Coronavirus Prompting Reaction in Washington

The newest mutation to the coronavirus has had a massive impact in China and has prompted a reaction from the World Health Organization (WHO). The impact on makers of devices and diagnostics has been minimal so far, but the signs are that this could change quickly if the virus continues to proliferate.

The 2019-nCoV virus has prompted two press briefings by a U.S. federal government task force led by HHS Secretary Alex Azar, developments that followed a Jan. 31 declaration of emergency by WHO. Much of the concern about the virus is that it can be transmitted even from those who are asymptomatic, but the test for the virus developed by the U.S. Centers for Disease Control and Prevention has proven less than fully reliable.

Robert Redfield, director of the CDC, said in a Jan. 31 press briefing that the CDC test will return both positive and negative results on a patient who has been confirmed to carry the pathogen. The U.S. government response has been questioned, given that influenza is still proving more lethal, but Anthony Fauci of the National Institute of Allergy and Infectious Diseases said influenzas predictably fade as winter gives way to spring, whereas the trajectory of the new coronavirus is unknown.

The FDA recently issued an emergency use authorization for the CDC test, a reverse-transcriptase polymerase chain reaction test to be used with swabs from the upper and lower respiratory tracts. The CDC posted a press release two days later in which the agency said the test will initially be shipped to roughly 200 domestic sites and another 200 sites located in other nations. The test provides results within four hours, CDC said.

The Department of Health and Human Services posted a Feb. 6 announcement stating that HHS is taking submissions for diagnostics that would receive federal funding under the Biomedical Advanced Research and Development Authority (BARDA) program. This program requires that the test in question would have to be available on a platform already cleared by the FDA, and that the test would be ready for live use within 12 weeks of receipt of the award.

Congress Prods FDA for Assurances

Capitol Hill has demonstrated some concern about the impact of the coronavirus outbreak on the availability of medical products from China. Two members of the Senate, Florida Republican Marco Rubio and Connecticut Democrat Chris Murphy said in a Feb. 6 statement that they have a series of questions they would like answered by Feb. 18. Among the questions is whether the FDA has the resources to determine whether the impact of the coronavirus in China will affect the availability of drugs and devices for U.S. patients.

Murphy and Rubio noted that China is the source of the majority of active pharmaceutical ingredients used to produce drugs in the U.S., and that 10% of devices used in the U.S. are also imported from China. FDA commissioner Stephen Hahn said in the Feb. 7 press briefing that there was no evidence of any slowdown in the supply chain of the various products in question at that point in time, but he noted that the situation “is fluid” and that this could change in short order.

Perhaps as disturbing as any other recent event associated with the coronavirus is the discovery that more than four in 10 coronavirus patients in a hospital in China had contracted the virus while at the hospital. The majority of the patients presumed to have contracted the virus at the hospital site were employees of the hospital, although this single-site study might not reflect the broader experience in China. Nonetheless, the authors say that as many as 10 health care workers had presumably been infected by a single patient.

FDA Inks Combo Product Feedback Guidance

The FDA and industry have been at loggerheads over various issues surrounding combination products, but a new draft guidance may help resolve some of those conflicts. The draft deals with industry requests for feedback on combination product applications, but does not take up the product jurisdiction question, which is again the subject of litigation.

The draft guidance introduces the phrase “combination product agreement meeting,” or CPAM, one of several types of meetings sponsors can invoke in obtaining feedback from the agency on scientific and regulatory questions. Center-specific interactions are also mentioned in the draft, and the agency said that CPAMs should complement rather than replace application-based mechanisms for each center. CPAMs also are not appropriate for resolving any disputes that are usually taken up by the lead center’s dispute resolution or appeals processes.

The guidance further states that sponsors should channel all communications to the designated point of contact, or POC, even if the sponsor’s query takes up a question that is better addressed by a center other than the lead center. The draft is a response to Section 3038 of the 21st Century Cures Act, which covers a number of elements of the combination product review question.

