Tracking Pedigree Rules

June 30, 2009 – 12:20 pm

The Buyer-Matheson bill has generated a lot of interest, and with good reason. Pharma, the wholesalers, the retailers, and FDA have reported discussions or close collaboration with the bill’s sponsors on the pedigree legislation. Though its near-term prospects are uncertain given legislative focus on the economy, the bill is expected to be reintroduced into the 111th Congress this year.

Buyer would set new federal-level direction for serialization and traceability. Discussion drafts of the bill reference the requirement in the FDAAA ACT of 2007 for a serialized SNI, while setting implementation dates for an electronic solution in line with California’s law.

Buyer defines an interim pedigree process as a migration path to electronic pedigree. The pedigree requirements would circumvent problems with FDA’s partially-implemented PDMA-based pedigree rule that went into effect in 2006. Among other things, the bill revises the definition of an authorized distributor of record. (see the upcoming “Pulling For Auto ID” story in the July issue).

Not incidentally, the bill calls out that states’ pedigree rules can’t exceed the federal provision, thereby establishing a uniform pedigree requirement, for the run up to 2015.

As things stand today, wholesalers face a thicket of state regulations, and different pedigree practices by their supply chain partners. Novis Pharmaceuticals is providing electronic pedigrees on all shipments, regardless of prevailing regulations in each state. The specialty therapeutics distributor has adopted SupplyScape’s Nexus traceability and e-pedigree platform for sending pedigrees via GS1’s Drug Pedigree Messaging Standard.

The company often has to chase down information from manufacturers, and key in data from hard copy transactions, for initiating pedigrees following varying pedigree mandates, says Jorge Rodriguez, vice president of operations.

“We developed our own set of criteria. We classify each item based on the compliance level of the pedigree, then manage and control those items accordingly with the help of our business systems,” Rodriguez says.

The data from upstream partners “varies tremendously” in content and form. Virtually all of Novis’s downstream partners access the pedigrees from the SupplyScape software through a portal on Novis’s Web site.

“Most of our customers don’t have the gateways to receive the pedigrees electronically. After the shipment leaves our building, we communicate that the pedigree is available through the web site and provide an access code.

“Our responsibility is to make the pedigree available to the downstream customer prior to or simultaneously with its arrival at their dock. We haven’t really looked into (how it is being used). Some customers are very diligent about it. There are probably others that have never (visited the site),” he says.

Additionally, Novis is supplying serialized bar-coded medications to customers participating in its RxID solution. The distributor assigns serial numbers to all items received. Inventoried 2D bar-coded labels are applied to products shipped to customers of the RxID solution. Hospitals participating in recent pilots scanned the codes at established locations, and tracked inventory information and items’ pedigree history using the MedBoard web-based medication tracking system from MedKeeper.

“RxID is our patient safety initiative to help our customers track the products they purchase from us. We expect they will authenticate the information, so they can then know a product is safe prior to its use,’ Rodriguez says.

David Vaczek

Don’t Eliminate Redundancy!

June 25, 2009 – 4:51 pm

FDA played enforcer today, seizing drugs made by Caraco Pharmaceutical Laboratories Ltd. While product cross contamination and inconsistent dosing were the significant issues, packaging and inspection were among the company’s list of violations. According to last October’s warning letter, Metformin HCI tablets were contaminated with metal, and the company explained that the metal was related to an operator failing “to properly tighten [something] during machine set-up.” Also cited was the firm’s “failure” to follow standard operating procedures for “product finishing, packaging, and disposition.”

The warning letter also states that, “Rather than allowing your operators to continue the in-process inspections of tablets (which appeared to be effectively detecting product defects), your response indicates that QCU will no longer allow the operators to perform these inspections in an effort to eliminate redundancies (inspections are performed by the QCU) and inspection discrepancies concerning the inadequate documentation of batch records.”

Eliminating such redundancy didn’t sit well with FDA: “You should not eliminate a process that improves the quality of your products without sound justification,” the letter stated.

