Wednesday, March 27, 2013

More FDA Inspection Tips (And One Unforgettable Quote from the FDA Compliance Director) March 26th, 2013 // 10:06 pm @ jmpickett March 26, 2013


After our recent very informative Webinar on FDA inspection tips, we asked some of our readers what the most important things are to avoid FDA 483s. Here are some of our favorite responses:
Pre-Inspection
  • It is important to practice inspection readiness on a daily basis. Run a mock audit often and review the findings. This way, you will have uncovered any potential FDA compliance problems. And, your quality team will be calm and confident on the day of the real FDA inspection.
  • Try to get your hands on FDA 483s and warning letters that are readily available from the FDA. This will give you a good idea what they are stressing in current inspections.
During the Inspection
  • On the day of the audit, you will want to only answer questions that FDA asks. There is one drug company out there that trained their employees like this: If the FDAer asks you if you know what time it is, you just say ‘yes.’ The moral is to keep every answer as simple as possible, and only directly answer the question asked and no more.
  • Have your senior management be the point people during the inspection. You don’t need to have a whole crew of people tailing the FDAers all day. Make sure you select people who are calm and confident. If you have some grumpy quality people, send them on a fishing vacation during the inspection (seriously, our recent Webinar speaker recommended just that to one client!).
  • Assemble a back room, or war room, during the inspection. In an ideal world, you will be able to have the conversation between the FDAers and your team piped into this room. You should have experts available from all of your product lines and QA/regulatory assurance should be ready to give any asked for documentation right away. Make sure someone knows where every document is that the FDAer may ask for. Nothing looks worse than not being able to find important documents.
  • Use the all-important close out meeting with the FDAer to clarify any items that are not clear. This will help you to understand what the investigator is thinking. Sometimes you may be able to clear up any misunderstandings an avoid some FDA 483 observations. You should not use this close out meeting to argue with the inspector. If there were any corrective actions taken during the audit, ask the investigator if these actions were enough.
  • Remember that the exit interview is critical many times to establish that senior management will do corrective actions. This can help to minimize further FDA actions. The FDAer on the inspection has much input on the compliance division decision on how to classify the audit. If senior management seems like they don’t care, you can expect the district will try to upgrade your 483 to a warning letter.
After the Inspection
  • After the audit, a good way to avoid a 483 is to respond to the observations as fast and completely as you can. Demonstrate that you have your stuff together. FDA is not very understanding if you have repeat violations from an earlier 483. Key – remember you MUST respond to 483 observations in 15 days, or FDA will not even open your response. You can easily flush $100,000 in consultant fees down the toilet if you do not respond within the 15 day time frame.
  • Just because the auditor wrote the observation does not mean that you cannot dispute it. You may dispute the facts upon which the observation is based, or you can argue whether the observation rises to the level of a 483 observation.
  • This has been heard directly from the mouth of the Director of the Office of Compliance: We know within 30 seconds of scanning your 483 response if you ‘get it’ or not.” Did we mention that answering a 483 quickly and thoroughly is really important?
Random Tips
  • We find that quality is mostly dependent upon the culture of your company. If people from all of the departments have a shared feeling of ownership of quality, the quality of the company will be much better. If people think that only the quality department should worry about quality, you could have trouble brewing.
Upcoming Expertbriefings.com Webinars 2013
Quoted from here

Speciality Pharmacies Cut Corners with Fatal Consequences


The Food and Drug Administration or FDA has arrived at a crossroads in their efforts to supervise ‘specialty pharmacies’. These are believed to be complicit in a mounting number of sickness’ and fatalities, according to an agency bulletin last week. It was the Washington Post that first exposed the substandard procedures and basic hygiene failures at three large drug producing, speciality pharmacies. The paper linked their products to a number of deaths and quite a few outbreaks of sickness since 2000.0
Continue reading here 

