Amidst the outcry over inadequate foreign inspections, FDA continues to struggle to meet requirements for monitoring pharmaceutical
plants in the United States. The agency's field force has suffered from budget cuts, and recent reorganization plans have
been derailed by opposition from regulatory staffers and from Congress. Perhaps demands to boost oversight of imports will
increase support for domestic regulatory activities as well.
The push on drug pricing Despite concerns about hazardous medicines from overseas, some members of Congress continue to press for more liberal drug-reimporting
policies to help consumers access low-cost medicines. Medicare Part D has greatly expanded government outlays for prescription
drugs, and everyone wants to keep the drug spend under control. Democrats claim that government authority to negotiate payments
for Medicare drug plans will help, as will full disclosure of manufacturer prices, curbs on drug advertising, and expanded
access to low-cost generic drugs.
To achieve this last goal, Congress will continue to seek a pathway for FDA to approve follow-on biologics. The legislators
agreed to drop that issue from FDAAA, but promised to take it up this year. And projections of big cost-savings from biosimilars
will keep it on the front burner.
Comparative effectiveness analysis Better information on which medical treatments work best for certain patients could improve healthcare and cut spending by
reducing inappropriate drug utilization and avoiding unnecessary or harmful procedures. That possibility is boosting support
for a larger government role in assessing medical-treatment effectiveness, while health plans and payers also demand more
evidence that medical products are cost-effective as well as safe and effective medically.
The challenge for drug and medical-product manufacturers is to encourage analysis of how drugs compare with alternative medical
and surgical procedures—and not to use this information to control prices or deny coverage for innovative products. Even if
a study indicates that a drug may be less effective for many patients, there should be room to prescribe that drug for a smaller
patient population that may benefit.
Curbing conflicts of interest More independent assessments are needed because some members of Congress and consumer advocates believe that pharma exercises
too much control over FDA decisions. The critics want to block scientists with industry ties from serving on FDA advisory
boards, but agreed to a FDAAA compromise that allows some conflict-of-interest waivers so that important experts will be able
to provide advice when needed. FDA has issued new policies to make COI and waiver policies more transparent and is taking
steps to reduce waivers overall.
Concerns about industry influence at FDA have colored the formation of the new Reagan-Udall Foundation, created by FDAAA to
support innovation and enhance safety for FDA-regulated products. FDA named a 14-member panel, headed by former FDA commissioner
Mark McClellan, to oversee the new organization. But Rep. Rosa DeLauro (D-CT), who chairs the House Appropriations subcommittee
in charge of FDA's budget, has objected that industry influence may lead the foundation to encourage the development of more
profitable, but not necessarily safer, products.
DeLauro plans to hold hearings on Reagan-Udall and other COI issues, while also directing how FDA spends its annual budget.
Sponsors have joined with the biomedical research community and other parties to urge a significant boost in agency resources
so that FDA can better manage its continually expanding responsibilities. A new report to FDA's Science Board says that the
agency needs more money and better computer systems to keep up with important scientific advances and adequately protect the
nation's health [see "Show FDA the Money"]. It's not clear whether Congress will respond to this challenge or if this expert
analysis will just gather dust on the shelf like so many similar undertakings.
Jill Wechsler is Pharmaceutical Executive's Washington correspondent. She can be reached at firstname.lastname@example.org