Democrats are back on top in the Congress and are mapping a broad agenda for change. Prescription drug pricing, medical product
safety, and access to treatments are high on the priority list. Manufacturers will be on the hot seat answering questions
about patent policies, high-risk products, and why new biotech therapies cost so much. However, the real challenge will be
gaining approval of a bill to reauthorize the Prescription Drug User Fee Act (PDUFA) before the program expires on September
30, 2007. Such legislation would renew user fees for medical devices and continue the pediatric drug exclusivity program.
Reaching agreement on these measures in a short time frame will require the industry to negotiate with some highly critical
Congressional leaders. Reps. John Dingell (D-Mich) and Henry Waxman (D-Ca), both key players in shaping the original user
fee program 15 years ago, will be orchestrating the debate. Dingell now chairs the House Energy and Commerce Committee, which
oversees the Food and Drug Administration (FDA) and health care programs. Waxman is the senior Democrat on that panel. He
will also be investigating industry practices and FDA programs as chairman of the House Government Reform Committee.
The more narrowly divided Senate will adopt a collaborative approach. Senate Health, Education, Labor and Pensions Committee
chairman Sen. Ted Kennedy (D-Mass) has cosponsored drug safety legislation with now ranking minority member Mike Enzi (R-Wyo).
The two plan to work together on PDUFA reauthorization and related measures.
PDUFA CHRISTMAS TREE
FDA officials and industry representatives have been discussing user fee options for several months with the goal of presenting
an agreed-on user fee plan to initiate the debate. The new five-year proposal includes requested fees, timelines for application
processing, and the range of FDA activities that fees will support, including a significant expansion in FDA postmarketing
safety oversight. The agreement is expected to boost user fees considerably, raising the cost of filing a market application
near the $1 million mark.
With Democrats and Republicans unlikely to agree on many legislative proposals this year, both sides will regard any PDUFA
bill as a ready vehicle for enacting a broad range of healthcare issues. Measures to enhance drug safety, to speed biogeneric
products to market, and to expand drug importing are all likely to be hung on the PDUFA Christmas tree.
"All these issues will be in play," acknowledges Jim Greenwood, president of the Biotechnology Industry Organization (BIO)
and formerly a leading Republican on the House Energy & Commerce Committee. Industry's task is to identify a working majority
in the House and Senate that can "deal with these issues responsibly," he says; with PDUFA, "we can't play veto games."
FOCUS ON SAFETY
A top priority for Congressional leaders is to enact drug safety legislation. The Kennedy-Enzi bill calls for stronger controls
on the use of high-risk therapies, a more powerful drug safety oversight board to resolve disputes, curbs on new drug advertising,
disclosure of clinical trial results, and penalties for failure to complete postapproval studies—but not an independent drug
safety office, as others advocate. Enzi and Kennedy held a hearing on the proposal in November 2006 to jump-start deliberations
on this issue.
Drug safety problems often involve inadequate product quality control, a topic that FDA continues to address through its "Pharmaceutical
cGMPs for the 21st Century" initiative. Since its final report on this program in September 2004, FDA's Council on Pharmaceutical
Quality has headed up agency efforts to adopt a more risk-based approach to GMP inspections, manufacturing supplements, data
submissions, and system documentation. FDA is holding a workshop in late February 2007 to review progress and to update industry
on the quality initiatives being implemented. Congressional panels and the HHS Inspector General are interested in knowing
how well manufacturers comply with GMPs.
FDA officials and industry executives worry that mandates for more safety data and curbs on drug uses will slow down new product
development and approval. FDA's "Critical Path" initiative and the more recent "Opportunities List" aim to offset such trends
by modernizing the drug development process to keep pace with advances in biomedical research.