In addition to defining the term “primary mode of action” and mandating that the FDA not use the mere presence of chemical action to justify designating the product a drug, Section 3038 of the Cures Act calls on the agency to issue guidance that characterizes a “structured process for managing presubmission interactions with sponsors.” That guidance is due within four years of enactment of the Cures Act and limits the comment period to 60 days. President Barack Obama signed the legislation in December 2016.

Meanwhile, another product jurisdiction case is in play in the courts, suggesting the agency still has its hands full persuading industry of its interpretation of the primary mode of action question.

DOJ Recovered $3 Billion in FCA Cases in 2019

The Department of Justice has enacted several changes to its approach to False Claims Act litigation over the past few years, but federal attorneys nonetheless managed to claw back more than $3 billion in settlements and judgments in 2019, according to a recent statement. As might be expected, the bulk of that sum was obtained in actions related to industries in healthcare, and 2019 marked the tenth consecutive year in which at least $2 billion was reclaimed in such settlements.

Assistant Attorney General Jody Hunt said $2.6 billion of the amount reclaimed in 2019 involved hospitals, doctors, and makers of drugs and devices, adding that the volume of activity reflects the Trump administration’s emphasis on deterring fraud and abuse. A large portion of the recoveries revolved around opioid analgesics, although even the nursing home industry did not escape scrutiny. The statement indicated that 633 whistleblower lawsuits were filed in 2019, averaging to roughly a dozen new cases each week.

Despite the DOJ’s praise for the volume of recoveries, the amount in 2019 falls far short of the $4.7 billion recovered in 2016. That amount was reportedly the third highest amount in history at the time, and only slightly more than half ($2.5 billion) came from healthcare prosecutions, approximately the same amount recovered from these industries in 2019.

Device Tax Repealed

After a decade of controversy and infrequent collection, the 2.3% tax on medical devices has been repealed as part of a series of spending bills for fiscal 2020. The bipartisan opposition to the tax made its demise seem inevitable, but the tax did not go down without a fight.

The U.S. House of Representatives passed two spending bills early in the week of Dec. 17, which in addition to the repeal of the device tax called for repeal of the Cadillac tax on premium health plans. Another tax that fell to the spending package was the health insurance tax, and the loss of all three represents a significant blow to the funding mechanisms for the Affordable Care Act. However, a number of other provisions of the ACA have fallen prey to the congressional axe, including the Independent Payment Advisory Board, which was removed by the Bipartisan Budget Act of 2018.

While the device tax was part of the statute for a decade, it has been infrequently levied on device makers thanks to routine congressional intervention. The latest two-year suspension, the second consecutive 24-month reprieve, was scheduled to expire Dec. 31, and industry and a number of medical societies and others had pleaded with Congress to do away with the tax.

In a Sept. 24, 2019, letter to leaders in the House and Senate, these stakeholders argued that the tax was not only bad for the U.S. economy, it also flew against the recent emphasis on advancing the state of medical science. While the authors do not directly cite the 21st Century Cures Act as a source of tension with the tax, they nonetheless argued that the imposition of the tax from 2013 to 2015 forced the abandonment of numerous R&D projects. Consequently, they said, “patients were denied new treatments.”

The Senate signed off on the spending package Dec. 19 and President Trump finally inked the White House’s approval late in the evening Dec. 20, shortly before funds for government operations were to expire. Scott Whitaker, president/CEO of the Advanced Medical Technology Association, advised Trump in an Oct. 17, 2019, letter that another suspension of the tax would merely renew the uncertainty surrounding the tax. Whitaker said another two-year suspension would force device makers to “plan and act as if the tax will ultimately be imposed on them.”

Some Sources of Uncertainty Remain

The demise of the tax comes shortly after the Senate affirmed Stephen Hahn as the new commissioner of the FDA. Hahn was confirmed in a Dec. 12 vote that affirmed the Trump administration’s nominee with a 72-18 majority, bringing to a close another source of uncertainty for device makers. Hahn’s background is in oncology, a sharp departure from the policy-driven expertise of his predecessor, Scott Gottlieb.

