FDA

HHS/FDA Proposed Deregulations: Recommendations for HIPAA and IRB’s approval and informed consent process

By Colleen Sproul

The US Executive Branch’s  Spring 2019 Unified Agenda of Regulatory and Deregulatory Actions is out, and HHS/FDA have identified for deregulation, among other things, the current IRB approval process in order to allow any U.S. clinical site to rely on the approval of just one IRB in order to conduct a study at that site.  All proposed rule changes were made by the agency in response to the Administration’s request for all agencies to identify “ineffective regulations” and propose deregulations to meet the Administration’s objectives to streamline and improve “cost effectiveness” (although it is not clear whether it is HHS that would see economic benefit).  

Institutional Review Board Proposals

  • Title: Institutional Review Boards; Cooperative Research 
    • Abstract: This proposed rule would replace current FDA requirements for cooperative research such that any institution located in the United States (U.S.) participating in multisite cooperative research would need to rely on approval by a single Institutional Review Board (IRB) for that portion of the research that is conducted in the U.S., with some exceptions.  This proposed rule would also establish an IRB recordkeeping requirement for research that takes place at an institution in which IRB oversight is conducted by an IRB that is not operated by the institution.

  • Title: Institutional Review Board Waiver or Alteration of Informed Consent for Minimal Risk Clinical Investigations
    • Abstract: This proposed regulation would permit an Institutional Review Board (IRB) to waive or alter the informed consent requirements under certain conditions for minimal risk clinical investigations. This would facilitate certain minimal risk clinical investigations to support the development of new products to diagnose or treat disease and would harmonize with the HHS Common Rule waiver provision that has been adopted and successfully employed by other agencies. This proposed regulation is intended to aid patient access to new products by facilitating investigators’ ability to conduct studies that may contribute substantially to the development of products to diagnose or treat diseases or conditions, or address unmet medical needs.

Health Insurance Portability and Accountability Act of 1996 (HIPPA) Proposals

Also proposed is the “removal of barriers” created by HIPAA compliance, which is especially interesting in light of the fact that, in 2018, the Office of Civil Rights set an agency record in HIPAA enforcement activity by levying fines totaling $28.7 million (against MD Anderson, Boston Medical Center and Brigham’s and Women’s Hospital and MGH, among others).   All proposed rule changes were made by the agency in response to the Administration’s request for all agencies to identify “ineffective regulations” and propose deregulations to meet the Administration’s objectives to streamline and improve “cost effectiveness” (although it is not clear whether it is HHS that would see economic benefit).

  • Title: HIPAA Privacy; Changes to Support, and Remove Barriers to, Coordinated Care
    • Abstract: This proposed rule would publish for comment proposals to modify provisions of the HIPAA Rules which present barriers that limit or discourage coordinated care and case management (including care coordination challenges arising from the opioid crisis) among hospitals, physicians (and other providers), payors, and patients, or otherwise impose regulatory burdens that may impede the transformation to value-based health care without providing commensurate privacy or security protections for patients’ protected health information (PHI) and while maintaining patients’ ability to control the use or disclosure of their PHI and to access PHI. This proposed rule would subsume the previous 0945-AA09 entry in the Regulatory Agenda.

Other HHS/FDA Proposals

The Office of Management and Budget’s Office of Information and Regulatory Affairs website has a synopsis of each regulation identified for “deregulation” by HHS/FDA, but the links to the meeting minutes for each proposal are inactive and the webpages with proposals under the Fall 2018 Unified Agenda are no longer active on the FDA website; it is not possible at this time to substantively review and compare the data (some of the HHS Spring 2019 proposals are updates to 2018 proposals) via the web.  Below is a list of changes we’ll be tracking as more information is made available as part of the public comment period:

