1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
Document 8
Funded ADHD Stimulant Medic
1982
ines
Pharmac chooses which medicines we will fund in NZ for ADHD, and the Special authority
ACT
(SA) criteria by which they are funded
Methylphenidate:
SA2411 (first line):
•
Immediate Release: Rubifen 5mg, 10mg, 20mg Ritalin 10mg
INFORMATION
•
Extended Release: Methylphenidate ER – Teva, 18mg, 27mg, 36mg, 54mg
•
Sustained Release: Rubifen SR 20mg
OFFICIAL
SA2450 (second line):
THE
•
Extended Release: Concerta 18mg, 27mg, 36mg 54mg
•
Modified Release: Ritalin LA caps, 10m
UNDER g, 20mg, 30mg, 40mg
Dexamfetamine: Noumed Dexamfetamine 5mg
RELEASED
Lisdexamfetamine: Vyvanse caps, 30mg, 50mg, 70mg
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
Document 8
Supporting Responsible U
1982 se
Pharmac have a statutory function to promote the responsible u
ACT se of pharmaceuticals
(Pae Ora (Healthy Futures Act) 2022)
Prescribing changes to ADHD stimulant medicines means:
INFORMATION
• more prescribers navigating our special authority process and needing clinical guidance
• more consumers will need to understand about our SA’s and controlled drug regulations
OFFICIAL
We are:
THE
• working with the MoH and Medsafe to provide Q and A’s and website information
• commissioned a bpac article, on the prescribing of these medicines
UNDER
• commissioned Healthify to support consumers with understanding the changes
• commissioned ADHD NZ to provide consumer resources
• working with the sector to see the
RELEASED specify by brand criteria removed from IR methylphenidate
Document 8
Stakeholder feedback – ADHD m
1982
edicines
Global methylphenidate supply issues have led to enquiries to Pharmac re switching
ACT
brands:
• From prescribers: "If I need to prescribe another formulation of methylphenidate
and/or get a new special authority, and the recommendation was for a branded
formulation – do I need another recommendation?"
INFORMATION
• From pharmacists: "Can we substitute strengths and volumes of the same
methylphenidate formulation at pharmacy le
OFFICIAL vel?“
THE
• "Can we switch IR methylphenidate products at pharmacy level?“
UNDER
• "Can we switch modified release methylphenidate products at a pharmacy level?"
These scenarios required collaboration with Medsafe and other agencies
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
Document 8
Regulatory considerations for methylphenidate
1982
• Medicines Regulations 1984
ACT
▪ Regulation 42 (4) – Brand Substitution
• Misuse of Drugs Regulations 1977
▪ Regulation 32 (2)(a) – Alterations to CD prescriptions
INFORMATION
There are several operational doc
OFFICIAL uments (e.g. the Pharmacy
Procedures Manual and prev
THE iously the HQSC Specify by Brand
advice) which we are engagi
UNDER
ng with stakeholders to align.
RELEASED
Document 8
Scenario 1: Substituting different strengths of the same
formulation
1982
Permitted if the total daily dose remains unchanged
ACT
•
When would this apply?
•
When a particular strength of a methylphenidate
formulation is unavailable.
•
Example:
•
Unavailable: Ritalin LA 40 mg capsules
Sig: Ritalin
Sig: 2 x Ritalin
INFORMATION
LA 40mg OD
LA 20mg OD
•
Available: Ritalin LA 20 mg capsules
Mitte: 30
Mitte: 60
•
What to do:
OFFICIAL
• Substitute and dispense with an equivalent total dose
using available strengths.
THE
•
Pharmacy action: Annotate the change (brand/strength
supplied, date of change, signature of pharmacist
authorising the change).
• Pharmacy to counsel patient of the change.
UNDER
•
No new prescription is required.
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
Document 8
Scenario 3: Substituting Immediate Release methylphenidate
products
1982
Permitted if the brands are approved (ie, have
been assessed for bioequivalence) and there is
ACT
no clinical reason to not substitute
•
When would this apply?
• The prescribed methylphenidate IR formulation is
unavailable, but another IR brand can be
supplied.
• Example:
INFORMATION
Sig: Ritalin IR
Sig: Rubifen IR
• Unavailable: Ritalin IR 10 mg tablets
10mg TDS
10mg TDS
• Available: Rubifen IR 10 mg tablets
Mitte: 90
Mitte: 90
OFFICIAL
•
What to do:
• Substitute and dispense with an equivalent IR
THE
methylphenidate brand.
•
Pharmacy action: Annotate the change (brand
supplied, date of change, signature of pharmacist
authorising the change).
UNDER
• Pharmacy to counsel patient of the change.
•
No new prescription is required.
RELEASED
Document 8
Scenario 4: Substituting Modified Release methylphenidate
products
1982
Not automatically permitted at pharmacy level
ACT
•
When would this apply?
• The methylphenidate MR formulation is out of
stock, and an alternative methylphenidate MR
formulation is available.
• Example:
Sig: Ritalin LA
Sig: Concerta XR
INFORMATION
• Unavailable: Ritalin LA capsules
40mg OD
36mg OD
• Available: Concerta XR tablets
Mitte: 30
Mitte: 30
OFFICIAL
•
What to do:
• Requires prescriber involvement.
