80_FR_27784 80 FR 27691 - Agency Information Collection Activities; Submission for Office of Management and Budget Review; Comment Request; Survey of Pharmacists and Patients; Variations in the Physical Characteristics of Generic Drug Pills and Patients' Perceptions

80 FR 27691 - Agency Information Collection Activities; Submission for Office of Management and Budget Review; Comment Request; Survey of Pharmacists and Patients; Variations in the Physical Characteristics of Generic Drug Pills and Patients' Perceptions

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 80, Issue 93 (May 14, 2015)

Page Range27691-27694
FR Document2015-11623

The Food and Drug Administration (FDA) is announcing that a proposed collection of information has been submitted to the Office of Management and Budget (OMB) for review and clearance under the Paperwork Reduction Act of 1995.

Federal Register, Volume 80 Issue 93 (Thursday, May 14, 2015)
[Federal Register Volume 80, Number 93 (Thursday, May 14, 2015)]
[Notices]
[Pages 27691-27694]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-11623]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

[Docket No. FDA-2014-N-1491]


Agency Information Collection Activities; Submission for Office 
of Management and Budget Review; Comment Request; Survey of Pharmacists 
and Patients; Variations in the Physical Characteristics of Generic 
Drug Pills and Patients' Perceptions

AGENCY: Food and Drug Administration, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Food and Drug Administration (FDA) is announcing that a 
proposed collection of information has been submitted to the Office of 
Management and Budget (OMB) for review and clearance under the 
Paperwork Reduction Act of 1995.

DATES: Fax written comments on the collection of information by June 
15, 2015.

ADDRESSES: To ensure that comments on the information collection are 
received, OMB recommends that written comments be faxed to the Office 
of Information and Regulatory Affairs, OMB, Attn: FDA Desk Officer, 
FAX: 202-395-7285, or emailed to [email protected]. All 
comments should be identified with the OMB control number 0910-New and 
title ``Survey of Pharmacists and Patients; Variations in the Physical 
Characteristics of Generic Drug Pills and Patients' Perceptions.'' Also 
include the FDA docket number found in brackets in the heading of this 
document.

FOR FURTHER INFORMATION CONTACT: FDA PRA Staff, Office of Operations, 
Food and Drug Administration, 8455 Colesville Rd., COLE-14526, Silver 
Spring, MD 20993-0002, [email protected].

SUPPLEMENTARY INFORMATION: In compliance with 44 U.S.C. 3507, FDA has 
submitted the following proposed collection of information to OMB for 
review and clearance.

Survey of Pharmacists and Patients; Variations in the Physical 
Characteristics of Generic Drug Pills and Patients' Perceptions (OMB 
Control No. 0910--NEW)

    Generic drugs make up approximately 85 percent of all human 
prescription drugs prescribed in the United States. While generic drugs 
are required to be pharmaceutically equivalent and bioequivalent to 
their brand-name counterparts, generics made by different manufacturers 
may differ substantially from their brand-name therapeutic equivalents 
and from each other in their physical appearance (e.g., color, shape, 
or size of pills). When pharmacists switch generic drug suppliers, 
patients refilling their generic prescriptions may therefore experience 
changes in their drugs' appearances. These changes may result in 
patient confusion and concerns about the safety and effectiveness of 
the generic drug products. Studies indicate that patients are more 
likely to stop taking their generic medications when they experience a 
change in their drugs' physical appearances, leading to harmful 
clinical and public health consequences as well as increased health 
care costs from avoidable morbidity and mortality.
    To provide additional information that may help guide regulatory 
policy or pharmacy business practices, we intend to conduct surveys of 
pharmacists and patients about their perceptions about and experiences 
with generic drug product pill appearance change. These surveys are 
intended to further our understanding of the relationship between 
changes in pill appearance and non-adherence to prescribed therapeutic 
regimens. The surveys may enable us to investigate factors that may 
explain the association between changes in pill

[[Page 27692]]