  • Title: Definition of the Term “Biological Product” 
    • Abstract: The Food and Drug Administration (FDA) proposes to amend its regulation that defines biological product to conform to the statutory definition (21 U.S.C. 262) adopted in the Biologics Price Competition and Innovation Act of 2009. 
  • Title: ●HHS Policy for the Protection of Human Research Subjects: Update to Subpart E (IRB Registration) 
    • Abstract: This rule would amend subpart E of 45 CFR part 46 (Institutional Review Board (IRB) Registration) to align subpart E with recent amendments to the basic HHS Policy for the Protection of Human Subjects (subpart A of 45 CFR part 46, also known as the Common Rule) and to give effect to one of the policy goals of the subpart A revision (i.e., eliminating unnecessary administrative burden on IRBs and institutions regulated under 45 CFR part 46). The general compliance date of amendments to subpart A of 45 CFR part 46 was January 21, 2019.
  • Title: Part 50 Protection of Human Subjects and Part 56 Institutional Review Boards
    • Abstract: This proposed rule would harmonize, to the extent practicable and consistent with other statutory provisions, several sections certain provisions of FDA’s regulations on human subject protection and institutional review boards with the recently revised “Federal Policy for the Protection of Human Subjects” (the revised Common Rule (45 CFR 46, subpart A)). The rule also proposes minor amendments to related regulatory provisions.
  • Title: Updates to 1974 Privacy Act Regulations
    • Abstract: This rulemaking will update regulations at 45 CFR part 5b, which detail how the Department implements requirements of the Privacy Act of 1974, as amended (5 U.S.C. 552a).

Contracts Associates Will Attend FDA Boot Camp in September 2018!

By Administrator

We are pleased to announce that Contracts Associates will attend ACI’s FDA Boot Camp in Boston this September! At this conference, we’ll join hundreds of other members of the Life Sciences community over a two-day span as we enhance our expertise in FDA regulatory law. With workshops covering everything from the clinical trial process for pharmaceutical products, to application and approval, ethical challenges, and more, this promises to be an informative and engaging experience!

UPDATED MAY 31, 2018: House Passes “Right to Try” bill – Compromising Public Health and Drug Development

By Administrator

UPDATED MAY 31, 2018

On May 30, President Trump has signed the “Right to Try” bill into law which allows terminally ill patients to bypass the FDA when attempting to gain access to experimental therapies. Patients have already been able to apply for investigational drugs outside of clinical trials via the federal “Expanded Access” law.

The Right to Try legislation does not guarantee that manufacturers will provide the drugs nor that insurance companies will cover the costs. The law was backed by libertarian think tank the Goldwater Institute.

Originally published on April 18: On March 21, only one week after an initial defeat in the U.S. House, the controversial “Right to Try” bill was passed by a vote of 267-149. The legislation is now on its way to the U.S. Senate.

“Right to Try” would provide access to experimental therapies to patients with life-threatening illnesses while weakening FDA oversight and compromising public health and medical research. The FDA already offers patients access to experimental drugs or medical devices outside of clinical trials via the Expanded Access (sometimes called Compassionate Care) program and approves the overwhelming majority of all applications received—about 99%. Under Expanded Access, the FDA continues to supervise administration of the experimental drugs which both helps reduce individual patient risk and works to improve overall public health outcomes.

The current “Right to Try” bill permits patients and their doctors to bypass the FDA and work directly with pharmaceutical companies for access to drugs which have merely completed Phase I clinical trials. Some patient groups argue that by cutting out FDA oversight and creating an alternative avenue for accessing experimental drugs, Right to Try actually increases patient risks and is demonstrably less safe than Expanded Access.

Over 75 patient groups sent a letter to the House opposing passage of the bill, citing the dangers it presented to patients such as the seven-day lagtime between patient access to the investigational therapies and FDA notification of any possible side effects or negative outcomes. Additionally, the patient groups cited the removal of FDA-sanctioned dosing and safety measures. They also cited shortcomings of the bill such as its failure to address significant barriers to patients such as access and cost.

The bill strips patients of potential legal remedies by protecting doctors and drug companies from liability in the case of negative outcomes for patients.

The legislation is also poised to compromise medical research and drug development by preventing the FDA from using any data from negative clinical outcomes in its drug-approval assessments. Barring FDA from using such data would shroud the successes or failures of the experimental drugs in obscurity—possibly preventing further large-scale advances in overall research and development.

Ultimately, “Right to Try” strips the FDA of established regulatory authority and protections, increases risk to patients, and obfuscates data and outcomes vital to continued success in research and development–all of which could result in serious, wide-ranging public health issues.

