Staking Claims: PTO Saving Patents, FDA Saving Lives

The world suffers no shortage of hyperbole, and sometimes those in the U.S. government get in on the act, too. Following are two stories of goverment agencies taking action in the month of May, with one agency easing up on a purportedly lethal administrative mechanism while the other asserts that its regulatory proposal would be quite the opposite of lethal.

PTO Revisits ‘Broadest Reasonable’ Standard

Those who saw the inter partes review process as an illegitimate shortcut to destruction of legitimate patents may have been cheered to see the U.S. Patent and Trademark Office declare that it would revisit its standard for interpreting claims that are the subject of an IPR, a welcome piece of news for patent holders.

Much of the criticism of the IPR process revolves around the notion that the process is a highly efficient patent-killing machine, and the use of broadest reasonable standard for interpreting the claims contested in an IPR was part of the problem. The difficulty for litigants was that matters appearing in an IPR or other PTO procedures might also be at play in the courts, thus setting up the prospect for differential outcomes due to PTO’s use of the broadest reasonable interpretation (BRI) standard.

Andrei Iancu, director of the PTO, said in remarks to a patent policy conference in April that the agency was taking a close look at various patent-related proceedings and the standards employed throughout those proceedings. The overall objective would be to increase the predictability of “appropriately scoped claims,” Iancu said, explaining that one of the agency’s tasks will be to close the gap between the prior art uncovered during the original patent examination and the prior art unearthed in litigation.

The PTO notice acknowledges that the BRI standard differs from the standards used in federal district courts and the International Trade Commission, and that nearly 87 percent of the patents caught up in proceedings instituted by the America Invents Act were also in play in the courts. This high rate of overlap, the agency said, suggests a need to use the same standard for claims interpretation. PTO also pointed to the outcome in the 2005 en banc hearing at the Federal Circuit for Phillips v. AWH Corp. as a stimulus to take a closer look at the viability of the BRI standard.

The agency said its views of the matter have also been shaped by a rethinking of the relative merits of extrinsic and intrinsic evidence. This portion of the PTO’s notice of proposed rulemaking states that the need to comport with Phillips means that the verbiage found in a claim will be interpreted by the “ordinary and customary meaning” of the words found in those claims. The PTO states that extrinsic evidence, such as expert testimony, may be useful, but not moreso than intrinsic evidence, and that the proposed rule would apply not only to IPR proceedings, but also to post-grant reviews and to proceedings for covered business method patents.

FDA Floats Life-Saving Combo Appeal process

The FDA has proposed to revise the process for appealing a determination regarding a combination product application, but the net effect of the proposed rule is anything but certain. One of the provisions of the proposed rule would eliminate what the agency characterized as a redundancy from the appeals process, but there are other feature of the proposed rule that invite closer scrutiny, such as the argument that one of the values of the rule is that it may save lives.

Up to now, the Part 3 appeals process for combination products has allowed a sponsor to appeal to the Office of Combination Products when the sponsor is unhappy with the OCP’s initial determination as to whether the product is primarily a drug, a device or a biologic. The FDA said it would delete section 3.8 from Part 3 altogether simply because appeals to the OCP cannot include information that was not part of the initial filing, and thus the outcome is likely to be unchanged. The notice also says that this part of the process led to some confusion regarding whether the sponsor can take the matter over the OCP’s head in the event of an adverse determination.

While the draft rule makes several claims on the subject of a net savings to industry after the first year, one of the more interesting observations on the part of the FDA is that if adopted, the rule would provide a public health benefit in the form of “illnesses and deaths avoided as a result of finalizing the proposed rule,” a curious observation to say the least. Conversely, one clear-cut benefit of the proposed rule is that it makes explicit that a sponsor need not contact the OCP if the product’s primary mode of action is clear.

One of the interesting parts of the rule in procedural terms is that only a sponsor would be allowed to file a request for designation for a particular combination of drug and device products. This would seem to foreclose any prospect of an industry collaboration, but another question in this context is whether the confidentiality of premarket submissions would disallow the disclosure of the status of a particular combination upon approval of that application.