appearance and non-adherence, including which factors could be modified 
to improve the safe and effective use of generic drugs.
    We intend to survey a national cohort of pharmacists about their 
experiences with dispensing generic drug pills that differ in 
appearance from previous refills of the same medication and dosage 
level (e.g., when pharmacies switch generic suppliers). A stratified, 
random sample of U.S.-licensed pharmacists will be obtained based on a 
master list from KM Lists. The target sample includes pharmacists with 
active licenses who practice in traditional community pharmacy settings 
and will be proportionally allocated across the U.S. in relation to the 
number of pharmacists in each state. Based on an 11 percent 
undeliverable rate and a 52 percent response rate, 2,161 questionnaires 
will be mailed to pharmacists to obtain the 1,000 responses required 
for adequate statistical power. The pharmacists' survey will consist of 
a mailed questionnaire rather than a telephone survey or an email 
survey. Prior experience conducting surveys has shown that it is easier 
to guarantee respondent anonymity using an impersonal, mailed 
questionnaire with no individual identifying information. The 
pharmacists will be asked about the frequency with which their pharmacy 
changes suppliers that lead to variations in the appearance of the 
generic drugs that they dispense, as well as strategies they use with 
patients to address the transition to pills that have a different 
appearance (e.g., alert stickers on pill bottles, verbal warnings, and 
other strategies). They will also be asked about patient responses to 
changes in pill appearance, including what types of appearance changes 
seem to affect patients most often (shape/color/size), how often 
patients report confusion about pill appearance, and how often patients 
ultimately refuse to accept the new product. Participation is expected 
to take approximately 20 minutes.
    We also intend to survey two different patient samples using two 
methodologies. The first is a telephone survey of patients who are 50 
years and older and who take one or more generic medications for at 
least one of the following chronic conditions: Epilepsy, diabetes, 
hypertension, hyperlipidemia, depression, and HIV. The telephone survey 
will be generalizable and will consist of well-defined methods to 
minimize sampling bias such as use of random phone numbers for both 
landlines and mobile phones, as well as small-batch sampling to ensure 
a high response rate that meets demographic diversity goals. For the 
second patient survey, patients will be selected from a proprietary 
research database of commercially insured patients containing medical 
and pharmacy claims linked to health insurance enrollment information. 
A nationally representative sample of patients with at least one 
chronic condition and who experienced a change in physical appearance 
of a generic pill will be identified by the research team using medical 
and pharmacy claims data. Both patient surveys will consist of 
questions covering topics similar to those asked in the survey of 
pharmacists and is intended to provide answers to the same topic areas 
from patients' perspectives. As before, topic areas will include 
beliefs about generic drugs, outcomes related to changes in generic 
drug pill appearance, and strategies used by pharmacists or doctors to 
alert patients to the possibility of changes in appearance. 
Participation is expected to take approximately 20 minutes.
    In the Federal Register of October 15, 2014 (79 FR 61872), FDA 
published a 60-day notice requesting public comment on the proposed 
collection of information. Comments submitted raised several issues 
pertaining to the proposed collection of information. We summarize the 
comments and provide our responses below:
    (Comment 1) Two comments expressed concerns related to trade dress 
protection issues, noting that the requirement that generic products 
differ in appearance from the Reference Listed Drug is well established 
in case law. A pill's physical appearance can qualify as trade dress, 
protected under the Lanham Act (Pub. L. 79-489), which functions to 
distinguish between products from different manufacturers. A drug's 
physical appearance can also be considered a protected form of non-
verbal expression under the First Amendment. If required to change the 
appearance of their medications, the generic industry would face 
additional development costs.
    (Response) The purpose of these surveys is to gather information on 
the awareness of patients and pharmacists about changes in the 
appearance of medications, the frequency with which changes in 
appearance occurs, strategies that pharmacists use to inform patients 
when the appearance of their medications changes, and the outcomes 
associated with these strategies. The results of the surveys will be 
used to inform the development of patient education about differences 
in pill appearance and inform the development of education for 
pharmacists on strategies to counsel patients when the appearance of 
their medications changes. The purpose of these surveys is not to 
reverse existing legal precedents, require the generic drug industry 
change the appearance of their medications, or support the infringement 
of intellectual property, First Amendment, or any other legally 
protected interests.
    (Comment 2) One comment mentioned that the term ``pill'' is used in 
the Federal Register notice to describe oral solid dosage forms such as 
tablets and capsules, but is defined by Merriam-Webster much more 
narrowly to exclude tablets and capsules, which has the potential to 
create confusion.
    (Response) Because the FR notice is seeking opinions from the 
public, we used language accessible to the general public. To avoid 
confusion, the word ``pill'' is defined in the introduction of each 
survey instrument to clarify its meaning, with the statement that the 
word ``pill'' includes both tablet and capsule dosage forms.
    (Comment 3) One comment mentioned that the survey findings may be 
used by FDA to guide pharmacy business practice, which is the 
jurisdiction of the State Boards of Pharmacy.
    (Response) As stated earlier, the purpose of these surveys is to 
gather information on the awareness of patients about changes in the 
appearance of their medications, the frequency with which changes in 
appearance occurs, strategies that pharmacists use to inform patients 
when the appearance of their medications changes, and the outcomes 
associated with these strategies. The results of the surveys will be 
used to inform the development of patient education about differences 
in pill appearance and inform the development of education for 
pharmacists on strategies to counsel patients when the appearance of 
their medications changes. FDA does not intend to, itself, guide 
pharmacy business practices.
    (Comment 4) One comment expressed concern that confidential patient 
information from an insurance database will be identified and shared 
with Federal Government employees, which may violate HIPAA regulations.
    (Response) These surveys received approval from the Institutional 
Review Board (IRB) at the academic medical center where the survey is 
being conducted, which was accepted by FDA's IRB (Research In Human 
Subject Committee). IRB approval ensures compliance with human 
subjects' protection laws, including HIPAA. No FDA personnel will have 
access to any identifiable patient information.

[[Page 27693]]

