FDA Lawyers Blog

On July 11, FLH Partner Brian J. Malkin will speak at Q1 Productions' Global Clinical Risk Management & Regulatory Policy Conference in Alexandria, VA on the topic "Developing a Single, Shared REMS in a Collaborative Setting". Joining Mr. Malkin will be Mark A. Collings, Ph.D., M.B.A., Director, REMS Programs, Pharmacovigilance and Risk Management, Endo Pharmaceuticals, Inc. The session description reads:

The FDA approves single, shared REMS for product categories with similar risk management programs to help relieve some of the burden on healthcare providers and pharmacies. The development of shared REMS requires that multiple companies and the FDA work in tandem to unify data and risk minimization systems, a model which some companies have also used to help organize risk management plans internationally. By ensuring a strong cross-corporate collaboration, internal regulatory policies, data analysis and communication systems can be synchronized internationally for advanced risk management programs.

• Structuring lines of communication within shared REMS network

• Establishing similar regulatory policies

• Utilizing data from all companies for international RMP development.

The Conference will be held on July 11-12, 2013. Throughout this two-day program, executive from industry will have an opportunity to discuss and debate the many challenges associated with profiling the risk of products as well as minimizing these risks and meeting regulatory expectations. As with all Q1 programs, the focus of the event will not only lie upon the educational content, but also providing attendees with an opportunity to network and build relationships across this highly dynamic and evolving market.

The fight over whether versions of the emergency contraceptives Plan B and Plan B One-Step (collectively "Plan B") should be available without a prescription to all women continued yesterday. Lawyers for FDA appeared before Judge Edward Korman of the Eastern District of New York urging him to stay his April 4 Order requiring the Agency to lift age restrictions on access to emergency contraceptives by May 10. FDA has appealed that ruling to the Second Circuit. The Agency has yet to implement the court's directive, but in late April it approved a supplemental new drug application ("sNDA") that lowers the age at which women can obtain these drugs without a prescription from 17 to 15. Judge Korman expressed skepticism as to the timing of the approval and criticized the Agency for not following his order. A ruling on the stay is expected by the end of this week.

FDA's actions have received mixed reviews. Last week, President Barack Obama reiterated his support of FDA's and the Department of Health and Human Services' ("DHHS's") determination that the age-restriction should be fifteen. He said that he was "very comfortable with the decisions they've made." Others have been more critical. Nancy Northup, President and CEO of the Center for Reproductive Rights, speaking after the Department of Justice's appeal to the Second Circuit said, "We are deeply disappointed that just days after President Obama proclaimed his commitment to women's reproductive rights, his administration has decided once again to deprive women of their right to obtain emergency contraception without unjustified and burdensome restrictions."

Written by Scot B. Pittman

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The approval of Plan B has a long history. Originally approved in 1999 for prescription-only use, Plan B became the United States' first emergency contraceptive. In February 2001, sixty-six organizations filed a Citizen Petition with FDA urging the Agency to switch Plan B, as well as any other emergency contraceptives, from a prescription-only drug to an over-the-counter ("OTC") drug and remove all age and point-of-sale restrictions. Despite repeated claims that it would address the outstanding petition, the Agency waited over five years to rule--denying the Petition in June 2006. FDA claimed that the petitioners had failed to provide sufficient data or information to meet the statutory and regulatory requirements of an OTC switch to any age group.

The U.S. Food and Drug Administration ("FDA") announced last Tuesday that it would not approve any generic versions of the original formulation of the prescription narcotic painkiller OxyContin® ("original Oxycontin®"). OxyContin® is a brand name for oxycodone hydrochloride, an opiate-based pain medication. Original Oxycontin® has been marketed by Purdue Pharma since 1995 and is notorious for its user misuse and abuse.

OxyContin® contains a large amount of oxycodone because it is designed to release the pain-relieving drug over an extended 12-hour period. However, original Oxycontin® can easily be crushed and then snorted or injected (or even sprinkled on food) to produce a rapid and intense euphoric high. The abuse of original OxyContin® in this manner can lead to addiction and dependence and has reportedly earned the product the nickname "hillbilly heroin." Its accessibility has magnified abuse rates; FDA reports that half a million people over age twelve began using original OxyContin® for non-medicinal purposes in 2008 alone. According to the Center for Disease Control, the death toll from prescription painkiller overdoses tripled in the first decade of the 21st century, and such overdoses "now kill more Americans than heroin and cocaine combined."

