G'day Acka.au,

I'd suggest taking a look at PDF::API2. The author of CAM::PDF has high praise for this module (see CAM::PDF - SEE ALSO [which also lists, and comments on, a couple of other PDF modules]).

For a gentler introduction to PDF::API2, you might consider PDF::API2::Simple; although, this may be a bit too simplistic for your requirements.

In PDF::API2 - PAGE METHODS, you'll find code examples for inserting new pages wherever you want (including a specific example of inserting at the start of the document).