Paediatricians: No wait, interstate?
Another parent has just told you they got an interstate paediatrician appointment within three weeks, diagnosis and medications. Is it legit or too good to be true?
Here are some important clarifications that you need to know from the Department of Health’s Medicines and Poisons Regulations Branch.
IMPORTANT UPDATE
The Schedule 8 Medicines Prescribing Code was updated in mid December 2023 to allow certain types of specialists who provide telehealth services to Western Australia residents to be authorised as stimulant prescribers for Western Australian patients.
According to the WA Department of Health:
“Interstate stimulant prescriptions may be dispensed in Western Australia where the prescription:
– is for a Western Australian resident with a Western Australian address on the prescription, and
– has been issued through a telehealth consultation with an approved specialist (such as a neurologist, psychiatrist, or paediatrician – specialty can be verified on the AHPRA register) practicing in another state or territory, and
– has been issued by an approved prescriber on or after 13 December 2023.”
Source: Department of Health, Dispensing interstate prescriptions (health.wa.gov.au), accessed 13 March 2024
It is always best to check the advice directly from Poisons on the above website link or to contact the Medicines and Poisons Regulation Branch to confirm your particular circumstances.
ADHD medications & WA regulations
There’s been a lot of buzz on local parent groups about using interstate paediatricians or psychiatrists to have children evaluated for developmental or behavioural concerns.
Two year wait times – you’ll do anything right? And with some families getting in within weeks interstate, it’s a very attractive option.
Here are some important clarifications from the Western Australian Department of Health that may help you navigate the best care for your child.
Note, these apply to Western Australia only as each state has their own rules and regulations.
Cue eyeroll … you would think that there would be some kind of national agreement right?
It’s not as though you’re crossing international borders. But for those moving to Perth it may feel like it!
Parents can have an interstate paediatrician or psychiatrist assess and diagnose their child, either by flying there or via telehealth.
The Medicines & Poisons Act 2014/Regulations 2016 do not regulate diagnosis of conditions such as ADHD or autism, only the prescription of Schedule 8 stimulant medications.
If you are considering applying for an Individual Disability Allocation for autism or other supported disability, it is worth checking with your school first if they will recognise an interstate diagnosis.
[And, seriously … if they won’t then that is some next level BS because have they heard about the waitlists here?????????]
Pros of an interstate diagnosis
👍Some families have been able to get an appointment within weeks, bypassing the average wait time of 18 months in Western Australia.
👍Others have found they can get a full assessment done faster interstate than in WA, helping them to get answers and support.
👍Some families have reported that telehealth consultations gave a more realistic insight into their child’s behaviour.
👍Their child was more comfortable in their home environment and demonstrated more natural behaviours with less masking.
Cons of an interstate diagnosis
Pharmacies in WA are NOT allowed to dispense certain stimulant medicines in WA if they have been prescribed by an interstate doctor.
This includes stimulant medications often used for ADHD such as dexamphetamine (Dex) lisdexamphetamine (Vyvanse) and methylphenidate (Ritalin).
Otherwise known as Schedule 8 stimulant medications.
Why?
WA’s Medicines & Poisons Regulations 2016 only apply within WA.
This means the WA Department of Health can only authorise a WA-based specialist as an “authorised stimulant prescriber”.
Don't be taken advantage of
If an interstate provider promises to you that they are an authorised stimulant prescriber in WA –
THAT’S NOT TRUE.
Not all providers are aware of the differences in State regulations.
There is a particular provider in Brisbane whose practice is telling patients that they ARE authorised to prescribe stimulants in WA.
THAT IS INCORRECT.
If a friend tells you that they’ve had no problems getting e-scripts for stimulant medications filled here from interstate prescribers – be wary.
If someone in a Facebook group tells you they got in within weeks, diagnosed same day and are now on stimulant medications.
They’re not fibbing. They have just been lucky.
You may find that a chemist checks the prescriber details in the future and refuses to dispense the medication.
And you’ll be up Schitts Creek without medications. 🤯
So, ask yourself, do you feel lucky?
Some good news ...
Restrictions only apply to Schedule 8 stimulants and don’t apply to Schedule 4 medications such as atomoxetine and guanfacine.
While not ideal, interstate prescribers CAN have scripts dispensed outside of WA and posted to you here. Including Schedule 8 stimulants.
It seems like an illicit drug shipment but it’s above board according to the Department.
But seriously, if you’re concerned call them and check, they’re doing an awesome job answering curly questions.
Stay tuned for more flexibility in the future as they work on modernising the regulations.
The benefits of e-scripts...
In the days of paper scripts, you were locked into having S8 stimulant medications dispensed from one nominated chemist.
The introduction of e-scripts has made it much harder for anyone to provide forged scripts and you can now have your medications dispensed at more than one chemist.
It only applies to e-scripts though.
Some chemists will want to verify a doctors handwriting or speak to them verbally before dispensing if you are using paper scripts.
Ask your treating specialist to move with the times to make it easier on you.
30 days at a time
In WA, prescribers stipulate the NUMBER of repeats and the INTERVAL for dispensing repeats on the S8 prescription.
This is usually once every month.
So every month you go back to the chemist to have the stimulants dispensed for the next month.
But … what if you’re going on holidays out of state or overseas and will be away when your next script is due?
Chemists can’t dispense the medications early.
But, Doctors can write “Reg 24” (now Reg 49) which allows the pharmacy to dispense all repeats at once.
In WA, prescriptions for all S8 medicines are valid for six months.
So if you Doctor does this, you could have up to six months of medications dispensed.
