ADHD: Pharmac changes funding rules for medication prescriptions

People with ADHD (Attention Deficit Hyperactivity Disorder) could save more than $200 a year on their prescriptions after Pharmac changed funding rules for the dispensing of two medications.

ADHD New Zealand says the change will help relieve the “admin load” on people who struggled with executive function.

A Tauranga woman with ADHD says the change is “good” but getting diagnosed in the first place is “the bigger issue”.

Pharmac announced on Monday that people taking methylphenidate or dexamphetamine - medication for ADHD - will now pay only one prescription for three months’ supply, instead of paying every month.

Pharmac’s director of operations said it was “pleased” to make the change and it would reduce the costs to about 48,000 New Zealanders who receive the funded drugs.

“It has the potential to reduce stress for people living with ADHD.”

Ashleigh Yates was diagnosed two years ago with ADHD and takes methylphenidate. She said the change was “good” but cited difficulties around getting a diagnosis in the first place, saying this was the “bigger issue”.

Last month, Yates told the Bay of Plenty Times she had spent about $2000 on appointments and medication for ADHD. Unable to get help through the public health system, she sought a diagnosis and subsequent treatment through a private psychiatrist.

Yates said only having to get a prescription once every three months was “awesome,” as it would save her time and “brain energy”.

As a fulltime university student, she got discounted doctor visits. The funding change would save her $20 every three months, she said.

Ayla-Anne Gwilliam was diagnosed with ADHD in July but is still trying to work out which medication will work best for her. Photo / Andrew Warner

Rotorua woman Ayla-Anne Gwilliam was diagnosed with ADHD in July and has been on medication since.

She takes dexamphetamine and said the change would save her $10 every three months.

However, she is seeing a private psychiatrist to find a different drug that did not give her side effects.

Gwilliam said if her psychiatrist issued a prescription, it cost her $35 to pick it up at the pharmacy.

ADHD New Zealand chief executive Suzanne Cookson said the funding change was “really good news” as it would help relieve the “admin load” on people who struggled with “executive function”.

She said the “simple change” could save people more than $200 per year.

Cookson based this calculation on her doctor’s fees at Peninsula Medical Centre in Miramar, Wellington.

“Previously you’re paying for a script 12 times [a year], now you’re paying for a script four times a year.”

She said the doctor charged two prescription rates - a standard rate for two working days cost $20 and an urgent same-day script was $28.

Paying the standard rate of $20 every 12 months would cost $240 per year. Four times per year was $80, creating a saving of $160.

Paying the urgent rate of $28 every 12 months would cost $336. Four times per year is $112, creating a saving of $224.

She said every doctor’s centre would set its own fees so it could be different for everyone.

Cookson said it was working with Pharmac, which was reviewing the rules around special authority applications. Current regulations require someone with ADHD to renew their special authority every two years to keep getting access to their medication.

In a media release, Pharmac announced an amendment to the pharmaceutical schedule from June 1 to align funding rules for ADHD treatments with law changes that enable controlled drugs to be prescribed for a maximum of three months’ supply when using the electronic prescription service.

Director of operations Lisa Williams said regulatory changes recently came into effect, meaning people could be prescribed up to three months of the ADHD treatments methylphenidate and dexamphetamine if the prescription was electronic.

“The legislation still requires the medicines to be dispensed monthly at most; however, with a three-month electronic prescription instead of a one-month prescription as it was before, people will only need to pay one prescription co-payment for three months’ supply of their medicine,” she explained.

The change would ensure that funded supply was consistent with recent changes to the electronic prescribing and dispensing of Class B controlled drugs.

Paper prescriptions remained limited to a one-month supply.

On special authority applications, Williams said Pharmac had agreed to review the renewal eligibility criteria, specifically the prescriber restrictions, for funded class B medicines.

Before any changes were made, it would take clinical advice from its mental health specialist advisory committee and obtain legal and health economic input to help it assess possible impacts, she said.

“We would also consider and ensure any changes would support wider changes in the delivery of health services to ensure equitable and safe access to treatment.”