    (Comment 5) One comment suggested that instead of conducting the 
study, FDA should data mine an internal source of data (product 
complaints received from pharmaceutical companies, healthcare 
providers, and consumers) to gather information on potential confusion 
and medication mistakes.
    (Response) The proposed study focuses on patient and pharmacist 
experiences and outcomes associated with changes in pill appearance, a 
topic of which patient confusion and medication mistakes are only a 
part. Although some medication mistakes and patient confusion data may 
be captured in our internal database (FDA's Adverse Event Reporting 
System), the specific data sought from the proposed study do not exist 
in this database.
    (Comment 6) One comment suggested that if the information on 
potential confusion and medication mistakes cannot be found in current 
databases, FDA should request that pharmacy school students conduct 
this study and publish results in a peer-reviewed journal to assure 
transparency and reduce government spending.
    (Response) High-quality surveys require substantial resources that 
would likely not be available to pharmacy students for class projects. 
These surveys are being conducted by an academic medical institution 
that has expertise in conducting surveys of patients and health care 
providers, which will provide high-quality and valid data and assure 
transparency. The results will be published in a peer-reviewed 
journal(s) and will be made publicly available.
    (Comment 7) One comment mentioned that these surveys will collect 
data on pharmacist and patient perceptions, which may not correlate to 
actual use data and thus may not provide meaningful information on safe 
and effective use of generic drugs or yield substantial evidence to 
support adoption of any regulatory policies. The comment noted that 
further investigations will be needed to understand how pharmacist and 
patient perceptions translate to actual practices and effects, and 
encouraged FDA to consider comments to Docket No. 2013-N-1434 in 
considering what further work will be needed and the level of evidence 
needed to support any regulatory policy changes.
    (Response) These surveys include questions on patient and 
pharmacist perceptions, as well as their actual experiences and 
behaviors as they relate to generic drugs and changes in drug 
appearance. The survey findings will be used to inform the development 
of patient education about differences in pill appearance and inform 
the development of education for pharmacists on strategies to counsel 
patients when the appearance of their medications changes.
    (Comment 8) One comment noted that if this study is conducted, the 
surveys should be carefully crafted to collect useful data using 
validated, well-developed methodology and assumptions. The comment 
requested the opportunity to review the proposed surveys and to submit 
additional survey questions.
    (Response) Well-established survey methods are being used in the 
development and conducting of this survey. The survey questions were 
carefully crafted according to published guidelines for survey question 
development (Refs. 1 & 2) and were further refined by an expert panel 
that included individuals with pharmacy-related professional 
backgrounds and patient representatives. The survey instruments will 
undergo cognitive testing and formal pre-testing to ensure questions 
are clear and answerable, and that study results are valid and useful. 
A copy of the draft surveys have been provided to the commenter.
    (Comment 9) One comment noted that the variations in the physical 
appearance of drug products may help pharmacists and patients avoid 
confusion, facilitate detection of counterfeit drug products, and serve 
pharmacovigilance purposes by providing information about the source of 
a specific product. Variation in pill appearance can also serve to 
notify patients that the source of their medication has changed. FDA 
should acknowledge the ways in which differences in pill appearance are 
beneficial when determining whether and how to conduct the survey.
    (Response) The focus of these surveys is on identifying patient and 
pharmacist concerns and problems related to changes in pill appearance, 
with the goal of informing the development of future patient and 
provider educational interventions and programs to address identified 
problems. However, it is acknowledged that changes in the physical 
appearance of medications could have both negative and beneficial 
effects. Therefore, questions have been added to gauge how changes in 
pill appearance may benefit pharmacists and patients.
    (Comment 10) One comment commended FDA for planning this study. The 
commenter was also pleased that FDA plans to conduct two separate 
patient surveys to ensure that a broad and relevant patient experience 
is reflected in the results.
    (Response) We thank this commenter for the support of our study and 
agree that conducting two separate patient surveys will improve the 
validity and generalizability of the results.
    FDA estimates the burden of this collection of information as 
follows:

                                     Table 1--Estimated Reporting Burden \1\
----------------------------------------------------------------------------------------------------------------
   Surveys of pharmacists and
  patients on variations in the                      Number of
   physical characteristics of       Number of     responses per   Total annual   Average burden    Total Hours
generic drug pills and patients'    respondents     respondent       responses     per response
           perceptions
----------------------------------------------------------------------------------------------------------------
Pharmacist surveys mailed \2\...           2,161  ..............  ..............  ..............  ..............
Pharmacist pretests.............               9               1               9           0.333               3
                                                                                    (20 minutes)
Pharmacist survey completes.....           1,000               1           1,000             0.3             300
                                                                                    (18 minutes)
Patient #1 survey calls.........           5,000  ..............  ..............  ..............  ..............
Patient #1 surveys screened.....           3,330               1           3,330           0.033             111
                                                                                     (2 minutes)
Patient #1 surveys eligible.....           1,200  ..............  ..............  ..............  ..............
Patient #1 survey pretests......               9               1               9           0.333               3
                                                                                    (20 minutes)
Patient #1 survey completes.....           1,000               1           1,000             0.3             300
                                                                                    (18 minutes)
Patient #2 surveys mailed \2\...           2,000  ..............  ..............  ..............  ..............

[[Page 27694]]

 
Survey of patients #2...........           1,000               1           1,000             0.3             300
                                                                                    (18 minutes)
                                 -------------------------------------------------------------------------------
    Total.......................  ..............  ..............  ..............  ..............           1,017
----------------------------------------------------------------------------------------------------------------
\1\ There are no capital costs or operating and maintenance costs associated with this collection of
  information.
\2\ Eligibility is determined prior to mailing the surveys; screening is not required.

References

    The following references have been placed on display in the 
Division of Dockets Management (see ADDRESSES) and may be seen by 
interested persons between 9 a.m. and 4 p.m., Monday through Friday, 
and are available electronically at http://www.regulations.gov.

1. Woodward, C.A., ``Questionnaire Construction and Question Writing 
for Research in Medical Education,'' Medical Education, 22, pp. 345-
363 (1988).
2. Fitzpatrick, R., ``Surveys of Patient Satisfaction: II--Designing 
a Questionnaire and Conducting a Survey,'' British Medical Journal, 
302(6785), pp. 1129-1132 (1991).


    Dated: May 8, 2015.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2015-11623 Filed 5-13-15; 8:45 am]
BILLING CODE 4164-01-P



                                                                             Federal Register / Vol. 80, No. 93 / Thursday, May 14, 2015 / Notices                                           27691