Tuesday, March 26, 2013

Updated: A Lawyer Cannot Let a Flawed Argument Go By--IACP's Argument Is Unfair

By Sue Tuck Richmond

In its recent letter to Congress, the IACP states,

[it] has seen no evidence  that the FDA has been unable to obtain access to the records they seek under the existing process,” according to the letter. “The Agency has provided no data on the number of pharmacies it has inspected, the number of pharmacies which did or did not claim the exemption, the number of court orders, warrants, or subpoenas that were requested to obtain those records after an exemption was claimed, or whether any of those court requests were declined 
These statements by the IACP are unfair for several reasons and misleading to those who don't understand federal court procedures and laws.  First, to be able to obtain a court order, warrant or subpoena from a federal district court is no easy task.  I have practiced in both state and federal court.  A federal court requires a whole lot more in most states than a state court does to obtain  an order, warrant or subpoena.  The FDA cannot on its own get the order, warrant or subpoena it must go through the United States Attorney's office in the district where it wishes to obtain the court order, warrant or subpoena.  It is beyond the scope of this blog post to discuss which district would have jurisdiction over what pharmacy and what information, etc.  That is an entirely different issue.  It is also an entirely different issue as to whether you are seeking a federal civil or criminal order, warrant or subpoena.  Different standards apply for obtaining civil versus criminal orders, warrants and subpoenas.  Also note that in additional to the  Federal Rules of Criminal Procedure and the Federal Rules of Civil Procedure that must be complied with each individual district court has its own rules that must be complied with--these are the procedural aspects that must be complied with.  Then there is the matter of the substantive law that must be complied with or meet.  In most cases, you most have a sworn statement from a federal agent backing up your facts and you must appear before a federal magistrate in some cases.  It is far beyond the scope of this blog entry for me to give a complete less on what is required and how detailed it is but it is not something you run out and get...it can take days and even weeks.  There are ways to get emergency orders, warrants and subpoenas but that is another matter.

Second, underlying the entire discussion above is the assumption and it is a big one here--that the FDA has jurisdiction over the matter.  Hum?  Does it?  Isn't that a gray area?  Isn't that something people disagree on? No clear cut authority exist right?   If you have never been in the hot seat before a federal district magistrate or a federal district judge answering questions, there is one thing you should know.  The one thing you should know is you had better be up front with that judge who is relying on you to tell him what the law is.  Well, your Honor....it is not clear the FDA has jurisdiction to inspect this pharmacy but we want you to sign this order, warrant or subpoena, etc.

There are probably several reasons the FDA hasn't provide any data on this.  My guess is very few, if any, United States Attorney's Office are going to take this type of request to a federal court in light of the circumstances.  Again it is very easy to be critical when one does not understand the process of the hoops that must be jumped through when clear authority does not exit, and even when it does.

As a side note after the ones being inspected or investigated have been tipped off, there is always the potential that evidence will be destroyed.  If the FDA clearly had authority to inspect and investigate then a court order, warrant or subpoena could be obtained and served at the same time the FDA first knocks on the door of the pharmacy.  Without that clearly defined authority there is a huge risk that evidence and information will potential be destroyed.

And on another note if a federal magistrate refuses or declines to issue the order, sign the warrant or subpoena then it can be appealed to the district court.  This is another topic  requiring its own explanation.  Government appeals are unlike any other.  There is a process requiring approval from the Department of Justice before an appeal may be initiated.  This takes time. The actual appeal takes time.  The time it takes versus the benefit gain is always a factor to be considered  If the district court judge denies the request that decision with Department of Justice approval can be appealed to the Circuit Court.  Again this takes take and follows a court imposed schedule.  The next stop is the Supreme Court.  The United States Supreme Court does not have to hear the case if it chooses not to do so.  The bottom line is there is a very long and detailed process that must be followed with lots of careful planning and thought process each step along the way.  It is not as easy as just saying why didn't the FDA just go get a court order, subpoena or warrant.


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Hanson et al V. New England Compounding Pharmacy

Hanson et al V. New England Compounding Pharmacy

Fraud: Deadly medicine  - Editorials - The Charleston Gazette - West Virginia News and Sports -

Fraud: Deadly medicine  - Editorials - The Charleston Gazette - West Virginia News and Sports -

GUEST OPINION: Enforce existing regulations; don't make new ones

GUEST OPINION: Enforce existing regulations; don't make new ones

TN pharmacists say compounding loophole needed because of drug shortages


Legislators have narrowed the scope of a bill that would have removed Tennessee’s patient-specific requirement for mixing medicines — a safeguard that compounding pharmacies violated and the state did not actively enforce.
A new amendment to the bill would allow health care providers to buy compounded medicines without individual prescriptions whenever a drug product is not commercially available. Persistent drug shortages are the reason this loophole is needed, according to Baeteena Black, executive director of theTennessee Pharmacists Association, and the two legislator-pharmacists who are sponsors of the legislation, Sen. Ferrell Haile and Rep. David Shepard.
“How many lives are you going to lose because you don’t have medication?” Haile said.
If Tennessee had enforced the patient-specific requirement, hospitals would have had a much harder time securing medicines that have been in short supply, such as propofol for patients on ventilators and intravenous calcium supplements for premature babies, Black said.
“It would have been a crisis,” she said. “There’s not enough to go around. Some patients would have to do without. They would have to try alternative drugs that might not be the drug of choice.”
Continue to read here

