Tag: FDA

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Can Compounding Pharmacies Continue to Compound Name Brand Weight Loss Drugs by Adding B12?

In the world of pharmaceuticals, compounding pharmacies play a crucial role in customizing medications to meet the unique needs of individual patients. However, the practice of compounding is tightly regulated to ensure patient safety and maintain the integrity of the drug approval process.

One contentious issue is whether compounding pharmacies can continue to compound name brand drugs by simply adding an ingredient like Vitamin B12 to the formulation. This blog post will delve into the regulations and guidelines provided by the FDA under Sections 503A and 503B of the Federal Food, Drug, and Cosmetic Act (FD&C Act) to analyze the validity of this practice.

Understanding FDA Regulations on Compounded Drugs

The FDA has established specific conditions under Sections 503A and 503B of the FD&C Act that must be met for compounded drugs to qualify for exemptions from certain regulatory requirements. These exemptions include current good manufacturing practice (CGMP) requirements, labeling with adequate directions for use, and new drug approval requirements. One critical condition is that the compounded drug must not be “essentially a copy of a commercially available drug product” unless there is a change made for an identified individual patient that produces a significant difference for that patient, as determined by the prescribing practitioner.

What Constitutes “Essentially a Copy”?

The FDA defines “essentially a copy” of a commercially available drug product as a compounded drug that:

  1. Has the same active pharmaceutical ingredient(s) (API) as the commercially available drug product.
  2. The API(s) have the same, similar, or an easily substitutable dosage strength.
  3. The commercially available drug product can be used by the same route of administration as prescribed for the compounded drug.

The Requirement for Significant Difference

For a compounded drug to be exempt from being considered “essentially a copy,” there must be a documented determination by the prescribing practitioner that the change in the formulation produces a significant difference for the patient. This determination must be specific and documented on the prescription. Examples of significant differences include:

  • Removing an allergenic dye for a patient with allergies.
  • Changing the dosage form for a patient who cannot swallow tablets.
  • Adjusting the dosage strength for a patient who requires a different dose.

The Role of Adding B12 to the Formulation

Can adding Vitamin B12 to a name brand drug formulation exempt the compounded drug from being considered “essentially a copy”? The answer is not straightforward. The addition of B12 must produce a significant difference for the patient, as determined by the prescribing practitioner. This significant difference must be documented on the prescription, specifying the change and the benefit it provides to the patient.

FDA’s Position on Minor Changes

The FDA’s guidance explicitly states that minor changes in strength or formulation that do not produce a significant difference for the patient do not exempt the compounded drug from being considered “essentially a copy.” For example, changing the strength from 0.08% to 0.09% is not considered significant unless it is specifically determined to be so for an individual patient.

Minor changes that do not produce a significant difference for the patient do not qualify the compounded drug for exemptions. This is to ensure that compounders do not evade the limits set by the FDA by making relatively small changes to a compounded drug product and then offering it to the general public without regard to whether a prescribing practitioner has determined that the change produces a significant difference.

Conclusion

The position that compounding pharmacies can continue to compound name brand drugs by simply adding B12 to the formulation is not valid unless the addition of B12 produces a significant difference for the patient, as determined and documented by the prescribing practitioner.

The compounded drug must meet all other conditions under Section 503A or 503B of the FD&C Act to qualify for exemptions. Without a documented significant difference, the compounded drug would still be considered “essentially a copy” of the commercially available drug product, and compounding it would not be permissible under FDA regulations.

Adding an ingredient like B12 to a name brand drug does not automatically make it permissible to compound unless it meets the specific criteria set forth by the FDA.

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Health Law Highlights

The Promise Artificial Intelligence Holds for Improving Health Care

Summary of blog post from FDA, by Troy Tazbaz:

The FDA emphasizes the importance of integrating AI responsibly, ensuring safety and effectiveness through collaboration and adherence to standards and best practices. Key strategies include adopting risk management frameworks, quality assurance practices, and maintaining transparency and accountability throughout the AI development lifecycle. Grassroots efforts and federal initiatives are contributing to the establishment of best practices for AI quality assurance in health care. The FDA’s Digital Health Center of Excellence (DHCoE) remains open to feedback and collaboration to advance AI in health care.

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Health Law Highlights

Chevron Runs Out of Gas: The Bumpy Road Ahead for Health Regulations After Loper Bright

Summary of article from Akin Gump Strauss Hauer & Feld LLP, by Anna Abram, Sudhana Bajracharya, Jenna Becker, Craig Bleifer, Nathan Brown, Kelly Cleary:

The Supreme Court’s decision in Loper Bright Enterprises v. Raimondo overturns the Chevron doctrine, which previously allowed federal agencies to interpret ambiguous statutes with judicial deference. This change raises the bar for agencies like CMS and FDA, requiring them to provide the “best reading” of statutory gaps rather than a “permissible” one. The ruling will significantly impact lower courts, which have continued to apply Chevron, and could lead to increased litigation challenging longstanding regulations. Additionally, the Corner Post decision extends the timeframe for challenging agency regulations under the APA, further exposing agencies to potential lawsuits. These developments will necessitate more precise statutory language from Congress and could constrain agency policy changes across administrations.

