leerink.pngOn February 12 and 13, 2014, Leerink Partners LLC (“Leerink”) held its annual Global Healthcare Conference at the Waldorf-Astoria Hotel in New York, New York. Each year the Conference includes emerging themes in healthcare, where Leerink’s equity analysts moderate discussions with MEDACorp specialists to provide unique and timely insights.

In addition to the company presentations, this year’s line up featured the following panels or keynote speakers with some observed comments or trends:

• Panel: The Future of Medical Devices in an Evolving Landscape: A Shifting Emphasis to Patient Monitoring and Customizable Solutions

  • Patients view surgeons that incorporate robotics in their practice as the better doctors, driving more surgeons to utilize them in their practice. As surgeons become more familiar with these devices, patients may have more options for surgical procedures and implants.
  • Larger companies are looking at controlling infections caused by implanted medical devices with special coatings–either anti-infectives or antibiotics, particularly for use in higher-risk patients. There is an increasing need, however, for implants to have built-in tools for monitoring the devices. But as medical devices become more complex, such as hip, knee, or total joint replacements, these devices will require preapproval marketing applications (“PMAs”) with clinical data rather than less costly and time-consuming 510(k)-type premarket clearance applications. Since PMAs cost companies more than 510(k) applications, these newer devices will cost third party payors and patients more.
  • Hospitals continue to be under a lot of pressure not to lose patients, so they may seek lower margins by having surgeons add anti-infective coatings or antibiotics rather than purchasing more costly versions with the coatings or by importing “generic” implants from other countries that may not be as rugged as the versions cleared for use in the U.S. FDA’s new unique device identifiers and improved monitoring, however, may reduce use of such imported devices with unclear pedigrees.

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On Sunday, February 16, BioCentury This Week television examined the policies surrounding the expected competition of innovator biologic products with biosimilar versions. Featured in the program were interviews with:

  • Geoffrey Eich, Executive Director of R&D Policy at Amgen Inc.
  • Craig Wheeler, President & CEO of Momenta Pharmaceuticals Inc.

BioCentury This Week.pngSunday, February 16: The Battle Over Biosimilar Business Models.

Biosimilars — lower-cost versions of expensive biologics — are coming to pharmacy shelves in the U.S. But biosimilars players disagree about how they should compete.

Should biosimilars be sold like inexpensive generic drugs? Or should they be sold at higher prices like branded drugs?

DNApurple.jpgOn February 4, 2014, the U.S. Federal Trade Commission (“FTC”) held a Workshop entitled: “Follow-On Biologics Workshop: Impact of Recent Legislative and Regulatory Naming Proposals on Competition“. The Workshop was well attended and sought to solicit a variety of views on the marketing of follow-on biologics, currently referred to as “biosimilars” under the Biologics Price Competition and Innovation Act (“BPCIA”).

Briefly, the BPCIA defines “biosimilarity” as “[T]he biological product is highly similar to the reference product notwithstanding minor differences in clinically inactive components” and “there are no clinically meaningful differences between the biological product and the reference product in terms of the safety, purity, and potency of the product.” A biosimilar is submitted as a 351(k) application, which must contain, among other things, information demonstrating that the biological product is biosimilar to a reference product based upon data derived from analytical studies, animal studies, and a clinical study or studies, unless FDA determines, in its discretion, that certain studies are unnecessary. To meet a higher standard of “interchangeability,” an applicant must provide sufficient information to demonstrate biosimilarity, and also to demonstrate that the biological product can be expected to produce the same clinical result as the reference product in any given patient and, if the biological product is administered more than once to an individual, the risk in terms of safety or diminished efficacy of alternating or switching between the use of the biological product and the reference product is not greater than the risk of using the reference product without such alternation or switch. According to the BPCIA, interchangeable biosimilar products may be substituted for the reference product without the intervention of the prescribing healthcare provider.