3/26/13 - FDA Seeks End of Road for Compounded Biologics

If the FDA gets the authority it wants, it could be the end of the road for compounded versions of some biologics and high-risk drugs.
In the aftermath of a deadly meningitis outbreak linked to drugs from the New England Compounding Center and ongoing quality problems with other compounders, the agency is working with lawmakers on legislation that would set stricter standards for compounding pharmacies and increase the agency's oversight.
One measure FDA Commissioner Margaret Hamburg is calling for is a ban on the compounding of complex and high-risk drugs and biologics.
Such products should only be made by an FDA-registered drug manufacturer under an approved new drug application, she said. In the past, seemingly minor changes in the manufacturing or packaging of a biologic have led to safety issues.
It's a move Genentech Inc., a unit of Basel, Switzerland-based Roche AG, would welcome, given ongoing concerns about compounded versions of its Avastin (bevacizumab), used off-label as a cheaper alternative to Genentech's Lucentis (ranibizumab in treating wet age-related macular degeneration (AMD) and other eye diseases.
Approved to treat certain forms of cancer, Avastin is manufactured, formulated and packaged specifically for administration by intravenous infusion in cancer patients, Genentech spokesman Terry Hurley told BioWorld Today.

Continue reading here

PharMEDium Supports a New FDA Category for Sterile Compounding

March 26, 2013
The purpose of this communication is to offer our perspective on recent articles in the mainstream press, and the recent blog post "FDA Must Have New Authorities to Regulate Compounding Pharmacies" by Dr. Margaret A. Hamburg, Commissioner of the U.S. Food and Drug Administration (FDA) (https://blogs.fda.gov/
First and foremost, PharMEDium has long advocated for FDA oversight of the compounding industry, for Congress to clarify the FDA’s authority, and for the adoption of rigorous national quality and safety standards. We support the passage of federal legislation to establish a new FDA category for sterile compounders governed by applicable current Good Manufacturing Practices (cGMPs). We believe FDA oversight of interstate shipments of sterile compounders is necessary.
PharMEDium has shared proposed guidelines for defining the new category of sterile compounders with the FDA, American Society of Health-System Pharmacists (ASHP), National Association of Boards of Pharmacy (NABP) and other organizations. We will continue to work with the FDA and other regulatory agencies to encourage passage of new legislation which addresses the specific needs of sterile drug compounding operations.
While our advocacy for increased federal oversight continues, we remain committed to complying with all applicable federal and state regulations. Since PharMEDium’s inception, we have been registered with the FDA and State Board of Pharmacy in our resident states and are licensed in all states to which we currently ship. The FDA routinely inspects our centers, and we have been fully responsive to the Agency.
The March 20, 2013 Washington Post article "States Cracking Down on Specialty Pharmacies" and the March 15, 2013 Wall Street Journal article "Pharmacies Feel More Heat " mention that PharMEDium is involved in regulatory discussions with New York State and Iowa. Neither New York State nor Iowa have identified any quality or patient safety concerns related to our compounding services. These specific state discussions relate to PharMEDium shipping medications to hospitals in anticipation of specific patient orders based on routine, regularly observed prescribing and dispensing patterns within the hospital.
PharMEDium is an outsourcer of sterile compounding services and operates as an extension of the hospital pharmacy, strictly using FDA approved sterile drugs and components. The hospital pharmacy is responsible for dispensing PharMEDium’s compounded preparations to its patients.
The recent articles suggest that "PharMEDium was one of several companies highlighted in a previous investigation about problems at manufacturing-style compounding pharmacies years before last fall’s outbreak." PharMEDium promptly addressed all concerns raised by inspectors and leads the industry with state of the art sterile compounding processes that meet or exceed the current USP Chapter <797> standards. We continue to provide total transparency to our customers and regulatory agencies. And, as previously stated, PharMEDium is in support of additional FDA oversight and new federal controls.
Patient safety is PharMEDium’s single highest priority and we are committed to maintaining the highest levels of quality in our sterile preparations. We believe this commitment, along with advocacy and support of a new federal compounding category, will help us to continue to support the many hospital pharmacies and patients that rely on us each and every day.

