, and the treating physicians are simply helping the attorney build a larger case.

This argument is clinically unsound. Here is the pharmacological reality — and how to respond.

[!KEY] The "over-treatment" argument against multiple PI prescriptions is clinically wrong — muscle spasm, inflammation, neuropathic pain, and sleep disruption each require drugs that work through entirely different biological mechanisms, and no single medication addresses all of them.

Why PI Patients Require Multiple Medications: The Multi-Mechanism Reality

Personal injury accidents produce injuries that affect multiple distinct biological systems simultaneously. The standard approach to managing these injuries — modern polypharmacy — targets each system with a mechanism-appropriate drug.

Consider a typical rear-end collision patient with cervical and lumbar injury:

Each of these conditions is a distinct, simultaneous consequence of the accident. Each requires a drug that works through a completely different mechanism. There is no single medication that addresses all of these systems. Using five medications for five different injury systems is not over-treatment — it is appropriate, targeted, mechanism-specific medicine.

The Defense Argument: What It Actually Claims

When a defense attorney argues "over-treatment" based on prescription count, they are implicitly claiming one of the following:

1. These injury components don't all exist simultaneously
2. One drug can address all of them
3. The prescribing physicians are not exercising independent clinical judgment

Each of these claims is wrong.

Claim 1 is factually incorrect. Post-traumatic soft tissue injury routinely produces simultaneous muscle spasm, inflammation, neuropathic pain, sleep disruption, and headaches. These are not speculative injury consequences — they are the standard, expected, well-documented sequelae of accident injury. The medical literature documents their co-occurrence in auto accident patients extensively.

Claim 2 misunderstands pharmacology. A muscle relaxant does not treat neuropathic pain. A gabapentinoid does not treat muscle spasm. An NSAID does not prevent CGRP-mediated migraine. There is no poly-indication medication that covers all of these conditions. If there were, one drug would be used.

Claim 3 requires attacking licensed physicians. The prescriptions come from treating physicians — neurologists, orthopedic surgeons, pain management specialists, and primary care physicians exercising independent clinical judgment. Characterizing their prescribing as "attorney-driven" or clinically unwarranted is an attack on professional licensees who are separately accountable to medical boards and their own professional standards.

The GI Protectant Is the Clearest Example

One medication that defense attorneys specifically target is the GI protectant (omeprazole, pantoprazole). "Why is the patient taking an acid reducer? That has nothing to do with the accident."

This argument reveals the attorney's lack of pharmacological knowledge. NSAIDs — the anti-inflammatory medications used for accident-related inflammation — cause gastric irritation and ulcers when used for extended periods. Every major prescribing guideline for NSAID therapy recommends co-prescribing a proton pump inhibitor for patients who require NSAIDs for more than 2-4 weeks.

The GI protectant is prescribed because of the NSAID. The NSAID is prescribed because of the accident. The chain of causation is direct. A GI protectant prescription in a PI record is evidence that the prescriber knew the patient would need NSAIDs for an extended period — confirming ongoing inflammatory injury management.

Brand Medications Are Not Evidence of Over-Treatment

A related defense argument: "Why is the patient on Qulipta instead of topiramate? The brand drug is just to inflate the bills."

This argument is also clinically wrong. A physician who prescribes Qulipta (atogepant) instead of topiramate (the old preventive) is:

• Using a medication specifically approved for migraine prevention through the CGRP mechanism that directly underlies post-traumatic migraine
• Avoiding the significant side effects of topiramate (cognitive impairment, hair loss, metabolic acidosis, paresthesias) that would impair the patient's function and legal participation
• Making a deliberate clinical choice to use state-of-the-art medicine

The brand choice documents clinical sophistication, not billing manipulation. Treating physicians who choose brand CGRP medications over topiramate are making evidence-based prescribing decisions supported by modern neurology guidelines.

Duration of Treatment Is Not Evidence of Over-Treatment

"The patient has been on these medications for 18 months — that's not necessary for a car accident."

Post-traumatic migraine is a chronic neurological condition that often persists for years. Neuropathic pain from nerve root compression requires sustained treatment until the underlying structural problem resolves or is surgically addressed. Chronic central sensitization — the neurological state in which the pain-processing system remains heightened long after tissue healing — can persist indefinitely without targeted pharmacological management.

The duration of medication use directly reflects the duration of injury-related impairment. A patient who continues filling Qulipta monthly for 18 months has a prescription physician who has assessed, at each refill, that migraine frequency remains clinically significant and that ongoing preventive medication is warranted. Each refill represents a separate clinical judgment.

[!KEY] Each monthly refill of a preventive medication is a separate physician clinical judgment that the condition persists and warrants continued treatment — 18 monthly fills represent 18 documented assessments of ongoing clinical necessity, not a single stale prescription running on autopilot.

[!NOTE] MERIT documentation provides pharmacist-authored medical necessity language for each medication in a PI regimen — directly addressing the over-treatment claim with clinical specificity that adjusters are far less likely to challenge than an undocumented prescription list.

How to Respond to the Over-Treatment Attack

Request the medical necessity documentation. Every prescription in a pharmacy lien should have associated medical records documenting the clinical indication. MERIT (Medication Evaluation & Rationale for Injury Treatment) documentation from LienScripts provides explicit, pharmacist-authored medical necessity language for each medication — directly addressing the over-treatment claim with clinical specificity.

Expert pharmacist testimony. A clinical pharmacist expert can explain, for each medication on the lien, the specific biological mechanism it addresses, why that mechanism is appropriate for the patient's documented injuries, and why the alternative (not treating that injury component) would be medically inappropriate.

Cross-examine the defense IME physician on each drug. Ask the defense's IME physician whether muscle spasm, inflammation, neuropathic pain, and sleep disruption can occur simultaneously in a cervical injury patient. Ask what medication addresses all of these conditions simultaneously. Watch the "over-treatment" argument collapse when the physician must concede that each drug targets a separate system.

The over-treatment attack on pharmacy liens is not a clinical argument — it is a litigation tactic. Responding with pharmacological specificity — mechanism by mechanism, drug by drug — demonstrates the clinical legitimacy of the treatment and the sophistication of the response.

[!KEY] Cross-examining the defense IME physician on the pharmacological mechanism of each drug in the regimen is the most effective deposition technique against the over-treatment claim — asking what single medication treats simultaneous muscle spasm, neuropathic pain, and CGRP-mediated migraine forces the physician to concede that separate drugs are clinically necessary.

LienScripts provides MERIT documentation supporting the medical necessity and standard-of-care justification for every medication on a pharmacy lien. Contact LienScripts to discuss how MERIT documentation can support your cases.

Related Resources

• Why PI Patients Often Need Multiple Medications
• How to Use Pharmacy Records in Your Demand Package
• Non-Opioid Pain Management in Personal Injury Cases: 2025 Update