As explained by Edith Ramirez, FTC Commissioner, many state legislatures have either passed or are considering legislation to explain how to handle biosimilars that are not interchangeable (and sometimes including interchangeable biosimilars), which may affect competition for the market at this juncture before even one biosimilar has been approved. In particular, many of the state laws or bills include provisions for prescriber notification of possible biosimilar substitution for the referenced innovator biologic product. FDA and other regulatory bodies are still considering universal nomenclature for biosimilars, which may either create the same or similar names for biosimilars and their referenced innovator biologic products. The FTC sees similarities between biosimilars and how generics were first perceived and opportunities to either facilitate or hinder acceptance of biosimilars in the market that they wanted to explore in this Workshop.
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FLH Partner Brian J. Malkin will present a special breakfast program for early-phase biotechnology companies: “Innovative Strategies for New Product Development” on February 5, 2014. The program will be held at the Montgomery County Department of Economic Development offices at 111 Rockville Pike, 8th Floor, Rockville, Maryland 20850 from 8-10 am.

Planned topics include:

  • Drug Development Trends

Banner REMS.pngOn January 28-29, 2014, ExL Pharma hosted its 6th Annual Risk Evaluation and Mitigation Strategies (“REMS”) Summit in Alexandria, Virginia. For the first time since the Summit has been held, key members from the FDA’s Division of Risk Management attended. In particular, Claudia Manzo, Director, FDA Division of Risk Management, spoke in the main opening panel along with FLH Partner Brian J. Malkin and Yola Moride, Ph.D., FISP, Professor, Université de Montréal. The opening panel featured a discussion of some key take aways from FDA’s Public Meeting on Standardizing and Evaluating REMS in July 2013 and follow-up meeting in December 2013 to identify and discuss new methods for communicating risk information as part of REMS to health care providers and its target populations. The Summit also featured a pre-conference workshop on regulatory negotiation and internal and external audits for REMS, as well as a concluding roundtable session, which focused on some of the key topics raised. The Summit was closed to the media to help encourage a free exchange of ideas.

As promised, the Summit built upon recent REMS events and discussions featuring the most experienced professionals from a cross section of small to large companies, pharmacy organizations, hospitals, academia and government agencies to share their perspectives, experiences, and leverage the discussions in a well-rounded and interactive platform to take a proactive approach covering:

  • Recent developments and initiatives

liquids.jpgWhether a beverage or a dietary supplement, liquid products are marketed more than ever before–now containing a wider array of ingredients, for many more intended uses and including traditional food substances, but at levels far exceeding previously used amounts. So how does one know if a liquid product is a beverage or a dietary supplement? And what regulations must be followed? To answer those questions, FDA has issued nonbinding recommendations in two new guidances this month: Distinguishing Liquid Dietary Supplements from Beverages and Considerations Regarding Substances Added to Foods, Including Beverages and Dietary Supplements. FDA hopes that these guidances will help the industry avoid misbranding with inconsistent product category labeling and adulteration for failure to meet the proper regulations.

When distinguishing between beverages and dietary supplements, as a general rule, dietary supplements are meant to supplement the diet, and beverages are for quenching thirst and providing fluid, nutritive value, taste or aroma. FDA’s Guidance sets out the following factors to consider in distinguishing between the two types of liquid products: labeling and advertising, product name, product packaging, serving size and recommended daily intake, recommendations and directions for use, marketing practices, and composition of the liquid product. The Guidance provides examples of how the factors can come into play in a determination. It is likely that a combination of factors, not one, will be determinative of a product’s category. For example, even if the label of a liquid product contains a Supplement Facts Panel, it could still be considered a “beverage” if it also contains a statement that the product “refreshes,” or the product could be a “food” if the label contains a picture of the liquid being poured onto a salad. The product name could also be determinative that a product is likely a “beverage”, if the product name contains conventional terms for beverages, like “drink”, “soda”, “orange juice”, “iced tea”, “bottled water”, or “coffee”. The product packaging is another determinant and, if the packaging is reclosable, is shaped similar to a common beverage package, or contains a single serving, then it is likely a “beverage”. The serving size or recommended daily intake may also indicate which category a liquid product falls under. For example, if the product is intended to be consumed all at once or contains a significant part of the entire daily drinking fluid intake for the average person then it is likely a “beverage”. Interestingly, marketing practices, another factor, such as metatags for “sodas,” “juices” or “beverages,” or paying for store shelf placement with other beverages could be determinative of a “beverage”. But the product is not necessarily a “beverage” if the marketing says the product should be taken with a meal, since dietary supplements are often recommended for use along with a meal. Finally, the composition of a liquid product may be determinative, although there is a lot of overlap now with both categories containing amino acids, proteins, and vitamins. Similarly, merely adding a dietary ingredient does not make a product a “dietary supplement”.

