Decision to fund another new brand of methylphenidate hydrochloride

Methylphenidate hydrochloride

Cap modified-release 10 mg

Rubifen LA

30

$14.82

Methylphenidate hydrochloride

Cap modified-release 20 mg

Rubifen LA

30

$19.38

Methylphenidate hydrochloride

Cap modified-release 30 mg

Rubifen LA

30

$24.24

Methylphenidate hydrochloride

Cap modified-release 40 mg

Rubifen LA

30

$29.07

Methylphenidate hydrochloride

Cap modified-release 60 mg

Rubifen LA

30

$34.68

Consumers, clinicians and professional organisations

• Many responders supported the proposal noting that funding another brand of methylphenidate would:
• Increase availability of methylphenidate.
• Strengthen supply resilience and reduce treatment disruptions.
• Alleviate stress and concern for patients and whānau.
• Improve symptom control by not changing between brands frequently.
• Reduce time spent by pharmacists and prescribers managing shortages.

We are pleased to progress a proposal that would improve the health outcomes of New Zealanders.

Consumers

A few responders considered they were supportive as long as existing funded ADHD medicines (e.g. Concerta or Ritalin LA) are not removed.

This proposal is to add a new brand of methylphenidate. We are not proposing to delist any currently funded ADHD medicines. All currently funded options would remain available for people to use. 

Clinician and Professional organisation

One respondent requested information about the different release characteristics for all available methylphenidate preparations (including onset of action, maximum activity and speed and time of clearance).

Another respondent noted that as a bioequivalent generic, Rubifen LA offers the same evidence-based pharmacological profile to Ritalin LA.

Pharmac does not hold detailed pharmacokinetic information for the methylphenidate presentations. The Rubifen LA New Zealand Data Sheet | Medsafe website [PDF](external link) has information on the pharmacokinetics and pharmacodynamics and is available on the Medsafe website.

Medsafe is the organisation responsible for determining if a product meets the requirements to be a generic version of an already approved product.

We are undertaking a review of the information about methylphenidate supply on our website as we have heard that it requires updating. We are also working with BPAC to commission a resource for healthcare professionals and their patients about the pharmacological management of ADHD.

Pharmacological management of ADHD in adults and children: a new frontier for primary care | BPAC(external link)

Access to other treatment options

Consumer

One respondent considered that Pharmac should invest in funding lisdexamfetamine as a first-line treatment option instead of funding more brands of methylphenidate.

The respondent highlighted that lisdexamfetamine (Vyvanse) provides a long duration of action, once‑daily dosing, and relatively mild adverse effects, while also reducing risks of diversion due to its prodrug formulation. They considered that this makes Vyvanse a superior treatment option compared to methylphenidate, which often requires multiple daily doses and different product formulations.

The respondent questioned why Vyvanse is restricted to second‑line therapy when the Pharmaceutical Schedule does not show a significant price difference compared to Ritalin LA or Concerta.

They also questioned whether first line use of lisdexamfetamine could ease methylphenidate supply issues.

Pharmac acknowledges the feedback regarding the role of lisdexamfetamine (Vyvanse) in the treatment of ADHD. The clinical benefit of lisdexamfetamine has been established, and Pharmac funded this medicine from 1 December 2024 to provide patients with an additional treatment option for ADHD. It was also considered that listing lisdexamfetamine could also help to alleviate supply pressures associated with methylphenidate.

The list price of lisdexamfetamine is comparable to other extended‑release ADHD medicines such as Ritalin LA and Concerta, and accordingly, all of these products are funded as second‑line treatment options.

In the current context of supply challenges, we have recently included funding criteria that allow lisdexamfetamine, Ritalin LA, and Concerta to be used as first‑line therapy where patients are unable to access a first‑line option due to supply constraints. This approach ensures continuity of care for patients while maintaining equitable access across available ADHD treatments.

Clinical advice on switching brands

Professional organisation

One respondent noted that methylphenidate modified release preparations are not interchangeable and must be prescribed by brand as per NZULM. Currently, switching between brands requires a new prescription. This is time consuming for patient, pharmacist, and prescriber.

We acknowledge the cost and time for people who are switching between brands of methylphenidate during this global supply shortage. We anticipate that funding an additional brand would mean there is more resilience in the supply chain, reducing the frequency of supply-related brand switches.

Impact on the sector

Professional organisation

Additional strain on pharmacies having to hold stock of three different brands leading to storage issues and greater risk of errors. Would support reducing number of funded brands once supply issues are resolved. 

We understand that having another brand would increase the volume of stock needing to be stored in pharmacies; however, the volume of stock would be likely to increase if the current brands had sufficient supply. Pharmacies also have processes to mitigate the risk of dispensing errors.

Other comments

Wholesaler and pharmacist

A few respondents requested that Pharmac standardise the approval criteria across all methylphenidate formulations and consolidate them into one Special Authority form.

We acknowledge the administrative burden of the Special Authority criteria for the two methylphenidate presentations.

Pharmac uses Special Authorities as a way to ensure medicines are funded for people who are most likely to benefit. This helps manage the medicines budget effectively.

For methylphenidate:

• SA2590 generally covers first-line, and/or lower-cost brands and presentations.
• SA2591 covers second-line, and/or higher-cost brands and presentations

This reflects clinical advice that most people respond well to the more cost-effective options. It also supports responsible use of funding while ensuring access to alternatives when needed.

We are working to update our website to be clearer about this for prescribers and patients.