Such problems at at modern pharma plant are surprising. In our May 2009 inspection technology feature, experts report that pharma companies are stepping up inspections, with some flocking toward systems that institute redundancy. Explains Bob Ries, lead product manager for product inspection at Thermo Fisher Scientific, in the article: “The pharmaceutical industry in particular has always been concerned with maintaining product quality, and it keeps setting the bar higher and higher. In the past, we inspected for contaminants measuring a half-millimeter. Now, we are looking for a quarter-millimeter. In the future, needs will be even more sensitive.”

FDA is sure on the lookout for issues that threaten product quality. Apart from Caraco troubles, the big headlines this year have been in problematic food quality. I hope that today’s news in pharma is an anomaly.

Daphne Allen

Thanks for the Discounts, But Pay Attention to Drug Noncompliance, Too

June 23, 2009 – 12:04 pm

Peter Mayberry beat me to it: the Healthcare Compliance Packaging Council applauds pharmaceutical industry discounts amounting to $80 billion for certain Medicare beneficiaries, but the group wonders why drug noncompliance is still being ignored. So do I!

“Published research points to several key reasons why people don’t take their prescription drugs properly,” notes Mayberry, who serves as executive director of HCPC. “And one reason that is almost always on the top of the list is ‘forgetfulness.’” HCPC says that such noncompliance “drains more than $180 billion from our national economy every year due to unnecessary emergency room visits, hospital stays, trips to the doctor, lost productivity, and early death.”

The discounts to Medicare beneficiaries are great news and will help jumpstart healthcare reform, but HCPC claims far greater savings can be achieved if immediate steps are taken to help people take their prescription drugs properly. If better packaging can improve compliance by a mere 10%, Mayberry notes, annual savings should equal about $18 billion. “Over ten years,” he pointed out, “that is more than double what the PhRMA program seeks to achieve.”

Mayberry points to an Ohio State University study that found that patients who received their drugs in blister packs with compliance-prompting features refilled their prescriptions in a much more timely manner and also achieved markedly better reductions in their blood pressure readings.

So, if patients get better healthcare results from better drug compliance, why aren’t compliance-enhancing packages filling pharmacy shelves?

In addition to drug companies offering discounts, for long-term healthcare benefits, they could put their money into compliance packaging. If patients follow their doctor-prescribed regimens better, they may not need more-costly healthcare procedures in the future.

PhRMA itself reports that “innovative new medicines make it possible to prevent or slow the progress of many diseases and avoid costly hospitalization and invasive surgery. Between 1980 and 2000, the number of hospital days fell by 56%. As a result, Americans avoided 206 million days of hospital care in 2000 alone because of our investment in health care.”

Think of how much MORE could be saved if Americans were more compliant with their drug regimens!

Daphne Allen

P.S. I have also wondered why compliance packaging isn’t being tapped to help gather comparative effectiveness data. If packaging keeps patients on treatment, think of the data! We’d have even more insight into how pharmaceuticals can help reduce future medical costs.

Intimacy (via Twitter)

June 22, 2009 – 3:45 pm

I’d like to give a shout out to my fellow editor Christiane Truelove, editor-in-chief of Med Ad News and R&D Directions, who reported from the Healthcare Communication & Marketing Association’s 2009 event last week, The Family. She shared speaker presentations via Twitter, and on Friday, in particular, my cell phone kept beeping with her tweets all morning. I felt like I was there!

Pharmaceutical marketing is changing, given the push back on promotional items and even drug samples, and Truelove shared speaker advice as they spoke. “Mario Nacinovich: mistakes made in the past, but there’s a lot to be proud of in pharma industry. Opportunity here to do responsible mkting” read one tweet. I couldn’t agree more. (Nacinovich is the president-elect of HCMA.)

One tweet should resonate with you: “Audience member points out it’s up to industry to create a more intimate relationship with the consumer.”One definite way is to start with what the patient holds in his or her hand: the package.