Despite these larger developments, device makers are facing a number of questions as the new year comes into view. The FDA software precertification pilot program is still apparently underway despite the agency’s vow to wrap up the pilot by the end of 2019, and the discussion draft regarding artificial intelligence has not yet advanced past the stage of an FDA talking point.

Another major sticking point for device makers is the matter of patent subject matter eligibility, which is the subject of a petition for cert to the U.S. Supreme Court. While the impact of recent Supreme Court case law has affected software in addition to in vitro diagnostics, the Patent and Trademark Office has developed examiner guidelines that have eased the pressure on software patents. Nonetheless, IVD developers and the Court of Appeals for the Federal Circuit are unmollified over what they see as a jurisprudential animus against diagnostic and other life science patents. Whether the Supreme Court will revisit the matter is unclear, but the case in question will be distributed for conference as of Jan. 10, 2020.

Senate Confirms Hahn as Next FDA Commissioner

The U.S. Senate has confirmed Stephen Hahn as the next commissioner of the FDA, bringing to a close a process that was unofficially in the works for approximately three months. Hahn takes the helm of an agency that has a number of controversial tasks before it, including the precertification program for software as a medical device and the ethylene oxide (EtO) problem.

The Dec. 12 Senate vote tallied at 72 votes to confirm and 18 to oppose, with Sens. Patty Murray (D-Wash.) and Tina Smith (D-Minn.) voting in opposition. Murray, Smith and Sen. Elizabeth Warren (D-Mass.) were the three authors of the correspondence with the FDA regarding the precertification program, but the Senate scorecard indicates that Warren did not take part in the vote, likely due to her campaign for the party’s nomination for next year’s presidential election.

Hahn takes the job at a time of increasing restiveness on Capitol Hill on several fronts, including the e-cigarette/vaping problem and the ongoing struggle to get ahead of the opioid epidemic. Drug pricing is a hotly debated issue on Capitol Hill as well, with reimportation only one of several proposals making the round in the House and Senate. Another issue – one over which the FDA has no control, but about which Hahn might nonetheless hear – is that the latest negotiation over the U.S.-Mexico-Canada Agreement on trade would leave each of the member nations at liberty to set their own policies regarding biotechnology patent exclusivity, a move adamantly opposed by industry.

While the problems surrounding medical device safety are largely the administrative province of Jeff Shuren, director of the Center for Devices and Radiological Health, some of these issues will likely require Hahn’s time and attention as he grapples with the varying imperatives at play in Congress. The EtO controversy shows no signs of abating despite that the Environmental Protection Agency has issued an advanced notice of proposed rulemaking on the question, a process that will likely run through most of 2020 before drawing to a conclusion.

EPA Posts Notice of Proposed Rule for Ethylene Oxide

Expectations regarding the EPA’s advanced notice of proposed rulemaking (ANPRM) for the use of EtO in medical device sterilization might have carried the hopes and fears of a wide range of stakeholders, including fears of much stricter regulation. That particular concern does not appear well founded at present, but a number of members of Congress are forming their own group to address the use of EtO in an effort to drive a more aggressive regulatory stance toward the sterilant.

The EPA posted a Dec. 5 press release making note of the FDA’s activity in this area, but also calling for nominations to a small business panel that would advise the agency on any impact a final rule would have on small entities. In addition to reviewing the existing regulations governing EtO, EPA will work with state and local agencies to determine whether immediate steps are needed to deal with any potential health hazards. EPA administrator Andrew Wheeler also pointedly referred to the importance of this chemical to public health, likely a nod to the medical device sterilization question.

The reaction on Capitol Hill to the EPA document is likely to be driven by a group of House members, numbering fewer than 10 as of late November, whose opposition to the use of the sterilant is a matter of record. In a Nov. 20  statement, the Ethylene Oxide Task Force said it will push legislation that would require the EPA to issue “strict” EtO emission standards. H.R. 1152 has struggled to gain traction since its introduction in February, however, and the bill’s listing at Congress.gov indicates that the companion Senate bill (S. 458) enjoys the sponsorship only of Illinois Democrats Dick Durbin and Tammy Duckworth.