THE
• A pharmacy cannot substitute a different
formulation without authorisation from the
prescriber.
UNDER
•
A new prescription is required.
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
Document 8
1982
ACT
GP with interest in
ADHD
INFORMATION
Dr Michael Buckley F
OFFICIAL RNZCGP
Member: AADPA ( Australasian
THE ADHD Professionals Association )
NZ National GP ADHD Peer Group
UNDER
Lived Experience
RELEASED
Document 8
Where we were 2 years ago
1982
ACT
• Wel ington Primary Liaison Group – Paediatric ADHD
• Underlying interest within Practice
• Burden of undiagnosed, underappreciated Adult ADHD
INFORMATION
• Heritability and effect on families
• Frustrated by capacity and access chal enges
• ? A different way
OFFICIAL
THE
UNDER
RELEASED
Document 8
Our 2-year Journey
1982
ACT
• DIVA Foundation - Worldwide Diagnostic Interview for ADHD.
• ( https://www.divacentre.eu )
• GP ADHD Peer Group
• Psychiatrist Support
INFORMATION
• Addition of Clinical Psychologist to our team
• Australasian ADHD Professionals Association [AADPA]
OFFICIAL
• ( https://aadpa.com.au )
THE
• Increased awareness within our wider practice
UNDER
RELEASED
Document 8
Primary Care is the best place for ADHD Care
1982
• Long Term Relationship
ACT
• Unique appreciation of Family, Community and Wider Societal Setting
• Always thinking about the differential diagnosis / effects
• Medical
• Developmental
INFORMATION
• Psychological / Psychiatric
• Environmental
• Interwoven into long term care
OFFICIAL
• Impact on management of other conditions
THE
• Places in the world where it never left general practice
UNDER
RELEASED
Document 8
1982
ACT
We Look after FA
INFORMATION MILIES
OFFICIAL
THE
UNDER
RELEASED
Document 8
Associated Conditions; Chicken or Egg
(Once you have started living a life with persisting/pervasive
1982 ADHD Traits)
ACT
• Depression
• Environmental Stresses
• Anxiety
• Attachment Disorders
• Bipolar
INFORMATION
• OCD
• Traumatic Brain Injury
• PTSD
• Substance Use
• Adjustment Disorder
OFFICIAL
THE
UNDER
RELEASED
Document 8
Looking ahead Screening
1982
ACT
• Ante and Perinatal
• Anxiety / Depression etc
• Prenatal A&D exposure
• (Especial y if Not Responding )
• Born Premature
• Oppositional Defiant / Conduct disorder
• Low Birth Weight
INFORMATION
• Neurodevelopmental Disorders • Environmental Risks/Predictors
• Out of Home Care
• ASD, Intel ectual Disability
• Imprisoned / Youth Justice
• Learning Disability
OFFICIAL
• Auditory/Visual Processing
• Acquired Brain Injury
• Tics, Language Disorders
THE
• Any Hx Substance abuse
• Close family member w ADHD or ASD
• Eating Disorders
•
UNDER
AN, Binge, ARFID
RELEASED
Document 8
Emerging Associations
1982
ACT
• Hypermobility (EDS 3)
• Disorders of interoception
• POTTS
• IBS
• Sleep Disorders
• Endometriosis
INFORMATION
• Disordered Eating
• Some Pain chal enges
• Childhood constipation
• Migraine
OFFICIAL
• Menstrual Cycle Associations
• Autoimmunity – IBD
THE
• Degree of impact of Menopause
• Mast Cel Disorders
UNDER
RELEASED
Document 8
Never a good time
1982
• The Bad News - Funding
ACT
• As good a time as any
• Transition period
INFORMATION
• Doing as properly as can – preserving diagnostic integrity being good Kaitiaki
• The one new condition that wil have a positive ROI
• Already champions around the country
OFFICIAL
• Dynamic time and intersecting directions themes and agendas
THE
UNDER
RELEASED
Document 8
Coming into the process – our view
1982
ACT
• AADPA conference late July
• The work is being done
• No Funding
INFORMATION
• Don’t wait
• Good existing training and resources
• Not much to bridge the gap
OFFICIAL
• Couldn’t real y start until could streamline and deemphasise the medication
THE
UNDER
RELEASED
Document 8
Reminding ourselves whom this is about/for
1982
ACT
• Consumers / Tangata Whaiora
“my life feels harder than it needs to be”
“ Is there anything I can do to improve that”
INFORMATION
• GP / NP Champions
OFFICIAL
• Wider Community of ADHD Professionals; Psychiatrists, Psychologists, Specialist ADHD
Coaches, HIPs, Health Coaches
THE
• Wider Community in general
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
Document 8
Ka whakairia te tapu
Kia wātea ai te a
1982ra
ACT
Kia tūruki whakataha ai
Karakia
Kia tūruki whakataha ai
whakakapi
Haumi ē, hui
INFORMATION ē, tāiki ē!