Another proposed change to the regulation, yet another response to Section 3038 of the 21st Century Cures Act, is that the FDA would review a combination product under a single application when appropriate, although the Cures Act did not foreclose the possibility of a component-by-component review. As currently written, the regulation states that the agency can require that an application’s components be reviewed separately, but the FDA said it may simply delete this language from the regulation “to avoid confusion.”

The difficulty for regulated industries is that the FDA would only belatedly issue guidance or rulemaking as the agency’s staff gain experience implementing the changes imposed by the Cures Act. It might be assumed that the combination of legislatively imposed changes, and the proposal to excise language not directly required by that legislation, will in the near term engender more confusion rather than less.

Hits and Misses for May 2018

Given the volume of news affecting the life sciences, there are always some favorable outcomes and some that trend in the opposite direction. Following are a few recent developments of note, including one that provided good news for the companies in question, and another that is still unfolding.

Fifth Circuit Blasts Pinnacle Hip Decision

In the area of liability law, the big miss over the past couple of weeks for litigants was the decision by the Fifth Circuit Court of Appeals regarding the Pinnacle hip multi-district litigation. The outcome is of course a significant win for DePuy Orthopedics and its parent, Johnson & Johnson, but the case was remanded to a lower court for reconsideration, and so the device makers are not off the hook just yet.

The court expressed quite a bit of ire over the handling of the case at the trial court, particularly regarding allegations the companies bribed the regime of Saddam Hussein in Iraq, but there were a few issues with paid witnesses that plaintiff’s attorneys had indicated were testifying without compensation. The outcome relieves the companies of a $151 million liability, which was itself a fraction of the $502 million originally arrived at in this case. The principle message to be learned from this outcome is that attorneys for plaintiffs can’t indulge in every whimsical allegation that comes to mind if they want these lawsuits to stay on an even keel.

FDA floats digital precert model

The precertification pilot program for software as a medical device drew raves from stakeholders when the FDA announced the program in September 2017, and the agency has now delivered on a draft working model of a full program. Whether developers see this as a hit or a miss might be conditional on several things, including whether the vendor has prior experience with device applications. The draft states that developers with previous experience in the device business will be subject to less scrutiny, something that information technology companies may see as discriminatory.

The precert concept relies on an organization’s demonstrated commitment to a culture of quality, but the agency said in a statement accompanying the draft working model that such a designation would mean that the organization in question “could potentially submit less information” on the product prior to going to market. The FDA addressed the question of third-party precertification with another response that amounts to “definitely maybe.” This uncertainty also underscored the agency’s remarks regarding whether certified sponsors will be subject to inspections, another conspicuous deviation from the precert pilot.

Opinions vary regarding whether this new paradigm for regulated software is as painless as some believe, given all the optimism surrounding the pilot. One regulatory attorney told a media outlet recently that the FDA document seems an implicit trade of faster times to market in exchange for more regulation. Regulatory attorney Bradley Merrill Thompson of Epstein Becker Green also said, “industry has to review this proposal with eyes wide open.”

In a somewhat related development, the FDA published a draft guidance for multiple function device products, and the Federal Register notice states that the FDA’s Bakul Patel is the contact point for the draft, making clear that this is principally about software devices and software functions that are secondary to the device primary function. Patel is the associate director for digital health at the agency’s device center, hence the authorship makes clear the focus of the draft despite that a device with no software at all could be a multi-function device.

The draft defines the term “function” as “a distinct purpose of the product,” but that distinct purpose could be a mere subset of the intended use or could make up the entire intended use. The most interesting part of the draft, which was made necessary by Section 3060 of the 21st Century Cures Act, is that it states that the “device function-under-review” will be the principle point of interest, although the agency will assess the impact of these other functions on the function under review, even when those other functions would otherwise enjoy enforcement discretion or would not be subject to regulation.