PTO Seeking Comment on AI as Patent Owner, Inventor

The U.S. Patent and Trademark Office still has its hands full over the question of the Supreme Court’s views on life science patents, but the agency must now begin to grapple with an entirely new set of dilemmas. PTO recently announced it is seeking feedback on the status of artificial intelligence (AI) as an inventor and as a patent owner, two questions that may defy answer in the near term.

U.K. Researchers Argue for Change

Researchers at the University of Surrey in Surrey, U.K., announced at the beginning of August that they had filed for patent protection for two inventions autonomously created by an algorithm known as DABUS. The inventions are for relatively simple products – one is a beverage container with a design based on fractal geometry, while the other is a device for attracting the attention of would-be rescuers – but the team at Surrey has applied for patents for these items in the patent offices for the U.K., the U.S., and the European Union.

According to the statement, the U.K. Intellectual Property Office has already concluded that the inventions pass the preliminary test for inventiveness, although the agency has not yet taken up the question of whether non-human entities can be cited as an inventor. So far, this is as much as the researchers at Surrey are asking the agency to consider.

Ryan Abbott of the University of Surrey School of Law said in the statement, “there would be no question the AI was the only inventor if it was a natural person,” and argued that DABUS should be listed as an inventor. Abbott said developers of an algorithm should be designated the assignee or owner of any patents produced by that algorithm, arguing that such an outcome would reward innovation and “keep the patent system focused on promoting invention by encouraging the development of inventive AI, rather than on creating obstacles.”

The question is not an entirely novel one as indicated by a discussion of the question in a law journal last year, but the difficulty for patent offices is that the statutes under which these agencies work seem to leave them with little leeway. The statute in the U.S. states that a patent can be awarded to “whoever” invents something useful, while the law in the U.K. make reference to “persons” as inventors. Thus much of the debate is likely to center on a need for legislation.

PTO Broaches Ownership Question

The American patent office announced Aug. 27 that it seeks feedback on whether further guidance from the agency is needed to “promote the reliability and predictability” of patent applications filed on behalf of AI. PTO also poses the question of whether new forms of patent protection are needed, adding that some of the issues surrounding software inventions are relevant for the discussion of AI patents.

There is a need for clarity regarding terminology as the PTO noted that the term “AI inventions” is used to denote both inventions that utilize AI and those that are developed by AI. PTO also is inquiring into the circumstances in which humans might be designated co-inventor with the algorithm, as well as whether the laws and regulations are in need of revision to address the question of inventorship.

However, PTO went further, asking whether an algorithm can and should be allowed to be designated the owner of the invention. As intractable as such a problem may be, some of the more prosaic questions are likely to prove challenging as well, such as whether a change is needed in the written description requirement regarding the level of detail provided about the algorithm. PTO noted that this question could prove difficult to answer, given that some deep learning systems may have layers of functions that are obscured, and that some functions may evolve without human assistance or intervention. PTO is taking comment through Oct. 11, but it seems likely that the debate over AI inventorship and ownership has only just begun.

Controversies in Limbo: Paclitaxel and the Lab Rate Reset

Occupants of the med tech industry are all too aware that the issues that affect their livelihoods often take quite a while to play out, a fact of life that can permanently damage a manufacturer’s fortunes. Following are two such episodes, one involving the paclitaxel problem for devices used in the femoropopliteal arteries and the other a scrum arising from a congressionally mandated reset of the Medicare clinical lab fee schedule.

Uncertainty Persists After Latest FDA Update on Paclitaxel

The controversy over the use of paclitaxel in drug-eluting balloons and drug-eluting stents for the lower limbs seems no closer to a resolution after the FDA posted a new update on the matter. The emphasis now is on consent and labeling, the agency said, but the question of whether the presumed mortality signal related to these devices is little closer, if any, to resolution than it was at the beginning of the year.