Written by Rachael P. McClure

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In addition to a patent for original OxyContin, which expired on Tuesday, Purdue Pharma also owns a patent for a reformulated, abuse-deterring version ("reformulated Oxycontin®"). This newer version was designed to resist being crushed and to form a gel that is difficult to inject when dissolved. Notably, FDA approved an updated label for this product last week, specifying the tablets' crush-resistant properties and warning of the fatal risks of misuse. (The label information is available here.) Purdue withdrew original OxyContin® from the market when its new version was approved in 2010 but retained the trade name.

Over the past months, there has been a lot of speculation (see recent blogs here , here, and here) whether the White House's proposed budget would cause a sequester situation for FDA, resulting in potential layoffs or program cuts, in an era of new user fees for generic drugs and biosimilar biological products. While initial reports and temporary budget fixes (called continuing resolutions) appeared to keep FDA's user fees intact and available for use, FDA's Commissioner, Margaret A. Hamburg, M.D., recently reported to members of a biotechnology trade association, the Massachusetts Biotechnology Council ("MassBio"), that it was not clear what would happen with user fees in the new federal budget.

Released on April 10, the White House's proposed fiscal year 2014 budget is a mixed bag that has been called a "political document rather than a serious piece of legislation" with a "series of bargaining positions" that "would bleed pharma." On the one hand, the plan would appear to confirm that FDA's user fees would not be sequestered, given that it supported the $4.7 billion in total program budget requested by FDA, which included user fees that would help fund over 90 percent of the requested increases. On the other hand, the budget includes a myriad of proposals that would change the way the government pays for medical care and products. For example, Medicare (senior citizens' drug coverage) Part D manufacturer discounts for branded drugs would be increased from 50% to 75% in 2015 (rather than 2020) and low-income individuals would be pushed more to generic drugs by increasing certain copayments for branded drugs and lowering certain copayments for generic drugs.

Written by Brian J. Malkin

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Many of the more controversial proposals were nestled in a document called "Reducing the Deficit in a Smart and Balanced Way". Here, the White House proposes, among other things, several items to purportedly lower drug costs, including: 1) authorizing the Federal Trade Commission to stop companies from entering into certain "pay-for-delay" agreements (see below) and 2) beginning in 2014, to reduce biologic product exclusivity from 12 years to 7 years and prohibit additional periods of exclusivity for minor changes to product formulations. These two items could open up some unanticipated debate regarding the White House's budget.

On April 7, Simeon Bennett from Bloomberg reported that individual members of the European Union are attempting to control the cost of medical care by containing the reimbursement of drugs intended for smaller patient populations, generally called orphan drugs. In Europe, orphan drugs are defined as a medicine to treat no more than 5 in 10,000 inhabitants. Many of these drugs undergo a centralized approval process via the European Medicines Agency (see related blog resource page here.) In practice, however, these drugs may only reach the market when each member state decides that its national health system will reimburse for the drug. For example, 35 orphan drugs reached the market in Belgium, 44 in the Netherlands, and 28 in Sweden in 2008. 35 such drugs reached the market in France and 23 in Italy in 2007.

According to Yann Le Cam, CEO of Eurodis, a French patient advocacy group for patients with rare diseases, "The price of orphan medicinal products is under much more debate. We have seen countries which were providing good access to orphan medicinal products now questioning the continuation of reimbursement."

Written by Brian J. Malkin

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Some examples provided in the Bloomberg report included the Netherlands demanding price reductions for certain therapies such as Sanofi's Myozyme® (alglucosidase alfa), an enzyme replacement therapy for patients with Pompe disease, which costs 700,000 euros ($909,000). As we previously reported from MassBio's Annual Meeting, Myozyme® was the largest research and development effort in the history of Genzyme, which was later acquired by Sanofi, and the result of a concerned father of two children with Pompe's disease pushing the promising therapy along to help it reach the public. Another example mentioned in the report included Ireland recommending against the government paying for Vertex Pharmaceuticals, Inc.'s Kalydeco® (ivacaftor) for cystic fibrosis until the company significantly reduced the price for the drug product. Yet another example was the rejection by the United Kingdom ("UK") to expand use of Alexion Pharmaceuticals, Inc.'s drug Soliris® (eculizumab) for two blood disorders, despite the recommendation for this use by an advisory panel. Instead, the government referred the matter to its National Institute for Health and Care Excellence, which we recently blogged on here, as an instrument to encourage value-based medicine in the UK.