Sponsors will have to conduct a risk analysis of the potential impact of these non-reviewed functions on the function under review, but these non-reviewed functional aspects of the device won’t be subject to post-market surveillance activities. Still, device makers will have to document design considerations for non-reviewed functions, such as software architecture, as well as any relationships between the reviewed and non-reviewed functions, such as shared computational resources.

While the draft may be an improvement on regulatory silence on the matter, it would seem to raise the question of why the entirety of the Quality Systems Regulation is not applicable to a device function that is nonetheless subject to risk analyses and some of the more labor-intensive documentation requirements that fall under the QSR.

FDA’s Intended Use Rule Back in Play

A number of regulatory and enforcement items have been up for grabs at the FDA over the past year, but few carry the weight of the agency’s review of the intended use rule. The FDA announced recently that it is suspending the implementation date for the rule, and is separating the tobacco-related portions of the rule from those governing drugs and devices. It’s a welcome step and one that is long overdue, but it is not clear yet where the agency will land on this matter.

Dexcom Warning Letter Pulled

To recap, this problem dates back to at least 2011, when Par Pharmaceutical Inc. sued the agency over the latter’s attempts to suppress Par’s on-label discussion of the company’s appetite stimulant, Megace ES, in a setting in which the drug was likely to be used off-label. Par agreed to pay a $45 million fine two years later, and the five-year corporate integrity agreement is finally set to expire later this year.

Glucose monitor maker Dexcom subsequently received an FDA warning letter alleging the device maker was aware that its devices had been sold for uses that fell outside the labeled indication, but the agency has since deleted that document from the warning letter database. The agency took an explicit approach to the issue in a Federal Register announcement in September 2015, a peculiar attempt to devise a rule that would cover tobacco products along with drugs, devices and biologics. The FDA said its intent was to clarify some of the related issues, but the 10-page draft included the curious observation that a lack of clarity might lead consumers to use tobacco products “in place of FDA-approved medical products.”

The final rule appeared in early 2017 and retained the plus-tobacco features of the proposed rule, but the document grew to 25 pages and included a more or less lengthy discussion of the Central Hudson test and other issues that came up in comments to the docket. However, the agency then delayed implementation of the final rule to March 21, 2017, and then to March 19, 2018, and FDA commissioner Scott Gottlieb said in the agency’s Jan. 12 statement that the final rule will be suspended yet again “until further notice.”

A Procession of Concessions Fails

The 2015 proposed rule rattled observers by stating that the agency’s determination of a product’s intended use “is not bound by” explicit claims made by the manufacturer, but can instead be inferred by “objective evidence,” including the circumstances “surrounding the distribution of the product or the context in which it is sold.” The FDA tried to assuage industry’s concerns by vowing that it would not act on distribution of a product “based solely on a firm’s knowledge” of off-label use, but this concession did little to mollify industry.

The agency took a somewhat different approach in the final rule, stating that “a totality of the evidence” would be employed to determine an intent to knowingly distribute a drug or device for off-label uses. However, the Advanced Medical Technology Association argued that an approach based on the totality of the evidence is “more outcome determinative than prescriptive,” and thus manufacturers would have little choice but to “curb important product-related communications.”

The intended use rule does not entirely capture the regulated speech problem, but it is a significant hazard, particularly since whistleblowers and the Department of Justice can readily avail themselves of fodder for prosecution. It is pertinent to note that the Par Pharma case involved multiple relators, who had netted more than $4 million when all was said and done.

States Moving Ahead

There are several questions looming for the FDA, but whether the agency is in a position to stand pat is not one of those questions. The State of Arizona passed a law last year that takes up the off-label communication issue, and there are indications that other states may soon follow suit. Gottlieb has already noted that the FDA must come to grips with recent jurisprudence on the off-label issue, and the agency can scarcely afford to be swamped by a pixelated map of state policymaking where commercial speech is concerned.

The easy answer to all this is that Gottlieb will scuttle the totality-of-evidence standard, but little beyond that is especially obvious. The FDA said it will take comment through Feb. 5 on this latest iteration of the intended use scrum, so there is still time to weigh in. Given that the docket for this issue already features nearly 2,000 comments, it’s clear that significant change is in the works.

