83_FR_11590 83 FR 11539 - Agency Information Collection Activities; Proposed Collection; Comment Request; Health Care Professional Survey of Professional Prescription Drug Promotion

83 FR 11539 - Agency Information Collection Activities; Proposed Collection; Comment Request; Health Care Professional Survey of Professional Prescription Drug Promotion

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 83, Issue 51 (March 15, 2018)

Page Range11539-11542
FR Document2018-05235

The Food and Drug Administration (FDA, Agency, or we) is announcing an opportunity for public comment on the proposed collection of certain information by the Agency. Under the Paperwork Reduction Act of 1995 (PRA), Federal Agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension of an existing collection of information, and to allow 60 days for public comment in response to the notice. This notice solicits comments on ``Health Care Professional Survey of Professional Prescription Drug Promotion.'' This study will examine how health care professionals experience and perceive prescription drug promotion directed to them.

Federal Register, Volume 83 Issue 51 (Thursday, March 15, 2018)
[Federal Register Volume 83, Number 51 (Thursday, March 15, 2018)]
[Notices]
[Pages 11539-11542]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-05235]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

[Docket No. FDA-2018-N-0215]


Agency Information Collection Activities; Proposed Collection; 
Comment Request; Health Care Professional Survey of Professional 
Prescription Drug Promotion

AGENCY: Food and Drug Administration, HHS.

ACTION: Notice.

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

SUMMARY: The Food and Drug Administration (FDA, Agency, or we) is 
announcing an opportunity for public comment on the proposed collection 
of certain information by the Agency. Under the Paperwork Reduction Act 
of 1995 (PRA), Federal Agencies are required to publish notice in the 
Federal Register concerning each proposed collection of information, 
including each proposed extension of an existing collection of 
information, and to allow 60 days for public comment in response to the 
notice. This notice solicits comments on ``Health Care Professional 
Survey of Professional Prescription Drug Promotion.'' This study will 
examine how health care professionals experience and perceive 
prescription drug promotion directed to them.

DATES: Submit either electronic or written comments on the collection 
of information by May 14, 2018.

ADDRESSES: You may submit comments as follows. Please note that late, 
untimely filed comments will not be considered. Electronic comments 
must be submitted on or before May 14, 2018. The https://www.regulations.gov electronic filing system will accept comments until 
midnight Eastern Time at the end of May 14, 2018. Comments received by 
mail/hand delivery/courier (for written/paper submissions) will be 
considered timely if they are postmarked or the delivery service 
acceptance receipt is on or before that date.

Electronic Submissions

    Submit electronic comments in the following way:
     Federal eRulemaking Portal: https://www.regulations.gov. 
Follow the instructions for submitting comments. Comments submitted 
electronically, including attachments, to https://www.regulations.gov 
will be posted to the docket unchanged. Because your comment will be 
made public, you are solely responsible for ensuring that your comment 
does not include any confidential information that you or a third party 
may not wish to be posted, such as medical information, your or anyone 
else's Social Security number, or confidential business information, 
such as a manufacturing process. Please note that if you include your 
name, contact information, or other information that identifies you in 
the body of your comments, that information will be posted on https://www.regulations.gov.
     If you want to submit a comment with confidential 
information that you do not wish to be made available to the public, 
submit the comment as a written/paper submission and in the manner 
detailed (see ``Written/Paper Submissions'' and ``Instructions'').

Written/Paper Submissions

    Submit written/paper submissions as follows:
     Mail/Hand delivery/Courier (for written/paper 
submissions): Dockets Management Staff (HFA-305), Food and Drug 
Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852.
     For written/paper comments submitted to the Dockets 
Management Staff, FDA will post your comment, as well as any 
attachments, except for information submitted, marked and identified, 
as confidential, if submitted as detailed in ``Instructions.''
    Instructions: All submissions received must include the Docket No. 
FDA-2018-N-0215 for ``Agency Information Collection Activities; 
Proposed Collection; Comment Request; Health Care Professional Survey 
of Professional Prescription Drug Promotion.'' Received comments, those 
filed in a timely manner (see ADDRESSES), will be placed