On April 1, FDA provided a combined response to three citizen petitions concerning the regulation of over-the-counter ("OTC") nicotine replacement therapy ("NRT") drug products. The petitions were submitted by the Commissioner of Health, New York State Department of Health (Docket No. FDA-2008-P-0116), the Director, Legal Resource Center for Tobacco Regulation, Litigation & Advocacy, University of Maryland Francis King Carey School of Law on behalf of the Association for the Treatment of Tobacco Use and Dependence ("ATTUD") and the Society for Research on Nicotine and Tobacco ("SRNT") (FDA Docket No. FDA-2008-P-0116), and four not-for-profit organizations, the American Cancer Society Cancer Action Network, the American Lung Association, the Campaign for Tobacco-Free Kids, and the American Legacy Foundation (FDA Docket No. FDA-2010-P-0454). For additional background on this topic generally, please see an earlier blog that we posted here about a NRT workshop that FDA held in October 2010 addressing the topics in these petitions.

Written by Brian J. Malkin

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The petitioners asked FDA to consider modifying the labeling of OTC NRTs, certain policy changes, and allowing greater access to the products. While the requests varied, a common theme was that the petitioners wanted consumers to have greater access to NRTs in smaller packages that would permit more flexible use of the products, other than the typical up-to-12-weeks smoking cessation program scenario contemplated by the clinical studies that supported the use of these products. For instance, some of the petitioners suggested that the labeling should include additional risk/benefit information concerning NRTs versus continued cigarette (or other tobacco product) use, including possible concomitant use of cigarettes and NRTs, as well as longer-term NRT use to reduce and perhaps ultimately eliminate an individual's cigarette use. The not-for-profit petitioners wanted FDA to make the development of NRTs a priority within FDA, including certain collaborations with manufacturers of NRTs, such as the development of appropriate trial designs, and to transfer evaluation of NRTs from FDA's drug division for addiction drug products to its division for oncology drug products.

The United Kingdom's ("UK's") method of controlling the prices its Department of Health pays for innovative medicines has been, up until now, the Pharmaceutical Price Regulation Scheme ("PPRS"). The PPRS has been a voluntary scheme run over many years between the Department of Health and the branded pharmaceutical industry represented by the Association of the British Pharmaceutical Industry ("ABPI"). Its objective was to deliver the provision of safe and effective medicines at reasonable prices to the National Health Service ("NHS") while promoting innovation, the rapid uptake of new clinically and cost effective medicines, and in a sustainable manner.

Over recent years, the National Institute for Health and Care Excellence ("NICE") has been taking on a more visible and key role. Its job has been to improve outcomes for people using the NHS by producing evidence-based guidance by way of advice to healthcare professionals and to develop quality standards and measures for those providing health care services and also providing information to practitioners and managers in both health and social care.

Written by Howard E. Rosenberg, Ph.D.

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The UK Government's response to the Health Select Committee report of 2012-2013 on NICE was to re-establish NICE as a new statutory body giving it a key position in the healthcare system. It gives NICE the role of deciding the value-based pricing of medicines. Thus, value-based pricing will replace the current PPRS, when it expires in January 2014.

On March 25, 2013, the U.S. Supreme Court heard oral argument in the Federal Trade Commission's ("FTC's") case challenging the Hatch-Waxman patent settlements Solvay (now owned by Abbot Laboratories) entered into with Watson Pharmaceuticals, Par Pharmaceutical, and Paddock Laboratories resolving their disputes involving Solvay's testosterone-replacement drug AndroGel®. The so-called reverse-payment settlements at issue in FTC v. Actavis, Inc., Sup. Ct. No. 12-416 ("AndroGel") involved the generic manufacturers' agreements to abandon their patent challenges and delay generic entry for nine years. The settlements also involved Solvay making certain payments to the generic manufacturers in return for backup manufacturing and marketing support. For additional background information, please see some of our more recent blogs here, here, and here.