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Written by Laura Chubb

On January 30, 2014, FLH Partner Brian J. Malkin will speak at the New York State Bar Association’s (“NYSBA’s”) Annual Meeting of the Food, Drug and Cosmetic Law Section. Mr. Malkin will introduce and speak with Molly Muldoon, FDA’s former Chief of Staff, on “FDA Regulation: The Intersection of Policy and Politics, The Opportunities and Challenges for Innovation–Perspectives from Two Former FDA Officials”. Ms. Muldoon was formerly an FDA Chief of Staff, overseeing operations and liaising with senior FDA leadership on key issues including the Affordable Care Act, Deepwater Horizon, food safety regulations and food borne outbreaks. Mr. Malkin is a former regulatory counsel at the FDA, who specializes in the strategic analysis of how policy affects FDA and IP innovation. Ms. Muldoon will discuss how effective communication, cooperation and collaboration remain critical to implement policy within FDA. She will also discuss the role of patient groups and other valuable stakeholders to work with FDA in shaping the development of FDA policies and how to achieve all of this in an increasingly political environment. In addition, the Meeting will feature the following presentations: Les Weinstein, Esq. former Ombudsman for the Center for Tobacco Products and for the Center for Devices and Radiological Health speaking on “The Role of the FDA Ombudsman–Who They Are, What They Do and How They May Assist You”; Frederick H. Fern, Harris Beach PLLC; John A. Murphy III, Assistant General Counsel, Pharmaceutical Research and Manufacturers of America; and Irving L. Wiesen, Law Offices of Irving L. Wiesen, P.C. speaking on “Compounding Pharmacies: Regulatory Solutions to a National Health Crisis”; George J. Annas, William Fairfield Warren Distinguished Professor and Chair Department of Health Law, Bioethics & Human Rights, Boston University School of Public Health, School of Medicine and School of Law and David S. Weinstock, LifeCell Corporation, speaking on “Ethical Conflicts in Clinical Medicine and Research: Consent to DNA Screening, Research on Extremely Premature Infants and International Drug Trials”. The Section’s meeting will conclude with its Annual Business Meeting.

Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for drugmoney.jpegOn January 24, 2014, Judge Walls of the U.S. District Court for the District of New Jersey dismissed the In re Lamictal Direct Purchaser Antitrust Litigation after concluding that the U.S. Supreme Court’s FTC v. Actavis ruling concerning the antitrust implications of so-called “pay-for-delay” settlements of Hatch-Waxman patent infringement cases only “applies to patent settlements that contain an unjustified reverse payment of money.”

The settlement in this case ended a patent infringement action between branded pharmaceutical manufacturer GlaxoSmithKline (“GSK”) and generic manufacturer Teva Pharmaceuticals (“Teva”). The settlement “allowed Teva to market generic lamotrigine [Lamictal®] before the relevant patent expired and ensured that once it did so, its generic tablets and chewables would not face competition from GSK’s own ‘authorized generic’ for a certain period of time.”

Direct Purchaser plaintiffs Louisiana Wholesale Drug Company and King Drug Company of Florence brought the present antitrust action against GSK and Teva, “alleg[ing] that the settlement violates federal antitrust laws.” The district court dismissed the case a first time in December 2012 for failure to state a claim under the then-existing antitrust laws. The Direct Purchasers appealed. While the appeal was pending, the Supreme Court issued its Actavis decision. As a result, the Third Circuit Court of Appeals remanded the case back to the district court for reconsideration of its earlier dismissal based on Actavis.
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On January 28, 2014, FLH Partner Brian J. Malkin will speak on a panel “Understand the FDA Report [Risk Evaluation and Mitigation Strategies (“REMS”) Standardization] and the Impact on the Industry” at ExL Pharma’s 6th Risk Evaluation and Mitigation Strategies Summit held on January 28-29, 2014 in Alexandria, Virginia. Joining Mr. Malkin in the panel will be Yola Moride, Ph.D., FISP, Professor, Université de Montréal to help provide an international perspective of this Report with planned topics to include:

  • Outlining of the FDA’s findings since the public meeting in July 2013
  • Explore the implications and impact on the industry