Packaging can help drug companies speak intimately with patients, day after day, beyond the doctor’s office or the pharmacy, in the privacy of their homes. Packaging can help deliver drugs in ways that engage the patient and keep them tuned into their regimens. I have seen sample packaging and starter kits that provide detailed patient instructions and cues that encourage greater understanding of the condition the drug treats. In some cases, the packaging can even help reassure patients who may be troubled with a diagnosis.

Of course, drug companies must watch what they promote in packaging and labeling. FDA issued guidance in May on promotional labeling for prescription drugs and medical devices, with emphasis on risk disclosure. “A promotional communication that conveys a deceptive net impression of the product could be misleading, even if specific individual claims or presentations are not misleading,” FDA writes.

As Nacinovich said above, the pharma industry has an opportunity “to do responsible marketing.” I believe that companies can utilize packaging and labeling to communicate product information in clear language that speaks directly to patients without misleading them. Packaging reminders, too, can foster better drug adherence, which can strengthen the relationship between consumer and product.

Packaging and labeling specifically designed with the patient in mind is certainly more “intimate” than standard pharmacy-issued amber vials!

Daphne Allen

P.S. Follow us on Twitter! @daphneallen and @ChristianeTrue!

Packaging Line Efficiency=Greener and More Competitive

June 18, 2009 – 12:35 pm

Several advance press releases for NPE 2009 are focusing on “earth-friendly” plastics and “sustainable” processes.  They also discuss “creating value” and “remaining competitive” in “difficult economic times.” I am intrigued by these statements because we are in the midst of preparing for next week’s “Sustainability 102″ Webcast on Packaging Line Efficiency, to be held on Wednesday, June 24.

In pharmaceutical and medical device packaging, one of the best ways to simultaneously reduce environmental footprints and remain competitive is to ensure that your packaging lines are running as efficiently as possible. In other words, get the most out of your lines while they are running, and ensure that they are not down when you need them to be up. Our experts speaking in the Webcast will be discussing ways to reduce labor, energy use, and waste on packaging lines; to minimize downtime and rejects; and to increase overall equipment effectiveness (OEE).

We believe that increasing line efficiency will be how pharmaceutical and medical device packagers first approach sustainability along with the ever-pursued requests to “downgauge” or “lightweight” their packages. Using less material, either through less packaging line waste or through smaller, lighter packages, puts less material into the waste stream. Line improvements can often be made much sooner than can material changes.

Format and material changes are certainly happening, too, but at a conservative pace. We are keeping our eyes on novel alternatives, such as those PolyOne will discuss in its June 23 press event at NPE. The polymer provider will discuss PLA biopolymer compounds that are blended with engineering thermoplastics for “higher heat and impact resistance.”

PolyOne will also share news on use of BPA-free Eastman Tritan copolyester, which we saw at last week’s MD&M East.

Other NPE exhibitors promoting greener options include Milacron Plastic Technologies with its PowerPak, a new injection molding machine consuming less energy; Telles with its Mirel bioplastics, which the company says can be used for inhaler housings; Wilmington Machinery with its plastic pallet-making system using 100% recycled materials; and AutoDesk with its Moldflow software that can be used to develop more environmentally friendly parts.

We will keep you posted. In the meantime, be sure to attend our Webcast on June 24 to find out how you can increase line efficiency now.

Daphne Allen

Labeling for Impact

June 18, 2009 – 11:03 am

For a customer looking to preserve billboarding space on sample packaging for a prescription drug, Carton Service-Packaging Insights (Norris, TN) has configured a line for placing two-piece, peel-off labels on the edge of the blister carton. The carton gluing and label application line features a Cognex vision system integrated with a new high-speed labeler.

For a line that will produce 12 million cartons annually, the customer needed assurance that 100% of the pressure sensitive labels are present and placed within the tight tolerances imposed by the carton’s side panels.

