As of April 1 2015, the PBS implemented new criteria for the prescription of testosterone with key differences from prior criteria. In September 2016, the Pharmaceutical Benefits Advisory Committee reported that in the 12 month period since this amendment there was a vast decline in the number of prescriptions filled for testosterone. Our study aimed to review the effect of these changes on local practices at a tertiary endocrinology outpatient service.
A retrospective chart review was conducted to identify all outpatient referrals to the Sunshine Coast Endocrinology service for management of hypogonadism in the two-year period since the PBS restrictions were implemented and determine to what extent patients were now excluded as a result of the changes. All endocrinology referrals from 1 April 2015 to 30 June 2017 were screened from which 173 patients met inclusion criteria. Demographics, biochemistry, indication for testosterone replacement and relevant comorbidities were examined.
Of the 173 outpatients, a smaller proportion had established testicular or pituitary pathology, while the majority (126, 72.8%) of patients had no established disorder. Of those patients with no established disorder, by strict interpretation, only 3 patients (2.2%) meet current PBS criteria, whereas 56 (40.3%) would have met the pre-2015 criteria. Fewer patients (35.3% vs 55.4%) meet the lower biochemistry requirements (i.e. two morning testosterone levels <6mmol/L vs <8mmol/L). 60.9% had a BMI >30, 26.2% were taking opiates, 15.9% were older than 70. In addition, 17.3% were in fact less than the required age of 40. Of the three patients meeting PBS criteria, two had untreated depression while the third patient had obstructive sleep apnoea and alcohol dependence.
By strict application of the revised criteria, it is apparent that very few patients with low testosterone values will continue to meet PBS inclusion in the absence of an established pituitary or testicular disorder.