The FDA’s Jan. 17, 2019, letter to physicians made reference to the medical journal article alleging that a higher mortality rate was seen in DCB and DES devices using paclitaxel as an antiproliferative, an association that began to emerge in some data sets at about two years. The agency held a two-day advisory hearing on the question during which several prominent cardiologists said the purported connection between paclitaxel and mortality compared to uncoated balloons and stents was poorly backed by the evidence. One clinician, Renu Virmani of the CVPath Institute in Gaithersburg, Md., said she had conducted more than 100 autopsies of patients who had been treated with paclitaxel-bearing devices in the coronary arteries and that none of those deaths were due to the antiproliferative. Virmani, whose remarks can be seen in the FDA transcript for the second day of the hearing, said those fatalities were instead caused by the patient’s underlying coronary artery disease.

The agency’s latest update, posted Aug. 7, is aimed at health care professionals, but the agency stated it is working with device makers and researchers on adding to the evidence base. At present, that evidence includes three randomized trials which enrolled slightly fewer than 1,100 patients, and the agency said the crude mortality rate at five years for these studies was nearly 20 percent for paclitaxel-coated devices and 12.7 percent with uncoated devices. This translates into a 57 percent increase in mortality risk, but the FDA also noted that a meta-analysis performed by Vascular InterVentional Advances Physicians on patient-level data arrived at a hazard ratio of 1.38. This analysis, the FDA said, was based on data provided by manufacturers.

The effect on device makers has been noticeable, with one device maker stating on an investor conference call that sales of their DCB device were cut by 50 percent, while another company lost out on a Medicare new technology add-on payment because of the association between paclitaxel and mortality. Despite the impact on utilization and thus sales, the FDA has acknowledged that there is no apparent connection between dose and mortality, and that there is as yet no demonstrated mechanism of causation.

The FDA announcement advised clinicians that the benefits of these devices may outweigh the risks for patients at “particularly high risk” of restenosis and repeat procedures to deal with the underlying disease. Sponsors of ongoing studies will likely have to amend their informed consent documents, which along with the media coverage could hamper trial enrollment and completion.

Appeals Court Sides with ACLA in Lab Rate Lawsuit

The Protecting Access to Medicare Act of 2014 called on the Centers for Medicare & Medicaid Services to reset the rates paid for lab tests by surveying labs for the rates paid by private payers, but the agency’s efforts to comply with that mandate were mired in controversy nearly from the outset. The American Clinical Laboratory Association filed a lawsuit against the agency in the U.S. District Court for the District of Columbia, but lost in that suit, although an appeals court recently overturned that dismissal.

The D.C. District Court dismissed the lawsuit in September 2018 due to a purported lack of subject matter jurisdiction, but the U.S. Court of Appeals for the District of Columbia reversed that finding in part. The appeals court said that while the rates provided by Medicare under the clinical lab fee schedule are not subject to judicial review, PAMA did not clearly provide that insulation from legal challenge to the methods used by CMS to collect the private payer data.

There is legislation in the House of Representatives that would suspend the rate reset effort another year, and would require that the National Academy of Medicine advise CMS on the question of sampling. The Laboratory Access for Beneficiaries Act of 2019 (H.R. 3584) was introduced to the House Ways and Means and Energy and Commerce Committees in June, but has the support of only 13 sponsors as of Aug. 11. There does not appear to be a companion bill in the Senate, either, according to the bill’s listing at Congress.gov. ACLA said in a July 30 statement that the D.C. District Court should “act quickly” to respond to the appeals court decision, but also that Congress should “immediately halt the data reporting process.”

Supreme Court, DOJ Revisit False Claims Act

The False Claims Act might be the most widely known tool in the Department of Justice’s enforcement toolkit, and the FCA was in the news twice in the month of May. As the saying goes, there is some good news and some bad news, but these are both developments to which those in the life sciences should pay close attention.