“They didn’t want to disrupt any of their graphics from a marketing standpoint. Issues of location, tolerances, and speed had to be addressed. We spent a significant amount of time as we engineered this solution to ensure consistency in the process,” says Scott Garverick, vice president, sales.

“It’s not hard to apply a label with a one-fourth-inch tolerance (package space on each side of the label) for production of 15,000 cartons an hour.  This configuration allows a 3/32-in. tolerance, on a line that has to run at 40,000 cartons an hour to make it worthwhile,” he adds.

For compliance purposes, the drug firm is asking the doctor or pharmacist to peel off the label for reapplication on a record chart for tracking that the drug was received or passed on to the patient.
The vision system is integrated with a gluer, and a high-speed mini-labeler with wipe on applicator from Web Technology, for gluing and applying the label at the same time.

David Vaczek

No Hurt, So No Alert?

June 15, 2009 – 5:29 pm

I attended David Howard’s impassioned session at MD&M East 2009 last week and immediately grew even more concerned about counterfeiting and diversion threats here in the United States.

Almost halfway through his session, an audience member asked Howard whether the threats he was discussing were here in the United States or just elsewhere in the world. “Both,” he answered matter of factly.

If you, too, have any doubt that counterfeiting and diversion occur in the United States, you may have missed FDA’s weekend announcement about stolen and diverted insulin.

FDA reports that “stolen vials of the long-acting insulin Levemir made by Novo Nordisk Inc. have reappeared and are being sold in the U.S. market. Three lots or a total of 129,000 vials of this product were stolen in all.”

MSNBC reports that the vials were stolen in North Carolina and reappeared at a medical center in Houston. Investigators no doubt are looking at the distribution path of these vials and how they ended up in legitimate practitioners’ hands. Will the lot numbers be enough? Did reading the lot numbers send up red flags–XZF0036, XZF0037 or XZF0038, to be exact–or did it take an affected patient to bring attention to the diversion?

And why is the public just hearing about the theft after the diversion? How many other drug or medical device thefts happen with little to no public notice? Is there a policy of, “No hurt, so no alert?”

Daphne Allen

06261974 Is Code for Happy Birthday

June 4, 2009 – 2:18 pm

On Wednesday GS1 US celebrated the 35th anniversary of the Universal Product Code (UPC) bar code at its U Connect Conference in Orlando. The first live scan of a UPC took place in a Marsh Supermarkets store in Troy, OH, on June 26, 1974, when a cashier scanned a package of Wrigley’s, GS1 reports. Interestingly, some lessons learned from this initial scan and those that followed in grocery and other retail environments could influence today’s healthcare reform.

“GS1 has been involved in healthcare for a long time, and GS1 Healthcare US is now a concentrated effort,” explains Dennis Harrison, head of GS1 Healthcare US. “We are taking the concepts used in retail for the last 35 years and applying those same principles to improve healthcare.’”

Improving healthcare involves ensuring patient safety and increasing supply-chain efficiencies, says Harrison. “When healthcare products, such as syringes, are referred to by different names, numbers, and descriptions, it causes confusion and inefficiencies.”

These inefficiencies don’t happen in retail, says Harrison.  GS1 reports that replacing individual price labeling with the UPC resulted in faster, more-accurate checkouts, saving consumers time and money. It also simplified product returns and rebates.

“Industry would not be as efficient without the UPC,” says Sandy Douglas, president of Coca-Cola North America, and chairman of the GS1 US Board of Governors. “The UPC provides a basis for the industry to track products from production to shelf, to move products between companies, and to get products to shoppers quickly.”

Adapting such traceability to healthcare product distribution and use could track product from manufacturer to distributor to hospital, bringing visibility to a chain vulnerable to counterfeiting and diversion. It could even link product to patient, increasing billing accuracy and reducing fraud.

In healthcare distribution, use of GS1’s Global Trade Item Number, the 14-digit number that has evolved from the 12-digit UPC to identify products globally, is emerging as the potential identifier of choice in healthcare. It can carry serial numbers, lot numbers, expiration dates, and other data through the addition of application identifiers. Several group purchasing organizations and trade associations have set deadlines for using the GTIN: widely discussed is the GTIN sunrise date of 2012.