Closing karakia
OFFICIAL
THE Restrictions are moved aside
So that the pathway is clear
So we may move forward
UNDER
Join, group, and affirm
RELEASED
Document 9
Session 3: Preparing for ADHD Prescribing Changes: Implementation update for Consumer
representatives
Date: 1 December 2025
Time: 90 mins
Format: Online Meeting
1982
Roles and attendees
Lead: Ministry of Health, supported by Medsafe and Pharmac.
ACT
Chair: Alice Chisnall-Kalouniviti
Support: Dr Jin Russell, Dr Anna Skinner
Attendees: ADHD NZ, Aroreretini Aotearoa, Young Neurodiversity Champions, Mental Health
Foundation, Healthify, Māori and Pacific groups, Pharmac, Medsafe
INFORMATION
Purpose
• Build a positive relationship with consumer groups to enable them to assist their
communities
• Outline the changes and what we expect (in patient friendly language)
OFFICIAL
• Share where information will be available, by whom, and when
THE
National FAQ document
Healthify (for patient info)
Pharmac – for supply issues
UNDER
Local service providers / people’s GPs
AADPA, Bpac, Goodfellow (clinical resources but some are freely available)
• Enable connections across advocacy groups and the health system
• Clarify the expectation that resources will not be developed by the Gov – organisations and
RELEASED
people will need to draw on the resources above to share and create resources for their
communities
• Explore future opportunities for feedback loops etc
Document 9
Agenda and Timing: Session Three Consumer Groups
Time
Duration Agenda Item
Details / What we’re aiming Presented by
for
3 min
Karakia / Opening
Welcome everyone, thank
Chair: Alice
you for joining. This hui is
about the ADHD prescribing
changes and what they mean
1982
for communities.
3 min
Session outline and
Aim: Empower advocacy
Chair: Alice
housekeeping
groups with accurate
Su
ACT pport: Jin
information and design ideas
for sharing messages.
Objectives: Explain changes,
share practical info, identify
ways to support
communities, gather ideas
for communication and
feedback.
Include context:
No new
INFORMATION
funding for services or
training – this is about
enabling you with the
information we share today.
E
OFFICIAL xplain format: mics off,
Teams “hand up”, introduce
in chat, transcription
THE
enabled. We will share
minutes afterwards.
5-10min
Introductions
Introduce organisations and
Organisation and
their roles, plus reps from
who connected to
each of them.
in the chat
UNDER
Ask audience to introduce
themselves and ask name,
org, what matters most to
community about these
changes.
20 min
RELEASED System update and key
Patient journey graphic,
MoH – Jin
information
current vs future settings,
- Ministry of Health, Medsafe what we expect.
& Pharmac
Reality + Key messages for
myths – Jin
Document 9
Medicines access and
supply. Explain Special
Authority simply,
methylphenidate approvals,
supply challenges, what to
do if out of stock. – Claudia
and Robyn
1982
15-
Models of Care with Primary
Dr David Codyre
20mins
care + Māori and Pacific
ACT
Health
-
Reassurance for the
community
-
Holistic way of
treating
-
Opening up the
opportunity for a
better way of working
for the community
INFORMATION
-
Supporting GPs and
NPs wanting to learn
more.
30min
Facilitated discussion
Focus on three points:
. Alice
consistent messaging,
r
OFFICIAL eaching the right people,
feedback loop.
THE
Frame as collaborative:
We’re not asking for new
activities, just ideas for
sharing info and staying
connected.
UNDER
5min
Wrap up and next steps
Resources will be on
Alice
Healthify and MoH. FAQ
coming soon. Thank you for
your input.
3min
Karakia to close
Acknowledge shared mahi
Alice
and commitment to
RELEASED
supporting communities.
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
Document 10
Kia hora te marino1982
Kia whakapapa po
ACT unamu te
moana
Karakia
Hei huarahi mō tātou i te rangi nei
whakatuwhera
Haumi ē, hui ē, t
INFORMATION āiki ē!
Opening karakia
OFFICIAL
May peace be widespread
THE
May the seas be as flat as pounamu
To provide a path for us today
J
UNDER oin, group, and affirm
RELEASED
Document 10
Setting the Scene
1982
Our goal of today is to
empower you with clear information so
ACT you can support your
communities effectively with this change.
Today we will
• Share what’s changing for ADHD care and why
INFORMATION
• Focus on the regulatory changes and what they mean for access to ADHD medicines
• Share an example of how the change might work in reality from Dr Codyre
• Workshop together how to support your comm
OFFICIAL unities
• Answer your questions and hear your conc
THE
erns
We won’t
UNDER
• Cover other policy or funding ADHD of services today
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED
Document 10
Where key information will be available
1982
•
Ministry of Health, Medsafe, Pharmac: Official FAQ document
ACT
Government agency led:
• Pharmac website – for supply issues
INFORMATION
• Healthify (for patient info)
• Health Pathways (for health practitioners)
OFFICIAL
Community/Other organisation led:
THE
• Local service providers / people’s GPs and NPs for local information
• ADHD NZ for patient, whānau and com
UNDER munity support information
• AADPA, Bpac, Goodfel ow (clinical resources but some are freely available)
RELEASED
