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Estimates: puberty blockers for transgender young people

Estimates & Committees
Janet Rice 21 Oct 2015

Senator RICE: Thank you, Chair. I want to ask about the cost to transgender young people to access treatment to block puberty. Accessing medical treatment—in particular, the stage 1 treatment, the puberty blockers, gonadotropin-releasing hormone analogues—is critical to transgender young people's wellbeing. They are a group at very high risk. In a recent survey half of them acknowledged that they had been diagnosed with depression, and 38 per cent acknowledged thinking about suicide. I want to know whether there is any current consideration of include puberty blockers under the PBS.

Ms Platona: There are a number of products already on the PBS. The main usage is of testosterone, which comes in a number of forms, including gel. That product is subsidised on the PBS for androgen deficiency, for micropenis and pubertal induction, which is delayed puberty. There are a number of other products that you have mentioned that are aimed at treating puberty and delayed puberty. We have made, at the direction of the PBAC, a number of changes to the usage of testosterone but they are mostly aimed at limiting usage—and more appropriate usage—of those products in men over the age of 40, where PBAC had in the past noticed an exceedingly large usage of the product in the past five years.

Senator RICE: That is a very different product. These products are for transgender young people who realise they are transgender and want to delay puberty. These puberty blockers, if they are privately prescribed, at the moment are about $5,000 per year, and transgender young people will typically be on them for a period of four years. It is a very high cost.

Ms Platona: Up until recently we have had no representation from the lesbian, gay, bisexual, transgender and intersex community. We have recently engaged with them in products that fall within their area of interest and will continue to work with them. I want to explain the way products become subsidised on the PBS. It is usually a pharmaceutical company that holds the data, and they make application to have these products subsidised on the PBS. The department receives that application and the PBAC undertakes an assessment of efficacy and safety and cost-effectiveness, and makes recommendations to the minister. We need to encourage manufacturers of these products to apply for the PBS subsidy, and then there are processes in place to assess their suitability for subsidisation under the PBS.

Senator RICE: Does it have to be the pharmaceutical company? For example, with the gender centre at the Royal Children's Hospital that is treating these clients at the moment, the hospitals are paying for them, and there is a very strong case as to why it should be the PBS covering them.

Ms Platona: Anybody can make an application to the PBAC and write to PBAC in support of an application with evidence that is required to support the case for efficacy and safety and value for money assessments. For example, nicotine replacement therapy is on PBS because a number of NGOs have got together and written to PBAC. But to have a product actually subsidised, the company needs to agree that they are willing to sell that product on the PBS because we must have an agreed price. So at some point if PBAC considers the application from a third party about this product we must engage at a subsequent point the company that is willing to supply those products under the condition of subsidy.

Senator RICE: Can I clarify that you have not received any application or any proposal before now? Ms Platona: I am happy to take all the names of the specific drugs with me and I am happy to provide an exact answer about the history of the products that you have explicitly mentioned.

Senator RICE: And whether there has been any consideration or any determination of them so far. Basically it is the puberty blocker, the gonadotrophin releasing hormone analogues.

Ms Platona: For the specific group of patients—

Senator RICE: For young people to block puberty until they are at an age when they are on hormones.

Ms Platona: I would be happy to do that.

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