We at Contracts Associates will continue to monitor this important issue.

Sidestep FDA Form 483—And The Resulting Setbacks

By Administrator

Bringing a new drug or medical device to market is incredibly exciting for any sponsor. Ideally, you’d like the clinical trial phase to proceed without delays, so you can get your new drug to market quickly—and start helping patients.

The FDA can issue a Form 483 after an inspection where an investigator has observed conditions or issues at a facility that might constitute violations of the Food Drug and Cosmetic Act and serves to alert the organization’s management. As a best practice, if issued a 483, companies or research centers should respond in writing without delay. The response should include a corrective action plan addressing the violations which the organization should immediately implement. Failure to respond or failing to take remedial measures could result a Warning Letter being issued by the FDA, or cause delays in studies and development.

The FDA maintains a list of Inspectional Observation Summaries broken down by program area (biologics, bioresearch monitoring, drugs, devices, etc.) which can be found on the FDA website. By viewing this data, sponsors, clinical sites, CROs and IRBs have the opportunity to learn the most common reasons for 483 and how to avoid similar pitfalls during the clinical trial process.

For example, in the program area of Bioresearch Monitoring, 248 Form 483s were issued between 10/1/2016 and 9/30/2017. Common reasons for the 483 include:

• An investigation was not conducted in accordance with the signed statement of investigator and/or investigational plan (frequency: 140 times)
• Failure to prepare or maintain adequate and/or accurate case histories with respect to observations and data pertinent to the investigation and/or informed consent (76 times)
• Informed consent was not properly documented in that the written informed consent used in the study was not approved by the IRB and/or was not signed by the subject or the subject’s legally authorized representative at the time of consent and/or was not dated by the subject or the subject’s legally authorized representative at the time of consent. (14 times)

Stick to the plan

An investigational plan forms a roadmap for any clinical trial, giving a brief overview of the type and scale of the study. Mandated by the FDA, it’s the outline that gets a trial from start to finish: quickly and safely. Sponsors and investigators must either stick to this plan, properly amend it—or risk receiving a Form 483.

An investigational plan is detailed and thorough, but a sponsor won’t typically be on site to ensure it’s being followed. As such, it’s important to know that your contracts and terms with your CROs are solid and equitable. Failing to review contracts could leave you open to both liability and FDA delays. Our attorneys possess the necessary industry experience and a meticulous, efficient approach to contract reviews which means sponsors can be confident that they’re protected should an investigational plan go awry.

Let the record show everything

To gain the best results from a trial and to pass inspections, meticulous record keeping is a must. Much like an investigational plan, proper record keeping requires diligence and thoroughness. It involves preparing and maintaining case histories and taking detailed documentation at every stage, from observation to delivery. Failing to properly monitor and maintain records for a trial isn’t just a common reason for a Form 483, but can also compromise the study.

Contracts Associates will ensure that each sponsor/CRO agreement includes detailed language about monitoring and record keeping. The agreement is intended to protect the sponsor in the event your CRO fails to keep proper records. Working with us will allow sponsors to harness our knowledge and expertise, which means you won’t have to worry about this type of exposure.

Obtain informed consent

The FDA doesn’t just monitor the safety of publicly available drugs or devices. It also monitors the safety of clinical trial participants, and obtaining informed consent is a core element of that.

Sponsors must ensure trial participants know their rights in relation to a clinical trial they’re considering. This includes exposure to unknown risks, possible side effects, and potential outcomes. Ensuring that your study is compliant with FDA regulations about informed consent is crucial to keeping your company protected and ensuring your milestones are met.

Your in-house counsel might not have the time or manpower to carefully review a trial’s informed consent forms before signing off on them. The attorneys at Contracts Associates can provide the additional assistance you need, on an as-needed basis. We can help you stay on schedule and ensure compliance with informed consent requirements. There’s no better plan than to have informed consent contracts reviewed quickly and thoroughly by experienced industry professionals like us.

