Pharmacoepidemiology of testosterone: Curbing off-label prescribing

ObjectivesTo estimate the impact of the first year of new Pharmaceutical Benefits Scheme (PBS) prescribing criteria that dictate eligibility for national health scheme subsidy of testosterone prescribing. DesignAnalysis of cumulative PBS data. SettingRetrospective analysis of testosterone prescribing from PBS data. ParticipantsNil Main outcome measuresPBS expenditure analysed by total expenditure, by state, and by product type as well as the age, indication, and prescriber type for new testosterone treatment. ResultsTotal PBS expenditure continued to exceed $20 million in 2014 before declining from 2015 with changes that were uniform by state and product type. Prior to 2015, over 80% were for men aged over 40years of age for low circulating testosterone in the absence of reproductive system disorders (Low T) initiated by GPs. From 2015, these features were markedly reduced without changing the numbers of new prescriptions for pathological reproductive disorders or specialist initiations. ConclusionsThe short-term impact of 2015 PBS criteria showed highly effective and well-targeted curbing of off-label testosterone prescribing. The findings indicate that the main driver for the recent upsurge in testosterone prescribing was treatment of middle-aged men for Low T initiated by GPs.