Changes to the regulatory and funding restrictions for stimulant treatments for ADHD

The prescribing of stimulants has attracted media attention in recent years with a Health Practitioner Disciplinary Tribunal process against an Auckland GP with special interest in attention deficit hyperactivity disorder (ADHD) through 2022-2024. This case highlighted that the restrictions on prescribing stimulant medications for ADHD meant that accessing treatment can be challenging for many patients.

In NZ, childhood ADHD assessments are undertaken by Te Whatu Ora Paediatric services and most Child Youth Mental Health Services, although there are significant barriers with wait lists and different referral pathways in different districts. For adult ADHD assessments these are not commonly undertaken in the public Te Whatu Ora system. Previously, restrictions under the Misuse of Drugs Regulations and Special Authority criteria required that a psychiatrist or paediatrician was involved in making the diagnosis and stimulant recommendation and therefore it generally necessitated the involvement of a private specialist for adult ADHD assessments thus leading to further restrictions in access. 

Health and pharmaceutical authorities, Pharmac and Medsafe recognised the difficulty in accessing treatment for some patients. A number of changes have already been implemented. For example, in June 2023, the Pharmaceutical Schedule was amended to allow funding for a 3-month total period of supply for Class B ADHD stimulants dexamfetamine and methylphenidate. This meant that these stimulants could be prescribed for a 3-month period with one monthly dispensing. 

Furthermore, in the past the Special Authority needed to be renewed every two years. From December 2024, however, this renewal criteria were removed from methylphenidate, dexamfetamine, and modafinil. This meant that patients starting on a stimulant treatment which requires a Special Authority approval, are able to access ongoing funded treatment, without the requirement for this approval to be renewed. 

Difficulties with the manufacturer supply of methylphenidate has further complicated matters. From March 2025, dispensing of Concerta or Ritalin LA was possible, only if other brands were not available. Previously people were only eligible for funded Concerta or Ritalin LA if they had tried other forms of methylphenidate first and had met other criteria. 

In 2025, Pharmac and Medsafe entered into consultation on further reducing the restrictions on prescribing of stimulants.

Changes to these restrictions will be implemented from 1 February 2026. Previously for patients of any age, the initiation of treatment with stimulants needed to be on the written recommendation of a medical practitioner with a vocational scope of practice of paediatrics or psychiatry. This has now been separated into different rules for initiating in children and for adults. 

The restrictions on who can prescribe stimulant medications are described in the approval notice published in the New Zealand Gazette.¹ 

As before, for patients 17 years and younger, medical practitioners with a vocational scope of practice of paediatrics or psychiatry may start people on stimulant treatments for ADHD. However, in addition, nurse practitioners working within paediatric services or child and adolescent mental health services may initiate prescribing. 

The significant change is for patients 18 years and older. Medical practitioners with a vocational scope of general practice, as well as those with a vocational scope of paediatrics or psychiatry, may now initiate prescribing, as well as nurse practitioners working within their area of practice.

Any medical practitioner or nurse practitioner may still prescribe when acting on the written recommendation of one of the practitioners who have initiated prescribing (noting that this is now broadened). 

Concurrent with these Medsafe changes, Pharmac is removing the prescriber restrictions and changing the Special Authority criteria for access to funding for stimulant medicines.² These changes align with the regulatory changes made by Medsafe and will allow more prescribers to submit Special Authority applications for funding of treatments for people diagnosed with ADHD. Specifically, Pharmac will change the Special Authority criteria to allow applications from any relevant practitioner. A relevant practitioner is a health practitioner authorised to prescribe the treatment consistent with the approval notice gazetted for the particular stimulant. These are the Medsafe criteria above. 

We then need to consider, if whether all vocationally registered GPs who will be able to initiate prescribing for adults with ADHD, should be doing so? Let’s take a step back from the decision to prescribe, to the diagnosis of ADHD. The fact that GPs are going to be allowed to initiate prescribing, suggests that the patients they do this for, will not have seen a psychiatrist to confirm the diagnosis. The diagnosis of ADHD is not always straightforward, and it is possible to confuse the presentation with other conditions such as severe anxiety, personality disorders and substance abuse issues. Therefore, GPs who undertake this work must be confident that they have the skills and training necessary to make the diagnosis of ADHD, be able to educate patients as to the management of this condition (pharmacological and non-pharmacological), be familiar with the dosing and monitoring of these medications and be able to adjust the dosing appropriately. This means the GPs who undertake this service will probably need to undergo additional training in order to ensure they are competent both to make an appropriate diagnosis, prescribe safely and provide ongoing monitoring. If GPs have not had the appropriate training, or undertaken specific education on this area of practice, they have no obligation to agree to do these assessments or initiate prescribing. 

Our view is that the initial assessment will not be able to be done within a routine 15-minute GP consultation and longer consultations will be required. This service will not come under the normal capitated services and as such, the service will essentially be privately funded, and GPs will be able to charge appropriately for that.

So, is there a medicolegal risk for GPs who do choose to undertake these assessments and/or initiate prescribing? The scope of General Practice is very broad, but not every GP has expertise in every area of practice, even if it is considered within scope for some GPs. For example, some GPs will have undertaken specific training in joint injection and have skills and expertise in that area, and it is perfectly appropriate for them to do this. However, if a GP has had no training in joint injections, it would be inappropriate for them to decide to ‘have a go’ without supervision or training. Similarly, when diagnosing and treating ADHD, there will be some GPs who may choose to upskill in this area and for them, undertaking this work will be appropriate. However, if a GP feels they do not have the necessary expertise in making the diagnosis of ADHD, or in initiating and monitoring the treatment, they should decline to undertake this work, even if a particular patient is keen that they should.

References 

1 https://gazette.govt.nz/notice/id/2025-go3319 

2 “Decision to change the regulatory and funding restrictions for stimulant medicines for ADHD” Pharmac (24 June 2024) https://www.pharmac.govt.nz/news-and-resources/consultations-and-decisions/2025-06-decision-to-change-the-regulatory-and-funding-restrictions-for-stimulant-medicines-for-adhd