Implications of Form 483

It’s important to keep in mind that Form 483 does not constitute the final Agency determination of whether cited conditions are absolute violations of the FD&C Act. Form 483 is a factor for consideration, along with all evidence or documentation collected on-site, and any responses made by the company. Only then does the FDA make a final determination as to what future actions might be necessary.

Proactive approaches with Contracts Associates

At Contracts Associates, we work with sponsors to ensure their clinical trials don’t fall behind schedule or expose the company to undue risk. We can even produce and maintain a personalized “risk register” for you, complete with contract terms and other matters that we become aware of in our reviews—helping you avoid future problems.

Our extensive industry experience means we don’t require training—or the time, cost, and effort associated with a learning curve. We provide quick and meticulous turn-arounds, and can help you meet your milestones. Contact us today to find out how we can help you.

UPDATED JANUARY 22, 2018: Implementation of the Common Rule is Delayed for Six Months

By Administrator

Updated January 22, 2018: HHS and fifteen other federal departments and agencies have delayed implementation of the revised Common Rule for six months. Originally set to take effect on January 19, 2018, the effective date and compliance deadline have been deferred until July 19, 2018.

The delay will provide institutions with at least six months to prepare for eventual implementation and compliance with the 2018 requirements—which might come as welcome news to those who were unprepared to meet the original deadline.

Currently, HHS and the fifteen other agencies are working toward a proposal to even further delay implementation of the revised Common Rule and will be seeking feedback and public comment via the rulemaking process.

Contracts Associates will continue to monitor the status of the revised Common Rule very carefully and will update this blog with any important new insights. If you have any questions about the changes, we encourage you to contact our office at 781-598-8000 or email our CEO, Colleen Sproul, at cms@contractsassociates.com so that we can provide you with the most current information regarding changes and compliance.

[Originally Published on January 4, 2018] The U.S. Department of Health and Human Services (HHS) has proposed a one-year delay in implementation of the revisions to the Common Rule. The updated rule was set to take effect on January 19, 2018 with compliance expected on the same date. But, as of this writing, the effective date and the applicability of the revised Common Rule is uncertain.

During the waning days of the Obama administration, the final text of the updated Common Rule was released by HHS. Upon entering office, the Trump administration immediately froze all new or pending regulations left over from the previous administration to allow them to be reviewed by the new President’s appointees. Implementation of the Common Rule changes was accordingly placed on hold.

What are the Revisions to the Common Rule?

The Common Rule, or the Federal Policy for the Protection of Human Subjects, is a set of regulations governing federally-funded research involving human participants, their data and biospecimens. First promulgated in 1991 and not updated since 2005, HHS proposed updating the Common Rule to reflect the rapidly-changing research landscape, especially in terms of human subject data and advancing digital technologies.

The revision process began in 2011 with the goal of enhancing protections of participants (relative to informed consent and data) and reducing administrative burdens. The Common Rule underwent significant revision with informed consent provisions requiring “a concise and focused presentation of the key information” in contracts. The updated rule also requires informed consent provisions to explain, among other things, the purposes of the research, risks and benefits of participation, and any appropriate alternatives so that a “reasonable person” can more easily decide whether or not to participate in the research.

In addition, the new rule requires that a version of the consent form that was used for enrollment purposes for each clinical trial be posted to a federal website. It also allows for gaining broad consent for secondary research use of identifiable data and biospecimens of participants.

So What Happens Next?

The Office of Management and Budget (OMB) is currently reviewing the proposal by HHS to delay implementation and compliance by one year. Along with the one-year delay, HHS is considering allowing three burden-reducing provisions to be implemented during the delay to ease administration. Precisely which three provisions remains unclear as they have not been specifically enumerated and the proposal currently exists as a title with no accompanying text.

It is unclear whether both the effective and compliance date would be pushed back, or only the compliance date, or whether there will be no changes at all and the new rule will be fully implemented on January 19, 2018. The possibility of delay in compliance might be seen as good news to some institutions who are unprepared to comply with the new rule and need time to make necessary changes. But as of now, the future of the revised Common Rule is unknown.

Contracts Associates will continue to monitor the status of the revised Common Rule very carefully and will update this blog with any important new insights. If you have any questions about the changes, we encourage you to contact our office at 781-598-8000 or email our CEO, Colleen Sproul, at cms@contractsassociates.com so that we can provide you with the most current information regarding changes and compliance.