This may also be helpful for those getting medications posted from interstate rather than relying on monthly deliveries (and potential delays).
What does this all mean?
It’s confusing, it’s complicated, there’s a lot to know and you really don’t want to be left without a continuous supply.
For neurodivergent parents managing stimulant medications for (often multiple) neurodivergent children, it can be an executive function disaster.
So what do the regulations mean in practical terms?
Here are a few example scenarios that have been playing out.
Example 1: Stable medications
John is 10 years old and on stimulant medication for his ADHD.
After some trial and error he is now on a long-acting stimulant medication and is doing well.
John’s parents ask their GP if she is willing to be a co-prescriber and she agrees.
John’s paediatrician completes the necessary authorisation paperwork.
The GP continues prescribing medication as per the specialist’s instructions.
The GP cannot change the stimulant type, formulation or dose without authority of the specialist.
John reduces his biannual appointments with his paediatrician to an annual review.
The family find this more convenient and cost effective.
Example 2: Interstate Telehealth
A Perth parent was able to get an appointment via telehealth for an ADHD assessment by a paediatrician/psychiatrist located in Brisbane for her child.
Child was diagnosed with ADHD and stimulant medications prescribed via an e-script which was sent to the parent.
Parent was able to get this medication dispensed in WA by providing the e-script at her local chemist.
However, pharmacies in WA are NOT allowed to dispense certain Schedule 8 medicines in WA if they have been prescribed by an interstate doctor.
With the introduction of electronic prescriptions, it is possible that pharmacists do not check the doctor’s address as they would do with a paper-based prescription, because forgeries are less likely with e-scripts.
The parent may find that when another pharmacist is asked to dispense the repeat, they won’t dispense because it was written by an interstate doctor.
Example 3: Flying Interstate
A mother was able to get an appointment with a paediatrician in Adelaide for her child for assessment of ADHD.
She had been advised the paediatrician could prescribe stimulant medications and dispense them from there.
This is correct as WA Legislation does not apply outside of WA.
The mother would need to have the scripts dispensed and posted monthly or ask the doctor to authorise the Adelaide pharmacy to dispense all repeats at once (e.g six months of medication).
The mother would need to consider what the plan would be for ongoing reviews and prescriptions such as through telehealth reviews or returning to Adelaide.
Example 4: Medication unavailable
A chemist is unable to dispense a patient’s regular S8 medication as they do not have any supply available.
This patient has only had paper scripts from their treating specialist.
Their script is on file with the chemist and they can only receive their S8 medications from this chemist.
They have two options:
1) ask their treating doctor to provide an e-script so they can source medications at other chemists
2) apply for a transfer to another chemist. Information is available on the Department of Health website but it is a tedious process. If you can, go with option 1.
TLDR: The rules, according to WA
Okay, so here’s the final summary of ADHD medication regulations for Western Australia as provided by the Department of Health’s Medicines and Poisons Regulations Branch:
Interstate prescribers are NOT authorised to prescribe stimulants for patients located in WA. [This has changed as at 13 December 2024 – see IMPORTANT UPDATE] Pharmacies in WA are NOT allowed to dispense certain Schedule 8 medicines in WA if they have been prescribed by an interstate doctor. [This has changed as at 13 December 2024 – see IMPORTANT UPDATE]
Parents CAN have an interstate paediatrician / psychiatrist diagnose their child and prescribe stimulant medication.
If the doctor can arrange for medications to be DISPENSED in another state and pharmacists in WA will not be handling the prescription, then WA Legislation does not apply. [This has changed as at 13 December 2024 – see IMPORTANT UPDATE]
The medication can either be collected and brought into WA or posted.
In WA, prescribers stipulate the NUMBER of repeats and the INTERVAL for dispensing repeats on the prescription, usually once every month. Doctors can write “Reg 24” (now Reg 49) which allows the pharmacy to dispense all repeats at once.
In WA, prescriptions for all S8 medicines, including stimulants, are valid for 6 months.
Specialists must initiate treatment with stimulant medications and review their patient annually. They can nominate a co-prescriber, such as the patient’s GP. The co-prescriber cannot change the stimulant type, formulation or dose without authority of the specialist.Clear as mud?
Where you should get your official advice from
Don’t get it from Facebook. Hell, don’t even take it from me.
Get your advice on all the little nuances of these regulations from the source.
The Department of Health regularly updates information on their website as things change relating to stimulant medicines.
For the latest advice it is always best to check their website at: health.wa.gov.au > search for stimulant medicines.
Or, you can call the Medicines & Poisons Regulation Branch on 9222 6883.
Stimulant prescribing legislation in WA will be changing in the future [hoorayyyy], once amendments to the Medicines and Poisons Regulations have been made.
When the change occurs, it will be communicated by Department of Health.
I don’t know how it will be communicated or to who, but I’m told all stakeholders will be notified.
So just in case I don’t make the stakeholder list, please do your own due diligence on how the regulations affect you.
Over to you
How do you stay on top of managing medications? Share your comments below.
Pia
Perth Kids Hub was created and is run by me, Pia Hazelwood.
I'm a Perth Mum of two gorgeous curly haired kiddos, wifey and a communications and marketing professional.
Since our first kiddo was diagnosed with a congenital heart defect 10 years ago, our family has been on a mystery-shopping tour of (seemingly) every kind of paediatric specialist and therapist in Perth.
Along the way we have met the most amazingly talented and dedicated people who are passionate about helping our little (and big) people to flourish. Whatever that looks like and means to them.
Perth Kids Hub has given me a creative outlet and a way of helping families to find their own amazing team, who can help their child or children understand how their brains and bodies work.
