P3 Law Semester Flashcards
General Definition of Law
Requirements for human conduct applying to all persons within their jurisdiction.
Provides framework for people to resolve their disputes.
Must remain flexible/vague to allow for individual differences, varying contexts of situations, and because they are based on human relationships.
What are the 4 market failures?
Public Goods Externalities Natural monopolies Information asymmetry A market failure justifies government regulation
Definition of public good
necessary and beneficial commodities that private entities will not supply because there is no incentive
(orphan drugs, vaccines, etc.)
Definition of an Orphan Drug
a drug that is sufficiently safe and effective to be marketed, but the number of patients who need it is so small that it is not commercially feasible for a manufacturer to market it.
Not enough demand, thus no profit
Government steps in to ensure availability
Definition of externality
When the production or consumption of a good affects people who do not fully consent to the effect, and when the costs of the good are not fully incorporated in the price of the good
Government regulates this to ensure that an individual’s behaviors do not create an indirect cost for someone else
Ex: air pollution from pharmaceutical manufacturers
Definition of natural monopoly
when the fixed cost of providing a good are high relative to the variable costs of producing the good
Government regulates this market failure to encourage companies to build new infrastructures, created jobs, and create new innovations
What makes up the legislature?
It is an elected body of people with the primary responsibility to enact laws
Legislative power of the federal government is vested in Congress (Senate and House of Reps)
Legislature makes what kind of law?
Statutes
Administrative agencies create laws through…
Hearings
Who creates administrative agencies?
Congress has a say in administrative agency appointments and appropriations
Significant influence
What are the 3 federal administrative agencies that influence pharmacy law?
Department of Health and Human Services (DHHS)
Federal Trade Commission (FTC)
Drug and Enforcement Administration (DEA)
Definition of information asymmetry
when a consumer is uninformed about the true value of a good
What are the two state level administrative agencies that regulate pharmacy practice?
State Boards of Pharmacy
State Department of Health Services
What is the Federal Register?
Basically the “Daily news paper of the Federal Government”
What is in the Federal Register?
Proposed and Final regulations and notices
How often is the Federal Register Published?
Daily
What does CFR stand for?
Code of Federal Regulations
What is in the CFR?
Final regulations divided and indexed by subject matter
How often is the CFR published?
Yearly
Type of law made by the courts
Judicial Opinion
4 Origins of a Bill
Lobbying Groups
Citizens
Government officials
President
Definition of Criminal Law
Government vs. a private party
Uses probable cause and a grand jury
Burden of proof must be “Beyond a Reasonable Doubt” in order to convict.
Definition of Civil Law
Private party vs. Private party
Alleging injury, based upon statute or common law legal rights with the objective to compensate the injured party
Definition of Administrative Action
Violation of a statute or regulation
OR
an act that warrants an investigation
What did the Nutrition Labeling and Education Act of 1990 do?
Mandated nutrition labeling on food products and authorized health or disease-prevention claims on product labeling (only if the product has obtained FDA approval). Only as long as they were made in compliance with FDA regulations
Definition of cGMP
Current Good Manufacturing Practice
Establishes the minimum requirements for the methods, facilities, or controls used in the manufacture, processing, packaging, or holding of a drug product
What did the Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006 do? (DSHEA)
Implemented mandatory reporting of serious adverse events through the FDA’s MedWatch program
Applies to Manufacturers, packagers/distributors whose name appears on product label
The Issue: Anyone can report and the AEs are not verified. Voluntary reporting (some report and some don’t know how to)
What disclaimer must accompany any structure or function claim made by a dietary supplement?
the FDA has not evaluated the claim and the dietary supplement is not intended to diagnose, treat, cure, or prevent any disease
what is the USP?
United States Pharmacopeia.
Establishes approved titles, definitions, and descriptions for drugs.
Sets standards for identity, quality, strength, purity, packaging, stability, and labeling
What is the USPC?
United States Pharmacopeial Convention
Independent of FDA, publishes the USP
Publishes compendiums that are used as legal resources of drug standards
What is the USP-NF?
United States Pharmacopeia - National Formulary Standards
contains monograph of active and inactive ingredients and serves as the official compendium for drug standards in the US
What is the USP-FCC?
United States Pharmacopeia - Food Chemicals Codex
sets standards for purity and quality of food ingredients
includes preservatives, flavorings, colorings, and nutrients
Published every 2 years
What is HPUS?
Homeopathic Pharmacopeia of the United States
Sets the standard for homeopathy products
This is the other official compendium under the FDCA
Regulated by FDCA, recognized by FDA
Class I Product Recall
Issued when there is reasonable probability that the product will cause serious, adverse health consequences of death
Class II Product Recall
Occurs when the product may cause temporary or medically reversible adverse health consequences, but the probability of serious adverse consequences is remote
Class III Product Recall
Applies to products that are not likely to cause adverse health consequences
What did the Medical Device Amendment of 1976 do?