The issue before the Court is whether reverse-payment settlements are per se lawful unless the underlying patent litigation was a sham or the patent was obtained by fraud (as the Eleventh and other circuits have held), or instead are presumptively anticompetitive and unlawful (as the Third Circuit held in K-Dur).

Written by Justine K. Donahue

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Deputy U.S. Solicitor General Malcolm L. Stewart argued on behalf of the FTC that the Court should adopt a "quick look" rule of reason analysis under the antitrust laws whereby reverse-payment settlements will be presumptively anticompetitive unless defendants can show that the payment from the brand to the generic was for a purpose other than delaying generic entry, or the payment offered some pro-competitive benefit. Notably, this quick look approach was adopted by the Third Circuit in K-Dur. Counsel for the respondent drug companies argued that the Court should adopt the "scope of the patent defense" applied by the Second, Eleventh, and Federal Circuits finding these agreements to be lawful absent sham litigation or fraud in obtaining the patent.

In a surprising turn of events, last week FDA's new Office of Generic Drugs ("OGD") Director Gregory P. Geba, M.D., M.P.H., voluntarily stepped down from his post after only about eight months after being announced as the new Director. Rather than hiring from within, FDA hired Geba from Sanofi US, where he had previously most recently served as Deputy Chief Medical Officer. FDA said then, "He [Geba] joins OGD at an opportune time to lead our expanding generic program into a reorganization of both structure and process to improve coordination, communication, and efficiency, as well as enhance the Office's ability to ensure that all generic drugs--which make up nearly 80 percent of prescriptions filled in the United States--are safe, effective, of high quality, and interchangeable with the brand name drug product/reference listed drug." Around this same time, FDA moved OGD to the same organizational level as the Office of New Drugs ("OND"), called a "Super office," signaling that the two offices now had the same reporting structure directly to the Director of the Center for Drug Evaluation and Research ("CDER"), Janet Woodcock, M.D., rather than a sub-office, as had previously been the case.

According to reports of an e-mail that Geba sent to FDA staff on March 13, Geba cited the movement of OGD's chemistry divisions into a new Office of Pharmaceutical Quality as one of the lead reasons for his resignation, as well as the relocation of his family to the Washington area. Geba reportedly wrote: "As I see it, two of the original reasons I came to [OGD] . . . would be challenged by resources needed for application to other extremely important efforts of the chemistry group in moving to [the Office of Pharmaceutical Quality." The e-mail explained that while Geba generally supported the transfer of the chemistry group to the Office of Pharmaceutical Quality. Geba thought, however, that the move could make it difficult for him to achieve his goals to approve generic versions of inhalers, topical creams, and other complex drugs, as well as addressing the importance of pill size, shape, color, and other characteristics to patients.

Written by Brian J. Malkin

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Geba helped FDA with its initial phases for implementing the Generic Drug User Fee Act ("GDUFA"). According to Geba, since GDUFA, OGD decreased the abbreviated new drug application ("ANDA") backlog by nearly 600 applications and approved nearly 200 ANDAs since October 2012.

On March 14-15, the Massachusetts Biotechnology Council ("MassBio") held its Annual Meeting in Cambridge, Massachusetts. The Meeting also featured a Keynote from FDA Commissioner Margaret A. Hamburg, M.D. (see related blog here). Key themes at the Meeting were the importance of the Cambridge/Boston biotechnology community for advancing new therapies and the unique resources available in the area that have made it an industry leader. Some of the Cambridge/Boston advantages discussed were the intellectual research capital (local universities such as Harvard and Massachusetts Institute of Technology), venture capital, and local biotechnology businesses, such as Biogen Idec and Genzyme, as well as other biotechnology companies that now have offices in the Cambridge/Boston area and are seeking partnerships to develop new products, such as AstraZeneca, Pfizer, Merck, Novo Nordisk, and Sanofi.

On the second day, Hamburg described here "special affection" for the Cambridge/Boston region dating back to her days at Harvard, saying that she hopes D.C. "would be as efficient and congenial as here." Hamburg said that the Cambridge/Boston region is a life sciences enterprise fueled by top notch research and medical care with the top five NIH-funded hospitals and a "biotech supercluster second to none" with "a remarkable 500 biotech and pharma companies here, and some thirty venture capital firms."

