Like I mentioned in the CB, I typically work with PDFs using application-specific wrapper modules which utilize PDF::API2::Simple. That module offers direct access to the underlying PDF::API2 object it uses when you need it.

The "application specific" modules can be anything from method calls for each part of a document to the back end for a template engine, depending on just what type of document I need to produce and how flexible the tool chain needs to be.

Other options exist, as a CPAN search for "PDF" will show. Pod::Pdf, PDF::FromHTML, PDF::FromHTML::Template, HTML::HTMLDoc and Business::ReportWriter::PDF look interesting for getting PDFs from different types of templates besides just the obvious PDF::Template. I'm not sure of the status of any of them, though.

Other more generic PDF creation tools, such as CAM::PDF, PDF::EasyPDF, Text::PDF, and PDF::Writer can be used to create PDFs.

There are also more specialized PDF creators for different types of tasks, such as PDF::ReportWriter, PDF::Report, and even Games::Bingo::Print.

There are tools out there to convert LaTeX and PS documents to PDF, too.

It's quite possible there are more ways from your input to a PDF than you ever care to evaluate. Starting with what your input might be and seeing how to massage that into input and code for one of the better-maintained PDF libraries is probably a good place to start.