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Health Law Highlights

Accelerated Approval Process Is Not Without Risk: Placing Recent FDA Action in Context

Summary of article from Troutman Pepper, by Kyle Dolinsky, Judith O’Grady:

The FDA withdrew approval for Pepaxto, a multiple myeloma drug, after post-marketing studies failed to confirm its clinical benefit. The drug had been granted accelerated approval, a pathway for drugs treating serious illnesses that offer therapeutic benefits over existing treatments. However, post-marketing studies are required to verify the drug’s benefit, and failure to do so can result in withdrawal of approval. This was the first time the FDA implemented formalized withdrawal procedures under the Food and Drug Omnibus Report Act of 2022. Despite the withdrawal, the risk of litigation concerning accelerated approval drugs remains unchanged.

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Health Law Highlights

How State-Level Psychedelic Medicine Legislation Raises Equity Concerns

Summary of article from Healthcare Brew, by Maia Anderson:

The FDA is likely to decide on the approval of an MDMA-based psychedelic medicine this year, with multiple states considering legalization for therapeutic use. However, there is concern about equitable access to these treatments. Psilocybin, MDMA, and a form of LSD have been granted breakthrough therapy status by the FDA, allowing for clinical trials for potential therapeutic uses. States are taking varied approaches to legislation, with some legalizing or decriminalizing psychedelics and others allowing research. There are concerns about the high cost of these therapies and their accessibility, particularly for people of color, with initiatives ongoing to educate clinicians and develop non-hallucinogenic variants to increase accessibility.

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Health Law Highlights

Louisiana Lawmakers Pass Bill Making Abortion Pills Controlled Dangerous Substances

Summary of article from AP News, by Sara Cline:

Louisiana is set to reclassify abortion-inducing drugs, mifepristone and misoprostol, as controlled and dangerous substances under a new bill that has received final legislative approval. Supporters of the bill argue it will protect women from coerced abortions, while critics, including numerous doctors, fear it will hamper their ability to prescribe these medicines for other reproductive health needs. The bill would place these drugs on the list of Schedule IV drugs under the state’s Uniform Controlled Dangerous Substances Law, requiring doctors to have a specific license to prescribe them and the drugs to be stored in certain facilities. Critics warn this could create barriers to treatment and cause unnecessary fear and confusion. The bill now awaits the signature of the conservative Republican Governor Jeff Landry, who has indicated his support.

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Profound Medical Wins FDA Nod for AI in Prostate Cancer Procedure

Summary of article from MassDevice, by Sean Whooley:

Profound Medical has received FDA 510(k) clearance for its second AI model, the Contouring Assistant, designed to treat prostate cancer. The Contouring Assistant is part of the company’s TULSA-Pro system, which uses transurethral ultrasound ablation (TULSA) to ablate diseased tissue in patients with various stages of prostate cancer, benign prostatic hyperplasia (BPH), or those requiring salvage therapy. The TULSA procedure uses real-time magnetic resonance guidance to preserve urinary continence and sexual function while targeting cancerous tissue. The newly cleared AI module uses machine learning to segment the prostate, aiding in the delineation of the target ablation volume. Profound Medical is also developing another TULSA-AI module, TULSA BPH, with more details expected later in 2024.

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Health Law Highlights

FDA Finalizes Rule Regulating Laboratory Developed Tests

Summary of article from Polsinelli, by Suzanne Bassett, Michael Gaba:

The FDA’s Final Rule regulating Laboratory-Developed Tests (LDTs) was published on May 6, 2024, and is expected to take effect in 60 days. The rule expands the definition of in vitro diagnostics (IVDs) to include LDTs and will significantly alter the regulatory landscape for LDTs, impacting manufacturers, patients, and healthcare providers. Despite over 6,500 comments, no substantial changes were made from the Proposed Rule to the Final Rule, but there were significant adjustments to enforcement discretion policies. The rule is expected to face legal challenges and potential legislative action from Congress. The Final Rule applies to all IVDs offered as LDTs, regardless of whether the test meets the traditional definition.

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Health Law Highlights

FDA Proposes Updated Guidance Concerning Cybersecurity of Medical Devices

Summary of article from Jones Day, by Maureen Bennett, Ryan Blaney, Alexis Gilroy, Colleen Heisey, Michael McFerran, Lauren Murtagh:

The U.S. Food and Drug Administration (FDA) has proposed an updated draft Premarket Cybersecurity Guidance on March 13, 2024, to aid in meeting cybersecurity requirements for FDA medical device submissions. This guidance, under Section 524B of the Federal Food, Drug, and Cosmetic Act, applies to any submission for a “Cyber Device”, which is defined as any device containing software, with potential internet connectivity, and susceptibility to cybersecurity threats. Manufacturers are required to provide documentation that includes plans for dealing with cybersecurity vulnerabilities, assurance of device and system security, and a detailed software bill of materials. The guidance also addresses the impact of device modifications on cybersecurity and the need for a “reasonable assurance of cybersecurity” in the device’s safety and effectiveness evaluation. The FDA will finalize the draft guidance after considering comments and suggestions submitted by May 13, 2024.

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Health Law Highlights

FDA Brings Lab Tests Under Federal Oversight

Summary of article from AP News, by Matthew Perrone:

The FDA has finalized a regulation that will gradually introduce oversight for new tests developed by laboratories. The rule mandates that these tests, including those for life-threatening diseases, must demonstrate accurate results within a timeframe of 3.5 to 4 years. However, existing tests will not require federal review and will be grandfathered into approval. All lab tests will need to register with the agency and report any issues. The move has been opposed by the testing industry, which argues it will limit access to critical tests, increase healthcare costs, and stifle innovation.