Tom Rasnic
VP, Quality, Regulatory and R&D
PharMEDium Services, LLC

Question of the Day--A Response to the IACP's New Position

By Sue Tuck Richmond

Why is the IACP and others so critical of the FDA for things such as the failure to follow up on warning letters when there are also examples of the states failing to follow up after issuing warning letters and doing the exact same thing?  For example,  in Texas they have in the past allowed the pharmacies to merely submit a letter stating after a warning letter/violation notice that the pharmacy is now in compliance and has taken the appropriate action rather than reinspecting) or state pharmacy boards  that send the FDA correspondence to local FDA offices rather than finding out the specific and appropriate person in the FDA to address the referral that a pharmacy appears to be manufacturing and furthermore the state does no followup after hearing nothing from the FDA).  Also what about the fact that the states have failed to police these compounding pharmacies that the FDA has now found serious problems with.  It is easy to sit here and point the finger back and forth at the states and the FDA, but this ultimately solves nothing and only creates a further divide between the two.  Rather than blaming shouldn't we all be trying to solve the problem and find the right solution.  I am fairly should if we want to get involved in the blame game there is plenty of blame to go around.

Compounding pharmacy death toll continues to rise Tuesday, March 26, 2013


For the second time in just the past month, the toll of people dying in connection with a Framingham pharmacy’s mold-contaminated painkillers has risen.
Now at 51 dead across the country, the latest fatality related to the New England Compounding Center occurred in Florida in the past week, according to statistics just  by the federal Centers for Disease Control.
The number of people battling meningitis and infection from tainted steroid injections that first came to light six months ago also rose in the past week from 722 to 730 — an increase of 16 cases since Feb. 25, the CDC reported. The compounded drugs were subsequently recalled.
Continue reading here

VOL. 128 | NO. 60 | Wednesday, March 27, 2013 Shortages Impact Compounding Pharmacies


By Jennifer Johnson Backer

 Updated 2:49PM
In recent years, the U.S. Food and Drug Administration has reported an increase in the number of drug shortages and discontinuations.
The number of drug shortages reported to the FDA gained 41 percent to 251 shortages in 2011, compared to 178 shortages reported in 2010. The agency says it continues to see an increasing number of shortages, including drugs used to treat cancer, anesthetics used for patients undergoing surgery, drugs needed for emergency medicine and injectable drugs. The FDA also has reported a spike in the number of medications that have been discontinued.
Brett Wright, the owner of Benevere Pharmacy in Collierville, says he’s noticed an increase in the number of his clients requesting medications that are no longer commercially available.
Wright, who is a pharmacist by training, opened Benevere Pharmacy in May. The pharmacy specializes in custom-making medications that are tailored to meet the medical needs of an individual patient. Sometimes compounding is needed because a patient may be allergic to a certain dye, or an elderly patient may need a medicine in a liquid or suppository form that is not available. In other cases, compounding is necessary because a drug has been discontinued altogether.
Continue reading here

Compounders Tweak FDA's Three-Prong Test, Say Expanding Agency Authority Is 'Premature'


Tuesday, March 26, 2013

US FDA: $10M in CR to Add More Capacity in China for Inspections

US FDA: $10M in CR to Add More Capacity in China for Inspections

World API Market Growth Slows, CPA Report Finds

World API Market Growth Slows, CPA Report Finds

CRO’s China Lab Hit With Form 483 Under US FDA’s HSP/BIMO Initiative

CRO’s China Lab Hit With Form 483 Under US FDA’s HSP/BIMO Initiative

Monday, March 25, 2013

FDA Inspections - How Investigators Typically Process the Results - Webinar By GlobalCompliancePanel

Submitted by Anonymous on Sun, 03/24/2013 - 23:59
04/03/2013 10:00 am
US/Pacific
Overview: The presentation will cover important documents such as the Establishment Inspection Report, and the FDA Notice of Observations. The presentation will also cover the different steps the investigator takes after he/she finishes the inspection and writes the Establishment Inspection Report in the various programs used by the agency to track inspection reports and regulatory considerations.
Why should you attend: You should attend to inform yourself and staff on how the evidence is collected by FDA investigators and how it is reviewed by several agency departments and what actions are taken as a result of the reviews. Learn to be ahead of the process and take effective steps to minimize the impact of the inspection or take effective corrective action to rectify your compliance status with the agency.
Areas Covered in the Session:
Law/Regulations of Inspections
Logistics of Inspections
Evidence Collection in an Inspection
Sample Collections and the Processing of Samples for Regulatory Actions
Notifications of Actions to FDA Import Operations for Import Alert Considerations
Who Will Benefit:
Regulatory Affairs Directors/Managers/staff
Plant Managers
Quality Assurance/Control staff
Mr. Luis Chavarria recently retired from the United States Food and Drug Administration (FDA) after more than 30 years of service. His unique career covered numerous national and international assignments. Starting with the position of Consumer Safety Inspector and ending with the position of Assistant Regional Director for Latin America in the Office of the Commissioner.
USA
GlobalCompliancePanel,
Livermore Common, Fremont, CA, 94539
Webinar Presenters: 
GlobalCompliancePanel