                                              presented coding challenges and that                    and Drug Administration, 8455                         202–395–7285, or emailed to oira_
                                              these challenges have led to the creation               Colesville Rd., COLE–14526, Silver                    submission@omb.eop.gov. All
                                              of subsets of LOINC to help facilitate                  Spring, MD 20993–0002, PRAStaff@                      comments should be identified with the
                                              coding.                                                 fda.hhs.gov.                                          OMB control number 0910-New and
                                                • Should FDA identify a LOINC                                                                               title ‘‘Survey of Pharmacists and
                                                                                                      SUPPLEMENTARY INFORMATION:     On
                                              subset for its use case?                                                                                      Patients; Variations in the Physical
                                                • If yes, should FDA create its own                   February 18, 2015, the Agency
                                                                                                      submitted a proposed collection of                    Characteristics of Generic Drug Pills and
                                              subset or leverage existing subsets?                                                                          Patients’ Perceptions.’’ Also include the
                                                • Which LOINC subsets should FDA                      information entitled, ‘‘Dispute
                                                                                                      Resolution Procedures for Science                     FDA docket number found in brackets
                                              consider?                                                                                                     in the heading of this document.
                                                • What steps can FDA take to                          Based Decisions on Products Regulated
                                                                                                      by the Center for Veterinary Medicine’’               FOR FURTHER INFORMATION CONTACT: FDA
                                              minimize the burden to sponsors and
                                                                                                      to OMB for review and clearance under                 PRA Staff, Office of Operations, Food
                                              applicants in adopting LOINC within
                                                                                                      44 U.S.C. 3507. An Agency may not                     and Drug Administration, 8455
                                              their organizations to support regulatory
                                                                                                      conduct or sponsor, and a person is not               Colesville Rd., COLE–14526, Silver
                                              submissions?
                                                                                                      required to respond to, a collection of               Spring, MD 20993–0002, PRAStaff@
                                              II. Comments                                            information unless it displays a                      fda.hhs.gov.
                                                 Interested persons may submit either                 currently valid OMB control number.                   SUPPLEMENTARY INFORMATION: In
                                              electronic comments to http://                          OMB has now approved the information                  compliance with 44 U.S.C. 3507, FDA
                                              www.regulations.gov or written                          collection and has assigned OMB                       has submitted the following proposed
                                              comments regarding this notice to the                   control number 0910–0566. The                         collection of information to OMB for
                                              Division of Dockets Management (see                     approval expires on April 30, 2018. A                 review and clearance.
                                              ADDRESSES). It is only necessary to send                copy of the supporting statement for this
                                              one set of comments. Identify comments                                                                        Survey of Pharmacists and Patients;
                                                                                                      information collection is available on
                                              with the docket number found in                                                                               Variations in the Physical
                                                                                                      the Internet at http://www.reginfo.gov/
                                              brackets in the heading of this                                                                               Characteristics of Generic Drug Pills
                                                                                                      public/do/PRAMain.
                                              document. Received comments may be                                                                            and Patients’ Perceptions (OMB Control
                                                                                                        Dated: May 6, 2015.                                 No. 0910—NEW)
                                              seen in the Division of Dockets                         Leslie Kux,
                                              Management between 9 a.m. and 4 p.m.,                                                                            Generic drugs make up approximately
                                                                                                      Associate Commissioner for Policy.                    85 percent of all human prescription
                                              Monday through Friday, and will be
                                                                                                      [FR Doc. 2015–11608 Filed 5–13–15; 8:45 am]           drugs prescribed in the United States.
                                              posted to the docket at http://
                                              www.regulations.gov.                                    BILLING CODE 4164–01–P                                While generic drugs are required to be
                                                Dated: May 6, 2015.                                                                                         pharmaceutically equivalent and
                                                                                                                                                            bioequivalent to their brand-name
                                              Leslie Kux,                                             DEPARTMENT OF HEALTH AND                              counterparts, generics made by different
                                              Associate Commissioner for Policy.                      HUMAN SERVICES                                        manufacturers may differ substantially
                                              [FR Doc. 2015–11596 Filed 5–13–15; 8:45 am]                                                                   from their brand-name therapeutic
                                              BILLING CODE 4164–01–P                                  Food and Drug Administration
                                                                                                                                                            equivalents and from each other in their
                                                                                                      [Docket No. FDA–2014–N–1491]                          physical appearance (e.g., color, shape,
                                                                                                                                                            or size of pills). When pharmacists
                                              DEPARTMENT OF HEALTH AND                                Agency Information Collection                         switch generic drug suppliers, patients
                                              HUMAN SERVICES                                          Activities; Submission for Office of                  refilling their generic prescriptions may
                                                                                                      Management and Budget Review;                         therefore experience changes in their
                                              Food and Drug Administration
                                                                                                      Comment Request; Survey of                            drugs’ appearances. These changes may
                                              [Docket No. FDA–2011–N–0509]                            Pharmacists and Patients; Variations                  result in patient confusion and concerns
                                                                                                      in the Physical Characteristics of                    about the safety and effectiveness of the
                                              Agency Information Collection                           Generic Drug Pills and Patients’                      generic drug products. Studies indicate
                                              Activities; Announcement of Office of                   Perceptions                                           that patients are more likely to stop
                                              Management and Budget Approval;
                                                                                                      AGENCY:    Food and Drug Administration,              taking their generic medications when
                                              Dispute Resolution Procedures for
                                                                                                      HHS.                                                  they experience a change in their drugs’
                                              Science Based Decisions on Products
                                                                                                                                                            physical appearances, leading to
                                              Regulated by the Center for Veterinary                  ACTION:   Notice.                                     harmful clinical and public health
                                              Medicine
                                                                                                      SUMMARY:   The Food and Drug                          consequences as well as increased
                                              AGENCY:    Food and Drug Administration,                Administration (FDA) is announcing                    health care costs from avoidable
                                              HHS.                                                    that a proposed collection of                         morbidity and mortality.
                                              ACTION:   Notice.                                       information has been submitted to the                    To provide additional information
                                                                                                      Office of Management and Budget                       that may help guide regulatory policy or
                                              SUMMARY:   The Food and Drug                                                                                  pharmacy business practices, we intend
                                                                                                      (OMB) for review and clearance under
                                              Administration (FDA) is announcing                                                                            to conduct surveys of pharmacists and
                                                                                                      the Paperwork Reduction Act of 1995.
                                              that a collection of information entitled,                                                                    patients about their perceptions about
                                              ‘‘Dispute Resolution Procedures for                     DATES: Fax written comments on the
                                                                                                                                                            and experiences with generic drug
                                              Science Based Decisions on Products                     collection of information by June 15,                 product pill appearance change. These
                                                                                                      2015.
tkelley on DSK3SPTVN1PROD with NOTICES