Statute of Limitations Expanded

Starting with the bad news, the U.S. Supreme Court handed down a 9-0 decision in Cochise Consultancy Inc. v. United States, ex rel. Hunt, the net effect of which was to give relators an additional three years to file a qui tam action before the statute of limitations closes the door. Cochise revolved around a contract with the U.S. Department of Defense, and the interpretation of the statute of limitations had varied among the U.S. circuit courts, thus the Supreme Court’s interest in the case.

The statute was generally interpreted as giving relators six years to file a whistleblower lawsuit, or within three years of the time that a federal government official knew or should have known about the alleged wrongdoing. That additional three-year window for relators was widely assumed to be predicated on the federal government’s intervention in the case, however. A district court dismissed the relator’s case, but the Eleventh Circuit reversed the lower court’s findings. The relator, Billy Joe Hunt, filed his action more than six years after the alleged wrongdoing, but within three years of his disclosure of the events in question to the FBI, although the U.S. federal government never intervened.

The U.S. Solicitor General supported the relator with an amicus brief stating that the text of the statute makes no distinction between qui tam suits in which the federal government does or does not intervene, a view affirmed by Justice Clarence Thomas, who penned the May 13 opinion. There are some potentially far-reaching implications for the life sciences, given that some FCA actions involve recurring claims filed with Medicare. A question Justice Thomas did not answer hinges on the statute’s language pointing to the scope of the FCA, which cites federal officials who are “charged with responsibility to act in the circumstances.” This would seem to be a pertinent question for Cochise, given that the relator in this case, Billy Joe Hunt, had discussed his findings with the FBI, not the Department of Defense, which presumably would have had oversight of defense contracts. These and other questions have been left for another day.

New DOJ policy Overwrites Yates Memo

Earlier in the month of May, DOJ announced a new policy regarding credit for cooperation for corporate defendants in FCA cases, a question that has been very topical for the department at least since 2003, the year of the Thompson memo. The tone of this latest announcement is much less stringent than might have been issued in connection with the now-famed Yates memo, but one of the more interesting passages suggests the department might be willing to eliminate a relator lawsuit in order to clear out an FCA case.

The new policy, credited to assistant attorney general Jody Hunt, provides corporate defendants with partial credit for any of three actions, including the implementation of remedial measures designed to prevent illicit conduct in the future. Hunt also said defendants can earn cooperation credit by preserving relevant documents beyond that which would be required by conventional business practices or legal requirements, which suggests companies in the life sciences may already be revisiting their record retention policies.

Beyond all this, the DOJ statement indicates that cooperation credit will “most frequently” be expressed as reduction in civil penalties and damages multipliers. However, the most interesting part of this development is seen only in the amended version of the Justice Manual, which now includes the statement that cooperation credit might avail the defendant of the DOJ’s assistance “in resolving qui tam litigation with a relator or relators.”

As is widely known, the Granston memo suggested the DOJ would be more likely to dismiss relator litigation when that litigation would interfere with other federal agencies’ efforts to fulfill their policies, but this change to the Justice Manual seems to take the Granston memo a step further in an effort to reward certain behaviors. How frequently the department would see fit to dismiss a qui tam in order to create inducements for other defendants to be more forthcoming is impossible to predict, but the frequency with which the FCA is invoked suggests observers might not have to wait very long at all to see this policy in action.

Paclitaxel Focus of Device Controversy

The technology behind percutaneous treatment for the coronary arteries has advanced much more rapidly than for the peripheral vasculature, but the use of paclitaxel, a chemotherapeutic agent, as a go-to antiproliferative for any part of the anatomy could be near an end. The FDA published a letter to physicians in January stating that a medical journal article suggested that paclitaxel-bearing drug-eluting stents (DESs) and drug-coated balloons (DCBs) for the peripheral arteries had demonstrated an unexpectedly high long-term mortality rate compared to bare-metal stents and non-coated balloons. However, the conclusions drawn in that medical journal are the subject of a dispute that may determine whether paclitaxel has any future at all in the circulatory system.

