Consultation to increase ADHD medicine access begins

17 December 2024

Media release Medicines

Today, consultation opened on a proposal by Pharmac and the Ministry of Health (Medsafe) to improve access to stimulant medicines used in the treatment of attention deficit hyperactivity disorder (ADHD).

The proposal suggests broadening the range of people who can initiate treatment of stimulant medicines which, over time, would lead to more doctors and nurse practitioners being able to diagnose and treat ADHD.

Group Manager of Medsafe, Chris James, says “the intent of the proposal is to increase access to ADHD medicines for people who need them. The proposal follows feedback from the sector that these changes may help reduce wait times and costs for people at a time when our workforce is under pressure.”

Chief Medical Officer of Pharmac, David Hughes, said the proposal, if approved, would improve access to ADHD medicines over time.

“This proposal follows years of work with the health and disability system, clinicians, and advocacy groups to support better services for people with ADHD in New Zealand, and we thank the advocacy groups in particular for all of their feedback over this time,” says Hughes.

Currently, for people to have access to ADHD stimulant medicines, a medical practitioner specialising in paediatrics or psychiatry must initiate the treatment. Subsequent prescriptions can then be prescribed by any medical practitioner or nurse practitioner when acting on the written recommendation of a specialist.

The consultation also seeks feedback on what would be needed to ensure medicines are prescribed appropriately, and that people with ADHD are able to safely access stimulant medicines. These include working within appropriate multi-disciplinary settings, defining training requirements, and specifying the circumstances for initiating prescribing based on the age of the patient.

The consultation closes on Tuesday 11 February 2025. After feedback has been reviewed to identify any issues that require further advice or consideration, Pharmac and the Ministry of Health will make a joint decision on both proposals. If approved, we’re proposing that the changes would be made from 1 July 2025.

Proposal to change the regulatory and funding restrictions for stimulant treatments for ADHD.

Questions and answers

Why is the Ministry of Health and Pharmac proposing this change?

What is the Ministry of Health proposing?

Dexamfetamine, lisdexamfetamine, and methylphenidate are medicines used in the treatment of ADHD. They are classified as Class B controlled drugs by the Misuse of Drugs Act 1975.

Approval from the Minister of Health is needed for doctors and nurse practitioners to prescribe these medicines. The approval process is the responsibility of the Ministry of Health and is done by Medsafe.

Currently, to be diagnosed with ADHD, a person needs to see a psychiatrist or a paediatrician. To start on ADHD medicines, they need to be prescribed by a psychiatrist or a paediatrician, or by a doctors or nurse practitioner with a written recommendation.

The Ministry of Health is proposing to change the approval notices for these medicines, so that more doctors and nurse practitioners are able to prescribe them.

We expect these changes will also encourage more doctors and nurse practitioners to be able to assess and diagnose people with ADHD over time.

What is Pharmac proposing?

Pharmac sets specific criteria that must be met before some medicines will be funded. We do this to make sure medicines are targeted to those who would benefit most from treatment.

Dexamfetamine, lisdexamfetamine, and methylphenidate all have Special Authority criteria that outlines who can prescribe them for the first time.

Currently our Special Authority criteria only allows applications from paediatricians and psychiatrists, or doctors or nurse practitioners on the written recommendation from an authorised specialist.

Pharmac is proposing to change its Special Authority criteria for ADHD medicines to align with the changes the Ministry of Health is making.

This will mean more doctors and nurse practitioners will be able to submit Special Authority applications for people starting funded ADHD stimulant medicines.

What does this proposed change mean for people?

If this proposal is successful:

People aged 18 years and above will be able to see doctors who specialise in paediatrics, psychiatry, general practice, or nurse practitioners working within their scope of practice, to be started on ADHD stimulant medicines.
People aged 17 and under will be able to see doctors who specialise in paediatrics and psychiatry, or a nurse practitioner working in paediatric or child and adolescent mental health services, to be started on ADHD stimulant medicines.

This would mean that people diagnosed with ADHD would find it easier to start ADHD stimulant treatments, as they will be able to see a wider range of medical and nurse practitioners.

Over time this would mean that people would be able to be diagnosed with ADHD by a trained health professional – such as a doctor, or a nurse practitioner who works in a specialised scope of practice.

We expect that psychiatrists and paediatricians will continue to support the assessment and diagnosis of ADHD for many people. But these changes would also encourage a larger number of doctors and nurse practitioners to be trained to assess and diagnose ADHD.

If approved, when will this change happen?

If this proposal is approved, the Ministry of Health will change the approval notices on 1 July 2025. Pharmac will update its Special Authority Criteria at the same time.

However, this doesn’t mean that you will be able to visit your doctor or nurse practitioner to be started on ADHD treatment immediately. If approved, Pharmac and the Ministry of Health expect that implementation will happen over time.