Written by Brian J. Malkin

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Hamburg described FDA as striving for true collaboration and regulatory flexibility with industry, including MassBio, and has been hearing that industry wants more clarity, certainty, transparency with decisions. Hamburg said that FDA is trying to have creative approaches--not a one size-fits-all approach. To this end, Hamburg described approaches that FDA has taken with four new products from the Massachusetts area: 1) Inclusig® for two rare forms of leukemia, 2) Juxtapid® (an orphan drug), 3) Linzess® for irritable bowl syndrome, and 4) Kalydeco® for cystic fibrosis. In addition, Hamburg highlighted new provisions in the Food and Drug Administration Safety and Innovation Act ("FDASIA") for expedited approvals, citing 31 breakthrough therapy designation requests, of which 9 have been granted, 10 denied, 11 pending, and 1 withdrawn. To help with more companies taking advantage of this new process, FDA will be publishing a new guidance shortly, Hamburg announced.

On March 14-15, the Massachusetts Biotechnology Council ("MassBio") held its Annual Meeting in Cambridge, Massachusetts. The Meeting featured key topics such as biosimilars and a Keynote from John Crowley, Chairman and CEO of Amicus Therapeutics.

On the first day of the conference, Crowley exemplified many of the speakers' entry in biotechnology, which originated with a family member or friend with a disease requiring development of a biotechnology product. For Crowley, it was his two children Megan and Patrick, were diagnosed with a severe neuromuscular disorder, Glycogen storage disease type II, known as Pompe's disease. Rather that sitting still to wait for a cure, Crowley became involved in the process, first moving to Princeton, New Jersey, to be close to doctors specializing in the disease and leaving his job with Bristol-Myers Squibb. He later took a position as CEO of Novazyme Pharmaceuticals, a biotechnology research company located in Oklahoma City founded by Dr. William Canfield, which was conducting research on a new experimental treatment for the disease. Novazyme was acquired by Genzyme Corporation, which was then the world's third largest biotechnology company. Crowley was put in charge of Genzyme's global Pompe program, becoming the largest research and development effort in the company's history.

Written by Brian J. Malkin

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Through these efforts, an experimental enzyme replacement therapy was developed, and Megan and Patrick Crowley received the therapy, which Crowley credits with saving his children's lives. Crowley went on to become President and CEO of Orexigen Therapeutics and was named the President and CEO of Amicus Therapeutics, based in Cranbury, New Jersey, which he helped take public in 2007. Crowley's efforts were documented in a Wall Street Journal article and other publications, which ultimately resulted in Harrison Ford working to bring the story to life in a major motion picture, Extraordinary Measures.

FLH Partner Brian J. Malkin will attend the Massachusett's Biotechnology Council's ("MassBio's") Annual Meeting in Cambridge, Massachusetts on March 14-15, 2013. FLH is a member of MassBio, reflecting FLH's commitment to the development and promotion of new biological and related products. Each year, the MassBio Annual Meeting focuses on the most timely and critical challenges facing the Massachusetts biotechnology industry. The meeting program is pulled together by a Steering Committee of leaders in the industry and the agenda encompasses keynote presentations, panel discussions, interactive working sessions, and extensive networking opportunities for all MassBio members. This year, keynote presentations feature John Crowley, Chairman & CEO of Amicus Therapeutics, Inc. and FDA Commissioner Margaret A. Hamburg, M.D. Key topics of interest include personalized medicine and companion diagnostics, biosimilars, RNA therapeutics, healthcare reimbursement strategies, research resource sharing opportunities and a variety of orphan drug candidate topics. Mr. Malkin looks forward to seeing you and catching up on the latest biotechnology developments with some of the best biotechnology leaders in the Massachusetts area and beyond.

The Supreme Court has another chance to clarify the scope of the safe-harbor provisions of 35 U.S.C. § 271(e)(1). Momenta Pharmaceuticals, Inc. and Sandoz Inc. petitioned the Supreme Court to review Momenta Pharmaceuticals, Inc. v. Amphastar Pharmaceuticals, Inc.. In that case, the Federal Circuit held that 35 U.S.C. § 271(e)(1) protected post-approval studies performed for FDA. Momenta's request comes roughly one month after the Supreme Court declined to grant cert in Classen Immunotherapies, Inc. v. Biogen Idec, another Federal Circuit case involving the scope of 271(e)(1) (blogged on here).

