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16, 2016 (81 FR 91071), FDA Has Proposed the Following Criteria to Evaluate the Nominated Substances

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16, 2016 (81 FR 91071), FDA Has Proposed the Following Criteria to Evaluate the Nominated Substances FDA Briefing Document Pharmacy Compounding Advisory Committee (PCAC) Meeting May 8-9, 2017 The attached package contains background information prepared by the Food and Drug Administration (FDA) for the panel members of the Pharmacy Compounding Advisory Committee (advisory committee). We are bringing certain compounding issues to this advisory committee to obtain the committee’s advice. The background package may not include all issues relevant to the final regulatory recommendation and instead is intended to focus on issues identified by the Agency for discussion by the advisory committee. The FDA background package often contains assessments and/or conclusions and recommendations written by individual FDA reviewers. Such conclusions and recommendations do not necessarily represent the final position of the individual reviewers, nor do they necessarily represent the final position of the Review Division, Office, or Agency. Table of Contents I. Introduction................................................................................................................... 3 A. Bulk Drug Substances That Can Be Used by Compounders under Section 503A.. 3 B. Drug Products and Categories of Drug Products that Present Demonstrable Difficulties for Compounding.............................................................................. 4 II. Substances Nominated for Inclusion on the 503A Bulks List ..................................... 5 III. Drug Products and Categories of Drug Products That Present Demonstrable Difficulties for Compounding....................................................................................... 6 A. Oral Solid Modified Release Drug Products That Employ Coated Systems....... 7 IV. Draft Points to Consider………………………………………………………………7 FDA Briefing Document Page 2 May 8-9, 2017 I. Introduction Section 503A of the Federal Food, Drug, and Cosmetic Act (FD&C Act) describes the conditions that must be satisfied for human drug products compounded by a licensed pharmacist in a State-licensed pharmacy or Federal facility, or by a licensed physician, to be exempt from the following three sections of the FD&C Act: section 505 (concerning the approval of drugs under new drug applications (NDAs) or abbreviated new drug applications (ANDAs)); section 502(f)(1) (concerning the labeling of drugs with adequate directions for use); and section 501(a)(2)(B) (concerning current good manufacturing practice (CGMP) requirements). The Drug Quality and Security Act added a new section 503B to the FD&C Act, under which a compounder can elect to register as an outsourcing facility. Outsourcing facilities, as defined in section 503B of the FD&C Act, are facilities that meet certain conditions described in section 503B, including registration with FDA as an outsourcing facility. If these conditions are satisfied, a drug product compounded for human use by or under the direct supervision of a licensed pharmacist in an outsourcing facility is exempt from three sections of the FD&C Act: (1) Section 502(f)(1) (concerning the labeling of drugs with adequate directions for use); (2) section 505 (concerning the approval of human drug products under NDAs or ANDAs); and (3) section 582 (concerning the requirements of the Drug Supply Chain Security Act). Outsourcing facilities remain subject to CGMP requirements. Outsourcing facilities can compound drugs with or without receiving patient specific prescriptions or orders. A. Bulk Drug Substances That Can Be Used by Compounders under Section 503A One of the conditions that must be met for a compounded drug product to qualify for the exemptions in section 503A of the FD&C Act is that a licensed pharmacist or licensed physician compounds the drug product using bulk drug substances that meet one of the following criteria: (1) Comply with the standards of an applicable United States Pharmacopeia (USP) or National Formulary (NF) monograph, if a monograph exists, and the USP chapter on pharmacy compounding; (2) If such a monograph does not exist, are drug substances that are components of drugs approved by the Secretary; or FDA Briefing Document Page 3 May 8-9, 2017 (3) If such a monograph does not exist and the drug substances are not components of drugs approved by the Secretary, appear on a list developed by the Secretary through regulations issued by the Secretary under subsection (c) of section 503A. (See section 503A(b)(1)(A)(i) of the FD&C Act). FDA is considering those substances nominated for inclusion on the list of bulk drug substances that can be used to compound drug products under section 503A of the FD&C Act (503A Bulks List). As discussed at the