Going Solo, and Who Needs Government Anyway?

Some days it seems the idea of interdependence is really gaining ground, but then there are days that seem to trash the idea completely. Below are a couple of stories of the latter variety, stories that might seem more pointed to the diversity ethic that is also very much in vogue in these early years of the 21st Century. First, however, we ask whether the FDA’s device center is losing its appetite for heavy-handed regulation.

FDA Going Soft on Software?

The Center for Devices and Radiological Health at the FDA was pretty quiet for the first half of the year, but is a little more active recently. For instance, CDRH published a digital health action plan in response to pressure from Congress, but the plan is also a tacit admission from the agency that its quality systems regulations (QSRs) don’t always work well where software is concerned.

The reader may remember the FDA’s interest in medical device data systems dating back to 2011. Hospital administrators were wary of the cost and hassle of standing up a QSR-compliant regime in the first place, but four years would pass before the agency renounced the idea, undoubtedly with the help of some arm-twisting from Capitol Hill.

The FDA’s digital health innovation action plan includes a precertification pilot that calls for a review of a publisher’s approach to software quality control rather than a full-blown premarket review of each product. The program is limited to items that qualify as software as a medical device (SaMD), however, and excludes items such as software integrated into devices.

The precertification pilot does include site visits, but the agency is willing to conduct virtual site visits in lieu of the real thing. Ergo, one can argue that this is QSR-lite at worst. Still, one has to wonder how much time will pass before an SaMD will start pushing the FDA’s safety and efficacy buttons despite FDA commissioner Scott Gottlieb’s assertion that the program is strictly for “certain lower-risk devices.” That lower-risk assurance seems odd, given that the sponsor will be on the hook for collecting post-market data for that product.

The day one of these calls for a de novo application might herald a time when the agency will scrutinize these SaMDs individually, but how long after that will a sponsor discover they have tripped the class III/PMA trigger? Only time will tell.

Disharmony from Asia

Some see global regulatory harmonization as a pipe dream, and India’s Central Drug Standards Control Organization has released a draft guidance dealing with standards for safety and performance of medical devices that would seem to support that view. This document, which supplements a novel regulatory framework specific to med tech in India, suggests that CDSCO will handle stand-alone software in the same manner as traditional medical devices despite the FDA’s hands-off approach.

CDSCO gave interested parties only three weeks to comment, hardly sufficient time to absorb the implications of such a document, particularly since the document is undated, other than to note the month of publication (July). The agency said it does not want to dictate how a device maker might demonstrate compliance, but the scope of the 27-page document encompasses a wide range of product categories, including combination products, a breadth of scope which might come across to some as lack of specificity disguised as flexibility.

In any case, the document also takes aim at devices “that incorporate software and stand-alone medical device software,” which is where it rubs up against the new approach at FDA in a disharmonious manner.

As noted above, the American regulator is steering an entirely novel tack for its regulation of SaMD, which had said last year would revolved around a guidance drafted by the International Medical Device Regulators Forum. India is not a participant in the IMDRF effort, although it is a member of the Asian Harmonization Working Party (AHWP), which is an IMDRF affiliate and which has inked its own SaMD proposal, said to be built around the IMDRF effort.

One way of looking at this is that the FDA is the outlier and that the disharmony is coming from Silver Spring, Md., and not from New Delhi, although it may be instructive to note that the latter has a very limited body of experience with med tech-specific regulations. Either way, publishers of SaMD will continue to face very different regulatory regimes if they want to do business in both the world’s richest market and its second most populous market.

No DOJ? No Problem

As is commonly known, the Department of Justice does not dive head first into every qui tam action that pops up, but government attorneys seem to be involved in nearly every whistleblower suit that costs the target company money. Celgene of Summit, N.J. offers the exception, getting stung with a $280 million hit in a False Claims Act case that asked the federal government to do nothing more than accept a nice, fat check from the company.

