PBS should fund drug to treat breast cancer, endometriosis and gender dysphoria, experts recommend

Triptorelin, already listed for prostate cancer, should have unrestricted use, the Pharmaceutical Benefits Advisory Committee says

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The federal government should fund treatment for thousands of women with breast cancer or endometriosis, and children with gender dysphoria, according to the Pharmaceutical Benefits Scheme’s advisory committee.

The committee met urgently in July in response to AstraZeneca’s announcement it would remove Zoladex from the market, risking leaving more than 7,500 women with breast cancer without an alternative treatment.

It recommended making the drug triptorelin – PBS listed since 2006 for prostate cancer – unrestricted, funding it for all uses. The government has historically implemented committee recommendations.

Both drugs block the release of oestrogen and testosterone, which can be a necessary part of treatment, or fertility preservation, for some forms of cancer and are considered essential medicines by the World Health Organization. They can also be used to treat endometriosis and to block puberty, for either precocious puberty or gender affirming care.

The director of policy and advocacy at Breast Cancer Network Australia, Vicki Durston, described the decision as “a significant step forward”, and said access to the drug could mean the difference between life and death for some patients.

Others had already chosen to have their ovaries removed as a result of the uncertainty over supply, she said.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Victorian state chair, Marilla Druitt, said it was unclear whether the drug would work exactly the same as Zoladex, but the decision was likely to be positive for endometriosis and pelvic pain patients.

“I’m glad we’ve got an alternative,” she said. “That’s fantastic, and it remains to be seen whether or not it will be as good, but pain is so complex, pain is a really hard thing to study because it’s got so many contributors.”

She said there needed to be additional research after it was introduced.

If taken up by the federal government, the listing would mean gender-affirming care would be funded by the federal taxpayer through the PBS for the first time.

That would remove a financial barrier to access to treatment for transgender children in Queensland and the Northern Territory.

In other jurisdictions the care was already free through the public system, but the Queensland government banned its public hospitals from prescribing drugs for gender-affirming care to transgender children last January, a decision that affected more than 491 patients on the waitlist at the state’s gender clinic. The ban was overturned by the supreme court, but immediately reimposed by the government. The Northern Territory imposed a similar ban in response.

The medical director of Gender Health Australia, Stuart Aitken, said the decision had sparked “absolute joy” in his patients.

“It takes away a huge barrier to accessing evidence-based care,” he said.

“It means that the ban has a very limited effect.”

The Brisbane GP Fiona Bisshop, from Stonewall Medical Center, said a PBS listing would reduce the cost of private prescribing from about $3,000 a year to just $300, or $25 a week.

“It kind of makes [the ban] a joke, really … it makes it laughable that the PBS is saying you can prescribe this for anything,” she said.

She said cost had been one of the primary obstacles to treatment in Queensland.

The state government’s own review of the treatments – which also considered hormone therapy – issued a similar warning, concluding that the ban created legal, ethical, governance, regulatory and oversight risks, including “inequity because of socioeconomic status or geographical location”.

The review found low-quality but consistent evidence suggesting that when carefully prescribed, puberty blockers can reduce gender-related distress that may otherwise intensify during puberty. It did not recommend continuing the ban.

The health minister, Tim Nicholls, extended the ban to at least 2031 , depending on the findings of a trial in the UK.

Like most drugs used in gender-affirming care, triptorelin is prescribed off label and is not approved for that use by the Therapeutic Goods Administration.

If approved, the expanded PBS coverage would take effect in November.