ADHD continuation prescribing in NSW

What continuation prescribing is

Psychostimulant medicines used for ADHD — dexamfetamine, lisdexamfetamine and methylphenidate — are Schedule 8 medicines in NSW. A pharmacist cannot dispense them unless the prescription carries an approval number issued by the NSW Ministry of Health, whichever state the prescription was written in.

A continuation prescriber is a GP who holds a general authority from the Ministry for this purpose. The authority allows ongoing prescriptions for people aged 6 and over who have already been diagnosed with ADHD and who are already established and stable on a psychostimulant, without a separate application for each patient.

It is worth being clear about what this approval is not. A NSW Health approval is an authorisation under the Poisons and Therapeutic Goods Act 1966. It is not a PBS authority, and the two are decided separately — a prescription can be lawful under NSW rules and still not attract a PBS subsidy.

The three prescribing pathways in NSW

NSW Health has created three distinct arrangements, and they are frequently confused with one another. Which one applies depends on whether a diagnosis already exists, and on the person’s age and treatment.

• Continuation prescriber — ongoing prescriptions for people aged 6 and over who are already diagnosed and stable on a psychostimulant. Cannot diagnose ADHD and cannot start medication.
• Endorsed prescriber — can diagnose ADHD and start psychostimulant treatment in people aged 6 and over. A limited number of GPs completed this training in 2026, so endorsed prescribers are still uncommon.
• Co-management or transfer of care — ongoing prescribing under a formal arrangement with a paediatrician, psychiatrist or neurologist, using an approval granted for that individual patient. This is the pathway with no lower age limit.

Who is eligible

Continuation prescribing applies to a person who is aged 6 or older, who has an existing ADHD diagnosis made by an appropriately qualified clinician, and who is already taking a psychostimulant and is stable on it.

NSW Health does not publish a fixed number of weeks or months that counts as "stable". The guidance describes a person who has been on the same dose for an appropriate period, whose symptoms are controlled and who is not experiencing significant side effects — in other words, someone who does not need further dose titration or specialist review before the next prescription. That judgement is made clinically, at the appointment.

Two groups are excluded from this pathway regardless of anything else: children under 6, and people who are drug dependent. Both need an individual patient approval from the Ministry rather than a general authority.

What a continuation prescriber can and cannot change

The authority permits dose adjustment up to a published daily ceiling, as clinically required and tolerated. Above those ceilings, input from a psychiatrist or paediatrician and a separate approval from the Ministry are required before prescribing can continue.

• Dexamfetamine — up to 50 mg per day
• Lisdexamfetamine — up to 70 mg per day
• Methylphenidate — up to 108 mg per day
• For children, NSW guidance notes that doses above 0.75 mg/kg/day of dexamfetamine, 1 mg/kg/day of lisdexamfetamine, or 2 mg/kg/day of any methylphenidate preparation are not required

Changing between medicines and formulations

This distinction causes more confusion than any other part of the scheme. A continuation prescriber may switch a person between different formulations of the same medicine — for example from immediate-release methylphenidate to a modified-release form of methylphenidate.

Changing to a different medicine is another matter. A move from lisdexamfetamine to methylphenidate, or from dexamfetamine to lisdexamfetamine, is a change of medicine rather than of formulation, and referral to a relevant specialist is required before it can happen.

Moving prescribing from a specialist to a GP

The prescriber has to be satisfied that a valid ADHD diagnosis already exists and that repeating the assessment is unnecessary. That confirmation does not have to come from the patient — it can be established directly between clinicians, by letter or by a phone call to the diagnosing specialist. A formal reassessment is not part of the process.

Continuity of care is a condition of the authority rather than an optional extra. The arrangement is designed around a person’s usual general practice — through MyMedicare registration, or through the practice providing the majority of that person’s GP care. It is not intended to operate as a one-off prescription service.

People whose diagnosing specialist has retired or closed their books are not necessarily stuck. Because the requirement is confirmation of a valid prior diagnosis rather than an ongoing specialist relationship, existing correspondence can often be enough.

Prescriptions, repeats and reviews

A prescription for a Schedule 8 medicine is valid for a maximum of six months, and may be written for a shorter period. Repeats are permitted, and the prescription must state the minimum interval between each supply.

NSW Health advises people to expect an in-person review every six to twelve months. Height, weight, blood pressure and heart rate are generally measured at least every six months, and national ADHD guidance recommends that medication be formally reviewed and discussed at least once a year.

Checking SafeScript NSW, the real-time prescription monitoring system, is a condition of the authority and happens at each prescribing decision.

Which medicines this covers

Three psychostimulants sit within the NSW approval system: dexamfetamine, lisdexamfetamine (Vyvanse) and methylphenidate (brands include Ritalin, Ritalin LA and Concerta).

The non-stimulant ADHD medicines — atomoxetine, guanfacine and clonidine — work differently and currently need no NSW Health approval to prescribe or continue. That does not automatically make them cheaper: PBS subsidy for ADHD medicines depends largely on whether the diagnosis was made before the age of 18, and several are not subsidised for adults diagnosed later. It is worth asking what a given medicine will actually cost.

Moving to NSW from interstate or overseas

Every Australian state and territory regulates stimulant prescribing differently, and NSW does not simply recognise arrangements made elsewhere. A NSW pharmacist cannot dispense a psychostimulant prescription without a NSW approval number on it, no matter where the prescription was written.

NSW Health has also confirmed that an ADHD diagnosis made by a GP in another state, or by a doctor overseas, does not count as a previous diagnosis for the purposes of continuation prescribing. Someone in that position needs to see an AHPRA-registered paediatrician, psychiatrist or neurologist in NSW before ongoing GP prescribing can begin.

When a specialist is still needed

Continuation prescribing is deliberately bounded, and several situations fall outside it.

• The person has not been diagnosed with ADHD, or the diagnosis needs to be reconsidered
• Treatment has not yet been started, or the dose is still being titrated
• A change to a different psychostimulant medicine is being considered
• The dose required exceeds the published daily ceiling
• The person is under 6 years of age
• Symptoms are no longer well controlled, or side effects are significant
• There has been a substantial break in treatment, which may require specialist re-initiation

Common misunderstandings

Not every GP can do this. The authority has to be applied for, and it requires completing an endorsed training program and practising within an accredited general practice. A GP without it cannot write these prescriptions, however willing.

A continuation prescriber cannot make the diagnosis. Assessment for undiagnosed ADHD still needs a specialist, or one of the small number of GPs who have completed endorsed prescriber training.

Approval under NSW law and subsidy under the PBS are separate questions, decided by different bodies against different criteria.