The company denied any culpability, and Celgene may have a case given that the Centers for Medicare & Medicaid Services is somewhat more lenient about off-label use of oncology drugs. However, court documents indicated that Celgene helped patients financially by contributing money to two patient-directed organizations, which were said to have “acted as conduits for Celgene” and thus had “eliminated any price sensitivity” for both patients and prescribing physicians.

The court also said “the United States did not intervene” without comment, although the court pointed to two other qui tam actions against the company, both of which were dismissed.

The biggest problem for Celgene might have been that the company purportedly persuaded physicians to influence guidelines published by the National Comprehensive Cancer Network, and was alleged to have “caus[ed] doctors to change ICD-9 diagnosis codes.” The lay person sitting in a jury box might find it difficult to hear of manipulation of codes used in Medicare billing without thinking the source of that manipulation was up to no good, particularly given how much very visible emphasis there is these days on Medicare fraud.

Life Sciences News Roundup, 6/22

Courtney S. Young, Esq. | Senior Attorney, Medmarc Risk Management

MedPAC Calls for Action to Reduce Number of PODs 

On June 15, the Medicare Payment Advisory Commission (MedPAC) issued its annual report, which enumerated problems with PODs and outlined actions that could be taken to reduce their prevalence. You can read more here.

FDA Seeks Comment on Two New Drug Promotion Studies

The FDA published two notices in the Federal Register on Monday articulating its plans to undertake new studies on drug promotion: (1) Experimental Study on Risk Information Amount and Location in Direct-to-Consumer Print Ads; and (2) Disclosures of Descriptive Presentations in Professional Oncology Prescription Drug Promotion.

 

Biosimilars, Biostatisticians, and the New EEU

There are very few days during which the worlds of drugs and medical devices are entirely quiescent, thanks to very active American courts and international regulatory churn. There is some good news in all this, but how good is it?

If you’re in the biosimilars business, the latest news is quite good, indeed.

SCOTUS rules for Sandoz

The U.S. Supreme Court ruled on June 12 that makers of biosimilars do not have to wait six months after the issuance of a biologics license application to begin marketing that product, a development that could bring some less costly biotech drugs to market more quickly and possibly take a bite out of spending on these agents.

In a 9-0 vote, the Court ruled in favor of Sandoz in Sandoz v. Amgen, a case that made a stop at the Court of Appeals for the Federal Circuit, where the outcome was quite different. Sandoz had argued that the terms of the Biologics Price Competition and Innovation Act of 2009 had essentially worked to add half a year of exclusivity to the 12 years already granted by the statute, and by some accounts, Sandoz’s Zarxio is about 15 percent less expensive than Amgen’s Neupogen, a drug for chemotherapy-induced neutropenia.

The news might not change the field dramatically in the near term, given that the FDA has approved only about half a dozen biosimilars to date, but one possible candidate for a quick entry to market is an oncology biosimilar for Avastin, which will undergo an FDA advisory committee review in mid-July. In an ironic twist, Amgen teamed up with Allergan to produce this biosimilar.

Expert witness refuted in Zoloft lawsuit

Pfizer scored a victory in the running lawsuit pertaining to the company’s flagship antidepressant Zoloft, but what may have been the most interesting part of this story is that a court rejected expert testimony relating to allegations that the selective serotonin reuptake inhibitor (SSRI) causes congenital heart defects.

The decision may have brought to a close an effort by more than 300 litigants, which absorbed a second consecutive negative outcome in the U.S. Court of Appeals for the Third Circuit. Both the appeals court and a district court decreed that the expert witness, Nicholas Jewell, a biostatistician at the University of California at Berkeley, had failed to plausibly link the drug to the birth defects. Among the problems with Jewell’s presentation is that he had rejected meta-analyses he had previously cited in a separate lawsuit pertaining to another SSRI.

Whether the plaintiffs will take this lawsuit any further is difficult to forecast, but a footnote on page 10 of the Appeals Court decision remarked that the plaintiffs’ attorneys had conceded that they are “unable to establish general causation” if the courts jettisoned Jewell’s testimony. Summary judgment was granted in favor of Pfizer.