A similar effort to use unique identifiers instead of custom account numbers for locations such as hospitals has also emerged as part of GS1’s Global Location Number (GLN) program. The sunrise date for GLN is 2010.

These foundational standards are necessary to achieve the type of electronic medical record system advocated by President Barrack Obama, says Harrison. “Traceability using common standards-not custom codes or multiple codes-is necessary for these systems to work,” he says.

GS1 celebrated the UPC anniversary by sharing slices of a giant UPC-adorned birthday cake with more than 800 attendees at its annual U Connect Conference. Not sure whether it was scannable.

Daphne Allen

P.S. Don’t miss our GTIN Awareness Survey! Click here to complete.

PVC Ban Bill in CA Won’t Affect You

June 4, 2009 – 2:16 pm

California bill AB 1329,” PVC Packaging,” from California Assemblywoman Julia Brownley (D-CA: 41st assembly district), was amended yesterday to exclude the following packages from its definitions of rigid polyvinyl chloride packaging container and flexible polyvinyl chloride packaging container:

(1) A container that encloses a dangerous drug, as defined in
Section 4022 of the Business and Professions Code, or a container
that encloses an over-the-counter human or veterinary drug,
including, but not limited to, a drug as defined in Section 109925 of
the Health and Safety Code or as defined in Section 321 of Title 21
of the federal Food, Drug, and Cosmetic Act.  
   (2) A container in which a medical device, as defined in Section
109920 of the Health and Safety Code, is enclosed.

We have asked Assemblywoman Brownley’s office to comment on the change. What do you think? Will exempting drug and medical device packaging from this bill take the pressure off these industries to abandon PVC?  Will the anti-PVC campaigns come to an end in healthcare?

Daphne Allen

FDA’s New Look Left Something Out

June 4, 2009 – 2:13 pm

Click on any of the FDA Centers’ pages on the agency’s Web site, and you’ll find a new, (consumer) friendlier FDA. I have seen notes here and there about a Web site redesign, so it is finally here.

I was excited to see that FDA updated its “Counterfeit Drugs” page. It is listed under the Consumer Resources headline, though, so it addresses consumers, not manufacturers. I wonder whatever happened to FDA’s Counterfeit Drug Task Force? An FDA Web site search yielded a 2006 speech as the most recent post.

Maybe FDA is trying to reduce market demand for counterfeit goods by dissuading consumers against their purchase. Links on FDA’s page include “Counterfeit Medicines - Filled With Empty Promises” and “Reporting Unlawful Sales of Medical Products on the Internet.”

In a down economy, consumers look for deals and steals, so maybe FDA’s warnings could give some shoppers pause. FDA’s warning reminds me of an Internet auction site search I did last week when researching a separate story. I found some “interesting” items for sale (brand names deleted):

“$19.99 FOR 6 NEW BLOOD GLUCOSE TEST STRIPS PACKAGES WITH 50 STRIPS IN EACH BOX. EXPIRED IN 2006.”

“$29.99 10 NEW BOXES BLOOD GLUCOSE TEST STRIPS THIS IS OVER 1000 NEW STRIPS…. SAVE MONEY BUY TODAY.” In response to a shopper’s inquiry about the expiration date, this seller wrote: “all are expired in 2007 but should still work fine. Want to make an offer on all?”

Could these up-for-auction strips be counterfeit, diverted, or substandard? Are they even anything to worry about? I certainly cannot tell from my computer screen. But their availability on the auction site indicates consumer demand and willingness to bargain shop, making conditions ripe for counterfeiting and diversion.

FDA is wise to point out the risks to consumers. Drying up demand could shorten supply. But I cannot help but wonder what happened to the task force? Manufacturers still need to remain vigilant in discouraging counterfeiting and diversion. I’ll ask FDA and report back.

Daphne Allen