 

FDA suddenly adds four-letter meaningless suffixes to new biologics’ nonproprietary names

By Administrator

Back in 2015, the FDA implemented a policy which required the addition of suffixes to biosimilars. On June 1 2016, the FDA suggested that sponsors could provide the FDA with up to 10 preferred proposed suffixes for its biosimilars and that the FDA would then choose which preferred suffix met its guidelines. Sounds like a good policy, right? Companies get to suggest their favorite “baby” names and the FDA picks one it likes. Well, the FDA withdrew that plan on June 20, 2016.

However the suffixes for biosimilars have been chosen since June 2016, it was clear that the FDA only applied this requirement for suffixes (which makes sense for biosimilars, so that consumers can tell them apart and doctors can report adverse events) to biosimilars. For example, Sandoz’s Zarxio’s nonproprietary name is “filgrastim-sndz”. Totally logical so far.

On November 16, 2017, the FDA approved Genetech’s hemophilia A biologic Hemlibra (good news for patients!) and assigned it a random suffix of “kxwh” (emicizumab-kxwh).    In the absence of published public comments (which would be published in the Federal Register) and/or the announcement of a policy decision, one has to assume that assigning these suffixes to all new biologics will be the law of the land.

We know the time an effort industry sponsors put into branding their biologics and we imagine that random characters appended to the end of such a carefully-considered name is not the most welcome of surprises. The FDA typically provides sponsors with substantial notice prior to making substantive policy changes (it is a government agency after all!); however, this sort of abrupt implementation of policy may be our new normal.

 

 

 

Phase III Clinical Trial Agreements: Ex-US Clinical Sites and FDA Inspections

By Administrator

With increasing frequency, an ex-US clinical site, in Poland or Hungary, for example, will delete all trial agreement references to compliance with FDA inspections (see sample text below), on the grounds that it is not required to comply with FDA inspections and/or is not subject to inspection by the FDA at all. In such cases, the site will seek to replace references to “FDA” with local, country-specific regulatory authorities.  However, foreign sites participating in clinical studies conducted under a FDA IND are subject to FDA inspections, and best practice dictates that the trial agreement should obtain the site’s agreement to notify sponsor’s in the event such an inspection takes place.

Sample ex-US trial agreement clause:

“The Institution and Investigator agree that personnel from regulatory authorities including but not limited to the United States Food and Drug Administration Food and Drug Administration (“FDA”) (“FDA”) may visit the Institution to inspect Study records (including portions of other pertinent records for all Research Subjects in the Study) and those procedures, facilities or Study records of any employee, contractor or agent that the Investigator or the Institution uses in conducting the Study. Investigator will notify Sponsor, promptly of any regulatory inquiries, investigations, site visits (whether announced or unannounced), correspondence or communication that relates to the Study and will consult and cooperate with Sponsor in responding to any such event, including providing documents, information and access as properly requested.Institution and Investigator will make all reasonable efforts to coordinate any scheduling of agency inspections to permit Sponsor and its designees to attend such inspections. Institution and Investigator will make reasonable efforts to segregate, and not disclose, any Records or other materials, correspondence and documents that are not required to be disclosed during such an inspection, including financial data and pricing information.  If the EC or any Regulatory Agency issues any notice, warning, demand, report or request related to the Study, Institution or Investigator, as applicable, shall send a copy of such document promptly to Sponsor, along with any proposed response to such document, before the same is submitted to the EC or any Regulatory Agency.”

By was of example, one can click here to view a 2015 Warning Letter, issued to a principle investigator, following a site inspection in France.

Of course, a sponsor may agree to a site request to omit reference to compliance with notification of an FDA inspection (remember, sponsors “audit” but the FDA “inspects”; the FDA does not “audit”, even though many in the industry use the terms interchangeably) in an effort to finalize the agreement in a timely manner. Our role at CA is to advise that the FDA can inspect any foreign site on a clinical study and we strongly urge sponsors to obtain a site’s agreement to be given immediate notice of any regulatory inspection during the study.