This is not the only multi-district litigation keeping attorneys at Pfizer busy, however. A very active set of lawsuits dealing with proton pump inhibitors and purportedly associated kidney damage would seem to implicate the OTC version of Nexium, marketing rights for which Pfizer picked up five years ago in a deal with AstraZeneca. The U.S. Judicial Panel on Multidistrict Litigation (JPML) declined in January to consolidate these lawsuits, but another motion for consolidation has been filed by attorneys with Seeger Weiss of New York.

Regulations, regulatory agreements on the move

Efforts to ramp up medical device regulatory schemes in outside-U.S. jurisdictions are nothing new, but device makers can add Malaysia and the Eurasian Economic Union (EEU) to the list of national and international entities diving into deeper regulatory waters. The news for device makers is somewhat mixed, but greater clarity alone is sometimes enough to overcome other considerations.

First, Malaysia’s Medical Device Authority has declared that adverse events associated with medical devices will have to be reported to the agency within 30 days. This apparently applies to all devices that are on the Malaysian market, regardless of where the adverse event took place. Any fatalities have to be reported within 10 days, and device makers have a mere 48 hours to advise the agency of any problems that might carry a public health consideration.

The EEU continues to work toward a single market for drugs and devices, a move which if successful would capture the markets of Russia and four other nations for a total 2015 population of nearly 184 million. There are reports that Tehran is interested in a free trade agreement with the EEU, although there is no indication that Iran would take part this new med tech regulatory bloc despite the deepening geopolitical ties with Moscow. Serbia is likewise said to be interested in doing business with the EEU, but it’s not clear whether Belgrade has full-blown membership in mind, either, although the protracted and difficult negotiations for entry into the European Union might strike some as suggestive.

To date, the EEU regulatory regime lacks several critical documents, such as a framework for quality management systems. Registration requirements for this international regulatory system would be phased in over the next four years, however, giving industry a little breathing room for offerings already available in this market.

FDA Introduces Portal for Public Reporting of Regulatory Misconduct

Kate T. Klaus, Esq. | Staff Attorney, Medmarc Loss Control

Earlier this week, FDA launched a new program in which individuals can report, directly to FDA’s Center for Devices and Radiological Health, allegations of regulatory misconduct on the part of medical device manufacturers and marketers. The agency understands very well the vast reach of the medical device industry, but its limited resources have allowed bad actors to market their products while attempting to remain below FDA’s radar. In addition to creating potential risks for patient safety, this flouting of regulations has long been a source of frustration for medical device companies that do operate within the bounds of the law and feel unfairly disadvantaged when competitors skirt the rules.

Examples of reportable misconduct include:

  • Advertising or promoting a device beyond the bounds of its indications for use;
  • Marketing a device without the necessary clearance or approval;
  • Failing to implement or comply with necessary Quality System requirements;
  • Importing devices that do not meet U.S. legal criteria;
  • Failing to register and list with FDA, thus preventing FDA from properly overseeing operations; and
  • Knowingly deceiving FDA in some fashion, whether falsifying documents or hiding information.

Reports are accepted through the FDA webpage, as well as by mail and email. While FDA encourages reporters to include their name and contact information in the event that additional information is required, reports can be filed anonymously. FDA will review the reports, evaluate potential risks to public safety, and determine the appropriate intervention or enforcement action.

What is the takeaway for medical device firms? For those already operating in compliance with FDA regulations, there should not be a burdensome impact. Even if FDA chooses to investigate an allegation, frivolous claims will likely be dispensed with easily when met with strong quality systems and thorough recordkeeping practices. However, for those firms attempting to fly beneath FDA’s radar, they may find themselves on the receiving end of a Warning Letter in short order. Your competitors have been watching your practices for years, but FDA has now empowered them to act.

For more information on compliance with FDA regulations, please see our Life Sciences Guidebook, available for sale on Amazon.