The article in the Journal of the American Heart Association describes a meta-analysis covering more than two dozen randomized, controlled trials for both DES and DCB devices, all coated with paclitaxel. The authors stated that all-cause death at both two and five years for paclitaxel devices was significantly higher than for their non-eluting counterparts when used in the arteries of the lower extremities, but that more study is warranted, in part because only two of those studies ran for a full five years. The authors hypothesize that the crystalline form of paclitaxel, which has a longer half-life than other formulations, may be the culprit.

Medtronic, the Dublin-based manufacturer of the In.Pact Admiral DCB, took issue with the JAHA authors in an article in the Journal of the American College of Cardiology, stating that there is no statistically significant difference in mortality between DCBs and plain angioplasty balloons at five years. As is the case with the JAHA analysis, there are a number of moving parts in the Medtronic summary, including that the data are drawn from patients in a variety of nations that exhibit different patterns of post-procedural care, not to mention differences in the use of dual anti-platelet therapy (DAPT). The company argued that much of the difference in mortality outcomes could hinge on the more aggressive use of DAPT in patients treated with bare-metal stents and plain angioplasty balloons.

Whether any of this clinical data will translate into regulatory action is impossible to forecast, but the FDA advised that it still sees the benefit of these devices as outweighing the risks. If Medtronic’s view – that the mortality rates at five years out, at least in statistical terms – wins the day, device makers might be on the hook for nothing more than a somewhat greater post-market surveillance liability. Makers of DCBs might already be on that track, as the Centers for Medicare & Medicaid Services (CMS) declared it will pay what clinicians and device makers see as a sub-optimal rate for these devices, unless and until CMS sees some compelling data that the difference in cost between DCBs and plain balloons is justified by outcomes.

E.U. Regulators Tackle Big Data, Definitions

Data may save lots of lives over the course of the 21st century, but the volume of data has created a number of headaches for regulators and life science companies alike. In response, two European regulatory entities have teamed up to take on these vital questions, and their report suggests it was no trivial matter just deciding upon a definition of the term “big data.”

The European Medicines Authority (EMA) and the Heads of Medicines Agency (HMA), the latter of which is a group of E.U. competent authorities, posted the report on the activities of the HMA/EMA Joint Big Data Task Force. The group formed six working groups to consider the data derived from a number of sources, such as genomics and clinical trial data, and set certain standards for regulatory acceptability of those data. Data standardization is a matter of some interest, as is the ages-old problem of data sharing.

The report states that there is an emphasis on providing some linkage between genomic data and clinical outcomes, but the authors say this will create pressure to provide timely updates of clinically relevant genomic information in medicinal product labels. There is also a keen interest, however, in defining performance standards for companion diagnostics, an ever-more pressing consideration as highly expensive cancer therapies continue to find their way to market.

The report includes information from a survey of stakeholders regarding their familiarity with big data, and it appears a number of the competent authorities in the survey enjoy “very limited expertise” on the subject. This lack of expertise is due to a perception that there is little need for it at present, but this dynamic is changing. Eight of the 24 competent authorities surveyed said they have no in-house expertise in biostatistics, but indicated they see a need for such expertise arising within the next five years; the study authors pointed out that such assets are already a necessity.

A total of 37 life sciences companies responded to the survey, with the group nearly evenly split between companies with more than 250 employees and those with 250 or fewer. This dividing line yielded quite different sets of considerations, with the larger companies expecting that big data will have the most significant impact on target identification and patient stratification, while their smaller counterparts emphasize outcome identification and patient-reported outcomes.

The two groups also had different concerns regarding data validity and the challenges associated with the use of big data, but shared concerns regarding regulatory harmonization and a need for regulatory guidance. The report concludes that the ability to manage big data will, in the future, be critical for the advance of regulatory science, but the authors also pointed to a need for a “systemic, coordinated, and integrated European approach” to such questions. While good intentions will prove vital to any such effort, the authors say that there is still a need to prioritize the various tasks of learning to manage and use big data, and that the current effort is moving along “in the right direction but not in a consistent and consolidated way.” The authors stated, “[W]e therefore need to guard against reverting to the status quo.” Comments on the joint task force report are due April 15.