                                              Regulated by the Center for Veterinary                                                                        surveys are intended to further our
                                              Medicine’’ has been approved by the                     ADDRESSES:  To ensure that comments on                understanding of the relationship
                                              Office of Management and Budget                         the information collection are received,              between changes in pill appearance and
                                              (OMB) under the Paperwork Reduction                     OMB recommends that written                           non-adherence to prescribed therapeutic
                                              Act of 1995.                                            comments be faxed to the Office of                    regimens. The surveys may enable us to
                                              FOR FURTHER INFORMATION CONTACT: FDA                    Information and Regulatory Affairs,                   investigate factors that may explain the
                                              PRA Staff, Office of Operations, Food                   OMB, Attn: FDA Desk Officer, FAX:                     association between changes in pill


                                         VerDate Sep<11>2014   17:59 May 13, 2015   Jkt 235001   PO 00000   Frm 00064   Fmt 4703   Sfmt 4703   E:\FR\FM\14MYN1.SGM   14MYN1


                                              27692                          Federal Register / Vol. 80, No. 93 / Thursday, May 14, 2015 / Notices

                                              appearance and non-adherence,                           diversity goals. For the second patient               appearance of their medications
                                              including which factors could be                        survey, patients will be selected from a              changes. The purpose of these surveys
                                              modified to improve the safe and                        proprietary research database of                      is not to reverse existing legal
                                              effective use of generic drugs.                         commercially insured patients                         precedents, require the generic drug
                                                 We intend to survey a national cohort                containing medical and pharmacy                       industry change the appearance of their
                                              of pharmacists about their experiences                  claims linked to health insurance                     medications, or support the
                                              with dispensing generic drug pills that                 enrollment information. A nationally                  infringement of intellectual property,
                                              differ in appearance from previous                      representative sample of patients with at             First Amendment, or any other legally
                                              refills of the same medication and                      least one chronic condition and who                   protected interests.
                                              dosage level (e.g., when pharmacies                     experienced a change in physical                         (Comment 2) One comment
                                              switch generic suppliers). A stratified,                appearance of a generic pill will be                  mentioned that the term ‘‘pill’’ is used
                                              random sample of U.S.-licensed                          identified by the research team using                 in the Federal Register notice to
                                              pharmacists will be obtained based on                   medical and pharmacy claims data.                     describe oral solid dosage forms such as
                                              a master list from KM Lists. The target                 Both patient surveys will consist of                  tablets and capsules, but is defined by
                                              sample includes pharmacists with                        questions covering topics similar to                  Merriam-Webster much more narrowly
                                              active licenses who practice in                         those asked in the survey of pharmacists              to exclude tablets and capsules, which
                                              traditional community pharmacy                          and is intended to provide answers to                 has the potential to create confusion.
                                              settings and will be proportionally                     the same topic areas from patients’                      (Response) Because the FR notice is
                                              allocated across the U.S. in relation to                perspectives. As before, topic areas will             seeking opinions from the public, we
                                              the number of pharmacists in each state.                include beliefs about generic drugs,                  used language accessible to the general
                                              Based on an 11 percent undeliverable                    outcomes related to changes in generic                public. To avoid confusion, the word
                                              rate and a 52 percent response rate,                    drug pill appearance, and strategies                  ‘‘pill’’ is defined in the introduction of
                                              2,161 questionnaires will be mailed to                  used by pharmacists or doctors to alert               each survey instrument to clarify its
                                              pharmacists to obtain the 1,000                         patients to the possibility of changes in             meaning, with the statement that the
                                              responses required for adequate                         appearance. Participation is expected to              word ‘‘pill’’ includes both tablet and
                                              statistical power. The pharmacists’                     take approximately 20 minutes.                        capsule dosage forms.
                                              survey will consist of a mailed                            In the Federal Register of October 15,                (Comment 3) One comment
                                              questionnaire rather than a telephone                   2014 (79 FR 61872), FDA published a                   mentioned that the survey findings may
                                              survey or an email survey. Prior                        60-day notice requesting public                       be used by FDA to guide pharmacy
                                              experience conducting surveys has                       comment on the proposed collection of                 business practice, which is the
                                              shown that it is easier to guarantee                    information. Comments submitted                       jurisdiction of the State Boards of
                                              respondent anonymity using an                           raised several issues pertaining to the               Pharmacy.
                                              impersonal, mailed questionnaire with                   proposed collection of information. We                   (Response) As stated earlier, the
                                              no individual identifying information.                  summarize the comments and provide                    purpose of these surveys is to gather
                                              The pharmacists will be asked about the                 our responses below:                                  information on the awareness of
                                              frequency with which their pharmacy                        (Comment 1) Two comments                           patients about changes in the
                                              changes suppliers that lead to variations               expressed concerns related to trade                   appearance of their medications, the
                                              in the appearance of the generic drugs                  dress protection issues, noting that the              frequency with which changes in
                                              that they dispense, as well as strategies               requirement that generic products differ              appearance occurs, strategies that
                                              they use with patients to address the                   in appearance from the Reference Listed               pharmacists use to inform patients
                                              transition to pills that have a different               Drug is well established in case law. A               when the appearance of their
                                              appearance (e.g., alert stickers on pill                pill’s physical appearance can qualify as             medications changes, and the outcomes
                                              bottles, verbal warnings, and other                     trade dress, protected under the Lanham               associated with these strategies. The
                                              strategies). They will also be asked                    Act (Pub. L. 79–489), which functions to              results of the surveys will be used to
                                              about patient responses to changes in                   distinguish between products from                     inform the development of patient
                                              pill appearance, including what types of                different manufacturers. A drug’s                     education about differences in pill
                                              appearance changes seem to affect                       physical appearance can also be                       appearance and inform the development
                                              patients most often (shape/color/size),                 considered a protected form of non-                   of education for pharmacists on
                                              how often patients report confusion                     verbal expression under the First                     strategies to counsel patients when the
                                              about pill appearance, and how often                    Amendment. If required to change the                  appearance of their medications
                                              patients ultimately refuse to accept the                appearance of their medications, the                  changes. FDA does not intend to, itself,
                                              new product. Participation is expected                  generic industry would face additional                guide pharmacy business practices.
                                              to take approximately 20 minutes.                       development costs.                                       (Comment 4) One comment expressed
                                                 We also intend to survey two different                  (Response) The purpose of these                    concern that confidential patient
                                              patient samples using two                               surveys is to gather information on the               information from an insurance database
                                              methodologies. The first is a telephone                 awareness of patients and pharmacists                 will be identified and shared with
                                              survey of patients who are 50 years and                 about changes in the appearance of                    Federal Government employees, which
                                              older and who take one or more generic                  medications, the frequency with which                 may violate HIPAA regulations.
                                              medications for at least one of the                     changes in appearance occurs, strategies                 (Response) These surveys received
                                              following chronic conditions: Epilepsy,                 that pharmacists use to inform patients               approval from the Institutional Review
                                              diabetes, hypertension, hyperlipidemia,                 when the appearance of their                          Board (IRB) at the academic medical
                                              depression, and HIV. The telephone                      medications changes, and the outcomes                 center where the survey is being
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                                              survey will be generalizable and will                   associated with these strategies. The                 conducted, which was accepted by
                                              consist of well-defined methods to                      results of the surveys will be used to                FDA’s IRB (Research In Human Subject
                                              minimize sampling bias such as use of                   inform the development of patient                     Committee). IRB approval ensures
                                              random phone numbers for both                           education about differences in pill                   compliance with human subjects’
                                              landlines and mobile phones, as well as                 appearance and inform the development                 protection laws, including HIPAA. No
                                              small-batch sampling to ensure a high                   of education for pharmacists on                       FDA personnel will have access to any
                                              response rate that meets demographic                    strategies to counsel patients when the               identifiable patient information.