Devices could not be classified as drugs anymore
Required:
Classification of devices according to their function
Premarket approval
Establishment of performance standards
Conformance with GMP regulations
Adherence to record and reporting requirements
FDCA Definition of Adulteration
FDCA states that a drug is adulterated if it is:
Prepared, packaged, or held in conditions where it may have been contaminated, exposed to a container that may have contaminated it, or manufactured under conditions that do not conform to current GMP
Consists of any filthy, putrid, decomposed substance, in part or whole
Prepared, Packaged, or held in unsanitary conditions which cause contamination
Creation or storage of drug do not comply with GMP
Product represents a drug in the official compendium, but it’s strength differs or quality is below what is stated in the official compendium
Product is mixed or packaged as to decrease quality or strength
Product contains an unsafe coloring Additive
FDCA definition of misbranding
labeling is false or misleading
any word or statement is not prominently placed on the label or tricky wording is used
Label should contain name and place of manufacturing, quality in terms of weight, measure, or numerical count, proportion of each active ingredient, and name of inactive ingredients in alphabetical order on outside of packaging
Breakdown of NDC code sections
5-4-2
5 - Manufacturer/Distributor code
4 - Specifies strength, dosage form, and formulation
2 - Packaging size and/or type of drug
FDCA definition of a new drug
a drug that is not generally recognized among experts as safe and effective for use
Definition of GRASE
Generally Recognized as Safe and Effective
If manufacturers can prove this, their product may not be considered a new drug
5 ways for an approved drug to become a new drug
Drug contains a new substance
There is a new combination of approved drugs
Proportion of ingredients in combination has changed
new intended use for the drug
Dosage, method, or duration of administration has changed
Phase I Clinical Trials
Small number of people
look at basic pharmacology (metabolism, BA, Toxicity)
Purpose is to detect adverse effects of Drug
Phase II Clinical Trials
Small number of patients who actually have the disease
Purpose is to determine efficacy of the drug and dosage
Phase III Clinical Trials
Large sample size
Performed in actual clinical settings
Usually double-blinded with control group (placebo)
Purpose is to test drug for safety and efficacy
Phase IV Clinical Trials
Post-marketing studies
Process for a new drug to become an approved drug
FDA can terminate at any phase of trials
FDA’s determination is final and cannot be subject to appeal or judicial review
about 1 in 10 drugs make it through the IND application. If FDA approves, the manufacturer then applies for an NDA to the FDA
Definition of REMS
Risk Evaluation and Mitigation Strategy
Risk management programs established under FDAAA 2007 to manage patient safety in high risk drugs
Various “elements to assure safe use” may be required to ensure patient safety:
- Medication Guide, PPI, Communication plan
- Special training or experience for HCP
- Use/Dispense only in specified setting
- Patient enrollment or registration
- Required monitoring and testing
Definition of ETSAU
Elements to Assure Safe Use May be required under REMS to ensure patient safety Includes: - medguide, PPI, Communication plan - Special training or experience for HCP - Use/dispense only in specified settings - Patient enrollment or registration - Required monitoring and testing
2 things the Durham Humphrey Amendment of 1952 did
Establish 2 classes of Drugs (OTC/RX)
Authorized Oral Rx Refills
Expiration Date Definition
Final day the drug is expected to meet the requirements of the USP drug monograph for the drug
Definition of BUD
Beyond Use Date
Established by Pharmacies
Drug Stability not guaranteed after the BUD
Should not exceed expiration date (usually 6 months to 1 year after made/filled or drug/ingredient expiration date, whichever is earlier)
Definition of CPA
Written contractual agreements in the form of protocols and procedures
Definition of NTI
Narrow Therapeutic Index
Safe and effective use of these drugs requires careful titration and patient monitoring
2 things the Prescription Drug Marketing Act of 1987 did
Prohibit resale of prescription drugs purchased by hospitals and health systems
Wholesale distributors of prescription drugs required to be licensed by the state
Definition of Pedigree
Record containing information on every transaction changing the ownership of the drug
3 components of OBRA ‘90
Rebates
Demonstration projects
Drug Use Reviews (DUR)
3 components of DUR
Retrospective review
Educational programs
Prospective review
What does Pro-DUR stand for?
Prospective Drug Use Review
Definition of “Best Price”
lowest price at which the manufacturer sells the product to any customer
Definition of AMP
Average Manufacturer Price
On average, how much the manufacturer charges the wholesaler in a quarter
OBRA ‘90 Rebate
Requires manufacturers to provide drug products to the medicaid program at their best price
What were the OBRA ‘90 Demonstration Projects
OBRA-funded demonstration projects to evaluate whether the DUR requirements would result in improved patient care and decreased cost
What are the OBRA ‘90 Retrospective DUR?
Performed by a DUR board made up of physicians and pharmacists.
Review medication use trends and data over specified time periods
Attempt to evaluate medication use
What are the OBRA ‘90 Educational Programs?
Conferences
Face-to-face meetings with prescribers or pharmacists
written materials
3 components of OBRA ‘90 Pro-DUR
Screening (7 categories of potential problems)
Counseling
Documentation
Elements of Counseling in Pro-DUR
Name/description of drug
Dosage form/dosage/ROA/Duration
Special precautions/directions for handling and storage
Common or severe SE, interactions and CI, and what to do
Techniques for self-monitoring
Refill information
What to do if a dose is missed
Elements of Screening in Pro-DUR
Therapeutic duplication Drug-disease interaction Drug-drug interaction Allergies Incorrect dosage duration of therapy clinical abuse/misuse
OBRA ‘90 3 requirements for documentation
to serve as a reminder to the pharmacist
provide reference to colleagues
show law enforcement officials that OBRA ‘90 requirements are being met
What are the 4 purposes of OBRA ‘90 documentation requirements
Serve as a reminder to the pharmacist
provide reference to other pharmacists
show enforcement officials that OBRA ‘90 requirements are being met
show surveyors who need records for what was done in connection to outcome of interest
What does HIPAA Stand for?
Health Insurance Portability and Accountability Act of 1996