BIO, PhRMA Not Opposed to AKS Proposal

Makers of drugs and biotech therapeutics might have been expected to resist the Trump administration’s proposal regarding the anti-kickback statute, but that proves not to be the case. Two leading trade associations have voiced their support for the proposal, although they each indicated they would take a closer look at the proposal before lending it their full-throated support.

It has been argued on more than one occasion that rebates paid to pharmaceutical benefits managers are rebates rather than kickbacks, a point made by at least one observer. There have been instances in which drug makers paid fines to deal with allegations they used rebates to gain exclusive listings in PBM formularies, but that is not the usual run of business where these rebates to PBMs are concerned.

The latest proposal by the Department of Health and Human Services includes a removal of the safe harbor for rebates paid to several entities, including PBMs, although PBM service fees would enjoy a safe harbor along with rebates provided directly to beneficiaries enrolled in federal government health programs. HHS Secretary Alex Azar said in a statement the proposal is “a major departure from a broken status quo that serves special interests,” and which “moves toward a new system that puts American patients first.” The proposal would further provide more transparency about such transactions, and Azar seemed to taunt Congress on this point, stating that members of both parties who have sought to lower prescription drug costs “have criticized this opaque system for years, and they could pass our proposal into law immediately.”

Despite the seeming promise of disruption of the existing system, both the Biotechnology Innovation Organization and the Pharmaceutical Research and Manufacturers of America issued statements that were generally supportive of the proposal. BIO President/CEO Jim Greenwood said in a Jan. 31 statement that the association “strongly supports the goal” of the proposal, but advised that BIO is taking a close look at the proposal. Greenwood said the current system creates some perverse incentives that feed the drug pricing problem, urging HHS to adopt a system that provides affordable access.

PhRMA emphasized a need to ensure that the $150 billion in annual rebates and discounts are used to lower costs for patients at the pharmacy. PhRMA President/CEO Steve Ubl stated that the existing approach favors products with high list prices, but he also pointed to the pressing problem of price hikes associated with drug products used for diabetes, which has been a significant flashpoint in recent months. Despite the supportive tone, Ubl said PhRMA would also take a close look at the proposal before offering specific comments.

FDA Rewrites Title of Abbreviated 510(k) Draft

The FDA’s device center managed to wrap up a 2018 draft guidance dealing with abbreviated 510(k) applications, but ended up renaming the document in the process. The net effect is seemingly to put another nail in the substantial equivalence coffin, which some might argue has been a policy priority for the Center for Devices and Radiological Health dating back to 2011.

The 2018 draft guidance bore a title that explicitly mentioned the abbreviated 510(k) program and suggested that a determination of substantial equivalence would be more easily obtained by demonstrating conformance with performance criteria. The final guidance is dubbed the Safety and Performance-Based Pathway, which advises that third party reviewers can be invoked for these devices, which was not acknowledged in the draft.

One of the more notable differences between the draft and the final is that the latter suggests that the performance criteria requirements for Declarations of Conformity might be more explicitly product-specific than perhaps was understood upon the emergence of the draft. The final guidance says a DoC ought to suffice to support a finding of substantial equivalence “unless noted otherwise in the relevant Safety and Performance Based Pathway guidance.” While there is a seemingly related provision in the draft – which states that the FDA may “establish performance criteria through guidance and/or special controls” – the revision appearing in the final seems to lend more teeth to the notion that at least some procodes will be the subjects of product-specific performance criteria.

Precisely when the agency might promulgate such guidance is not explained, but the implications of this and other recent policy changes at CDRH include that the historical understanding of the role of substantial equivalence is no longer in vogue at the Office of Device Evaluation. Only time will tell whether reviewers at ODE can resist the urge to use performance criteria as a means of imposing more regulatory hurdles for class II devices