February 2015 PCAC meeting, and as proposed in the Notice of Proposed Rulemaking published in the Federal Register of December 16, 2016 (81 FR 91071), FDA has proposed the following criteria to evaluate the nominated substances: (1) The physical and chemical characterization of the substance; (2) Any safety issues raised by the use of the substance in compounded drug products; (3) The available evidence of effectiveness or lack of effectiveness of a drug product compounded with the substance, if any such evidence exists; and (4) Historical use of the substance in compounded drug products, including information about the medical condition(s) the substance has been used to treat and any references in peer-reviewed medical literature. In evaluating the candidates for the 503A Bulks List under these criteria, the Agency has proposed to use a balancing test. Specifically, the Agency has proposed to consider each criterion in the context of the others and to balance them, on a substance-by-substance basis, to decide whether a particular substance is appropriate for inclusion on the list. B. Drug Products and Categories of Drug Products that Present Demonstrable Difficulties for Compounding Both sections 503A and 503B of the FD&C Act require compounded drug products to satisfy several conditions to qualify for the statutory exemptions from the FD&C Act listed in each section. One of the conditions for the exemptions under section 503A is that the compounded drug product is not a drug product that “presents demonstrable difficulties for compounding that reasonably demonstrate an adverse effect on the safety or effectiveness of that drug product.” See section 503A(b)(3). FDA Briefing Document Page 4 May 8-9, 2017 Similarly, one of the conditions for the exemptions under section 503B is that the compounded drug product “is not identified (directly or as part of a category of drugs) on a list published by the Secretary . of drugs or categories of drugs that present demonstrable difficulties for compounding that are reasonably likely to lead to an adverse effect on the safety or effectiveness of the drug or category of drugs, taking into account the risks and benefits to patients,” or “is compounded in accordance with all applicable conditions identified…as conditions that are necessary to prevent the drug or category of drugs from presenting [such] demonstrable difficulties.” See section 503B(a)(6). FDA is considering those substances nominated for inclusion on the list of drug products and categories of drug products that present demonstrable difficulties for compounding (Difficult to Compound List). As discussed at the November 2016 PCAC meeting, FDA proposes to apply six criteria to evaluate whether drug products or categories of drug products are difficult to compound under sections 503A and/or 503B of the FD&C Act: (1) The complexity of the formulation; (2) The complexity of the drug delivery mechanism; (3) The complexity of the dosage form; (4) The complexity of the bioavailability issues; (5) The complexity of the compounding process; and (6) The physicochemical or analytical testing complexity. II. Substances Nominated for Inclusion on the 503A Bulks List (in order of discussion at the meeting) A. Nicotinamide Adenine Dinucleotide (Tab 1) 1. Nomination (Tab 1a) (a) Fagron 2. FDA Review (Tab 1b) B. Nicotinamide Adenine Dinucleotide Disodium Reduced (Tab 2) 1. Nominations (Tab 2a) (a) Fagron (b) International Academy of Compounding Pharmacists FDA Briefing Document Page 5 May 8-9, 2017 2. FDA Review (Tab 2b) C. Nettle (Tab 3) 1. Nominations (Tab 3a) (a) National Community Pharmacists Association (b) International Academy of Compounding Pharmacists 2. FDA Review (Tab 3b) B. Ubiquinol (Tab 4) 1. Nomination (Tab 4a) (a) Fagron 2. FDA Review (Tab 4b) C. Vanadyl Sulfate (Tab 5) 1. Nominations (Tab 5a) (a) McGuff Compounding Pharmacy Services, Inc. (b) Integrative Medical Consortium (c) Alliance for Natural Health USA (d) American Association of Naturopathic Physicians 2. FDA Review (Tab 5b) D. Artemisinin (Tab 6) 1. Nominations (Tab 6a) (a) McGuff Compounding Pharmacy Services, Inc. (b) Alliance for Natural Health USA (c) American Association of Naturopathic Physicians (d) Integrative Medical Consortium 2. FDA Review (Tab 6b) III. Drug Products and Categories of Drug Products That Present Demonstrable Difficulties for Compounding FDA Briefing Document Page 6 May 8-9, 2017 A. Oral Solid Modified Release Drug Products That Employ Coated Systems (Tab 7) 1. Nominations (Tab 7a) (a) Public Citizen’s Health Research Group (b) AbbVie (c) GlaxoSmithKline (d) Biogen Idec 2. FDA Review (Tab 7b) IV. Draft Points to Consider A. May 8, 2017, a.m. session Draft Points for the PCAC to Consider Regarding Whether to Include Certain Bulk Drug Substances on the 503A Bulks List 1. FDA is proposing that nicotinamide adenine dinucleotide NOT be included on the 503A Bulks
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