Momenta identifies the issue for the Supreme Court as:

Whether the use of a patented invention in the course of post-approval manufacture of a drug for commercial sale, where the FDA requires that a record of that manufacturing activity be maintained, is exempt from liability for patent infringement under Section 271(e)(1) as "solely for uses reasonably related to the development and submission of information under a Federal law which regulations the manufacture, use, or sale of drugs.

Written by Scot B. Pittman

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The generic-drug company seeks Supreme Court intervention to remedy what it views as inconsistent and incorrect Federal Circuit law. The safe harbor states that it is not an act of infringement to make, use, offer to sell, or sell a patented invention solely for uses reasonably related to the development and submission of information under [federal drug laws]. 21 U.S.C. § 271(e)(1). In Classen, a divided Federal Circuit panel interpreted the provision to be limited to "activities conducted to obtain pre-marketing approval of generic counterparts of patented inventions, before patent expiration." Roughly one year later, another divided Federal Circuit panel, in Momenta, held that "the requirement to maintain records for FDA inspection satisfies the requirement that the uses be reasonably related to the development and submission of information to FDA.

Written by Brian J. Malkin

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The last day of the Generic Pharmaceutical Association ("GPhA") 2013 Annual Meeting also featured an FDA Keynote Address by FDA Commissioner Margaret A. Hamburg, M.D. For a summary of public sessions from Day Two, please see the previous blog here; a summary of the CEOs Unplugged session may be found here.

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Following the CEOs Unplugged session on day three, Hamburg delivered her Keynote Address. Hamburg said that GPhA was one of the few organizations that she has chosen to address each year since becoming Commissioner, "because of the dynamic character of this group, your prominent role in the nation's health care system and the importance of the work you do." Celebrating GDUFA and the FDA Safety and Innovation Act ("FDASIA"), Hamburg emphasized that FDA is making "quality one of the highest priorities this year," hoping that GPhA's members do the same. Despite generic drug companies providing 85 percent of all prescriptions filled, some studies have suggested that many physicians still have "negative perceptions about the quality of generic medicines," which Hamburg said was "troublesome - and assuredly not fair."

Hamburg reported "impressive strides in implementing GDUFA," explaining that FDA got the word out of new requirements and fees early, resulting in the collection of almost $125 million in fiscal year 2013 user fees to help brining in staff and other resources to help reduce the backlog of ANDAs above 2,500 applications with median review times at about 31 months. FDA has assembled a list of about 2,000 facilities supplying generic drugs to the U.S. following self-identification procedures.

Written by Brian J. Malkin

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The last day of the Generic Pharmaceutical Association ("GPhA") 2013 Annual Meeting featured a program known as "CEOs Unplugged" and an FDA Keynote Address by FDA Commissioner Margaret A. Hamburg, M.D. For a summary of public sessions from Day Two, see the previous blog here. This blog focuses on the CEOs Unplugged session. A subsequent blog will cover FDA's Keynote Address.

The CEOs selected for this year's program included Donald DeGolyer, President, Sandoz, Inc., Tony Mauro, President, Mylan, North America, Thomas Moore, President, Hospira USA, Allan Oberman, President and CEO, Teva Americas Generics, and Siggi Olafsson, President, Actavis Pharma.

Perhaps Oberman summed up the overall themes best when he acknowledged that the lines between innovator and generics are beginning to blur, where generic medicines are becoming more complex, and generic manufacturers are increasingly seeking a niche to compete in. The CEOs noted that none of the same CEOs were on the stage five years ago, which signals just how much the key players and CEOs have been changing. Other comments Oberman made included: (1) he hoped the Generic Drug User Fee Act ("GDUFA") approval and efficacy measures would be used effectively and manufacturing sites outside the U.S. would be under similar scrutiny as in the U.S., (2) no one is really planning for shortages, but it is important to have effective communication to prevent them in particular with FDA, (3) industry needs to stop "fear mongering" to figure out when biosimilars will be approved or interchangeable--some people will take biosimilars and others will not, just as with generic drugs, (4) more mergers in the generic pharmaceutical industry should be expected, especially in emerging markets, (5) generic pharmaceuticals should be more available in the eastern part of the world where access to medicine may still be restricted, which provides more growth opportunities, and (6) traditional generic manufacturers should consider either developing new molecular entities or combining older generics in ways to improve convenience, safety, or effectiveness.