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                                                                                    Federal Register / Vol. 80, No. 93 / Thursday, May 14, 2015 / Notices                                                                                     27693

                                                 (Comment 5) One comment suggested                               and effective use of generic drugs or                            that study results are valid and useful.
                                              that instead of conducting the study,                              yield substantial evidence to support                            A copy of the draft surveys have been
                                              FDA should data mine an internal                                   adoption of any regulatory policies. The                         provided to the commenter.
                                              source of data (product complaints                                 comment noted that further                                          (Comment 9) One comment noted that
                                              received from pharmaceutical                                       investigations will be needed to                                 the variations in the physical
                                              companies, healthcare providers, and                               understand how pharmacist and patient                            appearance of drug products may help
                                              consumers) to gather information on                                perceptions translate to actual practices                        pharmacists and patients avoid
                                              potential confusion and medication                                 and effects, and encouraged FDA to                               confusion, facilitate detection of
                                              mistakes.                                                          consider comments to Docket No. 2013–                            counterfeit drug products, and serve
                                                 (Response) The proposed study                                   N–1434 in considering what further                               pharmacovigilance purposes by
                                              focuses on patient and pharmacist                                  work will be needed and the level of                             providing information about the source
                                              experiences and outcomes associated                                evidence needed to support any                                   of a specific product. Variation in pill
                                              with changes in pill appearance, a topic                           regulatory policy changes.                                       appearance can also serve to notify
                                              of which patient confusion and                                        (Response) These surveys include                              patients that the source of their
                                              medication mistakes are only a part.                               questions on patient and pharmacist                              medication has changed. FDA should
                                              Although some medication mistakes                                  perceptions, as well as their actual                             acknowledge the ways in which
                                              and patient confusion data may be                                  experiences and behaviors as they relate                         differences in pill appearance are
                                              captured in our internal database (FDA’s                           to generic drugs and changes in drug                             beneficial when determining whether
                                              Adverse Event Reporting System), the                               appearance. The survey findings will be                          and how to conduct the survey.
                                              specific data sought from the proposed                             used to inform the development of                                   (Response) The focus of these surveys
                                              study do not exist in this database.                               patient education about differences in                           is on identifying patient and pharmacist
                                                 (Comment 6) One comment suggested                               pill appearance and inform the                                   concerns and problems related to
                                              that if the information on potential                               development of education for                                     changes in pill appearance, with the
                                              confusion and medication mistakes                                  pharmacists on strategies to counsel                             goal of informing the development of
                                              cannot be found in current databases,                              patients when the appearance of their                            future patient and provider educational
                                              FDA should request that pharmacy                                   medications changes.                                             interventions and programs to address
                                              school students conduct this study and                                (Comment 8) One comment noted that
                                                                                                                                                                                  identified problems. However, it is
                                              publish results in a peer-reviewed                                 if this study is conducted, the surveys
                                                                                                                                                                                  acknowledged that changes in the
                                              journal to assure transparency and                                 should be carefully crafted to collect
                                                                                                                                                                                  physical appearance of medications
                                              reduce government spending.                                        useful data using validated, well-
                                                                                                                                                                                  could have both negative and beneficial
                                                 (Response) High-quality surveys                                 developed methodology and
                                                                                                                                                                                  effects. Therefore, questions have been
                                              require substantial resources that would                           assumptions. The comment requested
                                                                                                                                                                                  added to gauge how changes in pill
                                              likely not be available to pharmacy                                the opportunity to review the proposed
                                                                                                                                                                                  appearance may benefit pharmacists
                                              students for class projects. These                                 surveys and to submit additional survey
                                                                                                                                                                                  and patients.
                                              surveys are being conducted by an                                  questions.
                                              academic medical institution that has                                 (Response) Well-established survey                               (Comment 10) One comment
                                              expertise in conducting surveys of                                 methods are being used in the                                    commended FDA for planning this
                                              patients and health care providers,                                development and conducting of this                               study. The commenter was also pleased
                                              which will provide high-quality and                                survey. The survey questions were                                that FDA plans to conduct two separate
                                              valid data and assure transparency. The                            carefully crafted according to published                         patient surveys to ensure that a broad
                                              results will be published in a peer-                               guidelines for survey question                                   and relevant patient experience is
                                              reviewed journal(s) and will be made                               development (Refs. 1 & 2) and were                               reflected in the results.
                                              publicly available.                                                further refined by an expert panel that                             (Response) We thank this commenter
                                                 (Comment 7) One comment                                         included individuals with pharmacy-                              for the support of our study and agree
                                              mentioned that these surveys will                                  related professional backgrounds and                             that conducting two separate patient
                                              collect data on pharmacist and patient                             patient representatives. The survey                              surveys will improve the validity and
                                              perceptions, which may not correlate to                            instruments will undergo cognitive                               generalizability of the results.
                                              actual use data and thus may not                                   testing and formal pre-testing to ensure                            FDA estimates the burden of this
                                              provide meaningful information on safe                             questions are clear and answerable, and                          collection of information as follows:

                                                                                                             TABLE 1—ESTIMATED REPORTING BURDEN 1
                                               Surveys of pharmacists and patients on variations in the                                              Number of                                                Average
                                                                                                                                   Number of                                   Total annual                                                Total
                                               physical characteristics of generic drug pills and patients’                                        responses per                                            burden per
                                                                                                                                  respondents                                   responses                                                  Hours
                                                                       perceptions                                                                   respondent                                              response

                                              Pharmacist surveys mailed 2 ................................................               2,161     ........................   ........................   ........................   ........................
                                              Pharmacist pretests .............................................................              9                           1                          9                   0.333                             3
                                                                                                                                                                                                             (20 minutes)
                                              Pharmacist survey completes ..............................................                 1,000                           1                  1,000                           0.3                       300
                                                                                                                                                                                                             (18 minutes)
                                              Patient #1 survey calls .........................................................          5,000     ........................   ........................   ........................   ........................
                                              Patient #1 surveys screened ...............................................                3,330                           1                   3,330                      0.033                         111
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                                                                                                                                                                                                               (2 minutes)
                                              Patient #1 surveys eligible ...................................................            1,200     ........................   ........................   ........................   ........................
                                              Patient #1 survey pretests ...................................................                 9                           1                          9                   0.333                             3
                                                                                                                                                                                                             (20 minutes)
                                              Patient #1 survey completes ...............................................                1,000                           1                  1,000                           0.3                       300
                                                                                                                                                                                                             (18 minutes)
                                              Patient #2 surveys mailed 2 .................................................              2,000     ........................   ........................   ........................   ........................



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                                              27694                                     Federal Register / Vol. 80, No. 93 / Thursday, May 14, 2015 / Notices

                                                                                                        TABLE 1—ESTIMATED REPORTING BURDEN 1—Continued
                                               Surveys of pharmacists and patients on variations in the                                                                  Number of                                                Average
                                                                                                                                              Number of                                            Total annual                                         Total
                                               physical characteristics of generic drug pills and patients’                                                            responses per                                            burden per
                                                                                                                                             respondents                                            responses                                           Hours
                                                                       perceptions                                                                                       respondent                                              response

                                              Survey of patients #2 ...........................................................                            1,000                             1                   1,000                   0.3                    300
                                                                                                                                                                                                                                (18 minutes)

                                                    Total ..............................................................................    ........................   ........................   ........................   ........................       1,017
                                                 1 There    are no capital costs or operating and maintenance costs associated with this collection of information.
                                                 2 Eligibility is determined prior to mailing the surveys; screening is not required.


                                              References                                                                 SUPPLEMENTARY INFORMATION:     On                                            and Drug Administration, 8455
                                                The following references have been                                       February 27, 2015, the Agency                                                Colesville Rd., COLE–14526, Silver
                                              placed on display in the Division of                                       submitted a proposed collection of                                           Spring, MD 20993–0002, PRAStaff@
                                                                                                                         information entitled, ‘‘FDA Recall                                           fda.hhs.gov.
                                              Dockets Management (see ADDRESSES)
                                              and may be seen by interested persons                                      Regulations’’ to OMB for review and                                          SUPPLEMENTARY INFORMATION: On
                                              between 9 a.m. and 4 p.m., Monday                                          clearance under 44 U.S.C. 3507. An                                           January 8, 2015, the Agency submitted
                                              through Friday, and are available                                          Agency may not conduct or sponsor,                                           a proposed collection of information
                                              electronically at http://                                                  and a person is not required to respond                                      entitled, ‘‘Guidance for Industry: Formal
                                              www.regulations.gov.                                                       to, a collection of information unless it                                    Dispute Resolution; Scientific and
                                                                                                                         displays a currently valid OMB control                                       Technical Issues Related to
                                              1. Woodward, C.A., ‘‘Questionnaire                                         number. OMB has now approved the
                                                   Construction and Question Writing for                                                                                                              Pharmaceutical Current Good
                                                                                                                         information collection and has assigned                                      Manufacturing Practice’’ to OMB for
                                                   Research in Medical Education,’’
                                                   Medical Education, 22, pp. 345–363
                                                                                                                         OMB control number 0910–0249. The                                            review and clearance under 44 U.S.C.
                                                   (1988).                                                               approval expires on March 31, 2018. A                                        3507. An Agency may not conduct or
                                              2. Fitzpatrick, R., ‘‘Surveys of Patient                                   copy of the supporting statement for this                                    sponsor, and a person is not required to
                                                   Satisfaction: II—Designing a                                          information collection is available on                                       respond to, a collection of information
                                                   Questionnaire and Conducting a                                        the Internet at http://www.reginfo.gov/                                      unless it displays a currently valid OMB
                                                   Survey,’’ British Medical Journal,                                    public/do/PRAMain.                                                           control number. OMB has now
                                                   302(6785), pp. 1129–1132 (1991).
                                                                                                                           Dated: May 8, 2015.                                                        approved the information collection and
                                                Dated: May 8, 2015.                                                      Leslie Kux,                                                                  has assigned OMB control number
                                              Leslie Kux,                                                                Associate Commissioner for Policy.                                           0910–0563. The approval expires on
                                              Associate Commissioner for Policy.                                         [FR Doc. 2015–11624 Filed 5–13–15; 8:45 am]                                  April 30, 2018. A copy of the supporting
                                              [FR Doc. 2015–11623 Filed 5–13–15; 8:45 am]                                BILLING CODE 4164–01–P
                                                                                                                                                                                                      statement for this information collection
                                                                                                                                                                                                      is available on the Internet at http://
                                              BILLING CODE 4164–01–P
                                                                                                                                                                                                      www.reginfo.gov/public/do/PRAMain.
                                                                                                                         DEPARTMENT OF HEALTH AND                                                       Dated: May 8, 2015.
                                              DEPARTMENT OF HEALTH AND                                                   HUMAN SERVICES                                                               Leslie Kux,
                                              HUMAN SERVICES                                                                                                                                          Associate Commissioner for Policy.
                                                                                                                         Food and Drug Administration
                                                                                                                                                                                                      [FR Doc. 2015–11609 Filed 5–13–15; 8:45 am]
                                              Food and Drug Administration                                               [Docket No. FDA–2014–N–1076]                                                 BILLING CODE 4164–01–P

                                              [Docket No. FDA–2014–N–1031]                                               Agency Information Collection
                                                                                                                         Activities; Announcement of Office of                                        DEPARTMENT OF HOMELAND
                                              Agency Information Collection                                              Management and Budget Approval;                                              SECURITY
                                              Activities; Announcement of Office of                                      Guidance for Industry: Formal Dispute
                                              Management and Budget Approval;                                            Resolution; Scientific and Technical                                         U.S. Customs and Border Protection
                                              FDA Recall Regulations                                                     Issues Related to Pharmaceutical
                                                                                                                         Current Good Manufacturing Practice                                          [Docket No. USCBP–2015–0020]
                                              AGENCY:       Food and Drug Administration,
                                              HHS.                                                                       AGENCY:           Food and Drug Administration,                              The U.S. Customs and Border
                                              ACTION:      Notice.                                                       HHS.                                                                         Protection Airport and Seaport
                                                                                                                         ACTION:       Notice.                                                        Inspections User Fee Advisory
                                              SUMMARY:   The Food and Drug                                                                                                                            Committee (UFAC)
                                              Administration (FDA) is announcing                                         SUMMARY:   The Food and Drug                                                 AGENCY:  U.S. Customs and Border
                                              that a collection of information entitled,                                 Administration (FDA) is announcing                                           Protection, Department of Homeland
                                              ‘‘FDA Recall Regulations’’ has been                                        that a collection of information entitled,                                   Security (DHS).
                                              approved by the Office of Management                                       ‘‘Guidance for Industry: Formal Dispute
                                                                                                                                                                                                      ACTION: Committee Management; Notice
                                              and Budget (OMB) under the Paperwork                                       Resolution; Scientific and Technical
                                              Reduction Act of 1995.                                                     Issues Related to Pharmaceutical                                             of Federal Advisory Public Committee
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                                                                                                                         Current Good Manufacturing Practice’’                                        Meeting.
                                              FOR FURTHER INFORMATION CONTACT: FDA
                                              PRA Staff, Office of Operations, Food                                      has been approved by the Office of                                           SUMMARY:  The U.S. Customs and Border
                                              and Drug Administration, 8455                                              Management and Budget (OMB) under                                            Protection Airport and Seaport
                                              Colesville Rd., COLE–14526, Silver                                         the Paperwork Reduction Act of 1995.                                         Inspections User Fee Advisory
                                              Spring, MD 20993–0002, PRAStaff@                                           FOR FURTHER INFORMATION CONTACT: FDA                                         Committee (UFAC) will meet on
                                              fda.hhs.gov.                                                               PRA Staff, Office of Operations, Food                                        Tuesday, June 2, 2015, in Washington,


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Document Created: 2015-12-15 15:32:49
Document Modified: 2015-12-15 15:32:49
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
DatesFax written comments on the collection of information by June 15, 2015.
ContactFDA PRA Staff, Office of Operations, Food and Drug Administration, 8455 Colesville Rd., COLE-14526, Silver Spring, MD 20993-0002, [email protected]
FR Citation80 FR 27691 

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