[[Page 11540]]

in the docket and, except for those submitted as ``Confidential 
Submissions,'' publicly viewable at https://www.regulations.gov or at 
the Dockets Management Staff between 9 a.m. and 4 p.m., Monday through 
Friday.
     Confidential Submissions--To submit a comment with 
confidential information that you do not wish to be made publicly 
available, submit your comments only as a written/paper submission. You 
should submit two copies total. One copy will include the information 
you claim to be confidential with a heading or cover note that states 
``THIS DOCUMENT CONTAINS CONFIDENTIAL INFORMATION.'' The Agency will 
review this copy, including the claimed confidential information, in 
its consideration of comments. The second copy, which will have the 
claimed confidential information redacted/blacked out, will be 
available for public viewing and posted on https://www.regulations.gov. 
Submit both copies to the Dockets Management Staff. If you do not wish 
your name and contact information to be made publicly available, you 
can provide this information on the cover sheet and not in the body of 
your comments and you must identify this information as 
``confidential.'' Any information marked as ``confidential'' will not 
be disclosed except in accordance with 21 CFR 10.20 and other 
applicable disclosure law. For more information about FDA's posting of 
comments to public dockets, see 80 FR 56469, September 18, 2015, or 
access the information at: https://www.thefederalregister.org/fdsys/pkg/FR-2015-09-18/pdf/2015-23389.pdf.
    Docket: For access to the docket to read background documents or 
the electronic and written/paper comments received, go to https://www.regulations.gov and insert the docket number, found in brackets in 
the heading of this document, into the ``Search'' box and follow the 
prompts and/or go to the Dockets Management Staff, 5630 Fishers Lane, 
Rm. 1061, Rockville, MD 20852.

FOR FURTHER INFORMATION CONTACT: Ila S. Mizrachi, Office of Operations, 
Food and Drug Administration, Three White Flint North, 10A-12M, 11601 
Landsdown St., North Bethesda, MD 20852, 301-796-7726, 
PRAStaff@fda.hhs.gov.

SUPPLEMENTARY INFORMATION: 

I. Background

    Under the PRA (44 U.S.C. 3501-3520), Federal Agencies must obtain 
approval from the Office of Management and Budget (OMB) for each 
collection of information they conduct or sponsor. ``Collection of 
information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and 
includes Agency requests or requirements that members of the public 
submit reports, keep records, or provide information to a third party. 
Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires 
Federal Agencies to provide a 60-day notice in the Federal Register 
concerning each proposed collection of information, including each 
proposed extension of an existing collection of information, before 
submitting the collection to OMB for approval. To comply with this 
requirement, FDA is publishing notice of the proposed collection of 
information set forth in this document.
    With respect to the following collection of information, FDA 
invites comments on these topics: (1) Whether the proposed collection 
of information is necessary for the proper performance of FDA's 
functions, including whether the information will have practical 
utility; (2) the accuracy of FDA's estimate of the burden of the 
proposed collection of information, including the validity of the 
methodology and assumptions used; (3) ways to enhance the quality, 
utility, and clarity of the information to be collected; and (4) ways 
to minimize the burden of the collection of information on respondents, 
including through the use of automated collection techniques, when 
appropriate, and other forms of information technology.

Health Care Professional Survey of Professional Prescription Drug 
Promotion

OMB Control Number 0910--NEW

    Section 1701(a)(4) of the Public Health Service Act (42 U.S.C. 
300u(a)(4)) authorizes FDA to conduct research relating to health 
information. Section 1003(d)(2)(C) of the Federal Food, Drug, and 
Cosmetic Act (FD&C Act) (21 U.S.C. 393(d)(2)(C)) authorizes FDA to 
conduct research relating to drugs and other FDA regulated products in 
carrying out the provisions of the FD&C Act.
    As part of its federal mandate, FDA regulates whether direct-to-
consumer (DTC) advertising of prescription drug products is truthful, 
balanced, and accurately communicated (see 21 U.S.C. 352(n)). 
Similarly, the FD&C Act prohibits the dissemination of false or 
misleading information about medications in consumer-directed and 
professional prescription drug promotion. FDA regulates within the 
framework of free speech and due process principles of the United 
States Constitution. To inform current and future policies, and to seek 
to enhance audience comprehension, the Office of Prescription Drug 
Promotion conducts research focusing on (1) advertising features 
including content and format, (2) target populations, and (3) research 
quality. This proposed research focuses on the physician target 
population. FDA surveyed physicians about their attitudes toward DTC 
advertising and its role in their relationships with their patients in 
2002 (Ref. 1) and again in 2013 (Refs. 2 and 3). The 2013 survey 
included multiple types of prescribers: Primary care physicians, 
specialists, nurse practitioners, and physician assistants. Whereas the 
focus of both previous FDA surveys was on DTC advertising and 
promotion, the current study is designed to address issues related to 
professional prescription drug promotion. The goal is to query a 
representative sample of health care professionals (HCPs) about their 
opinions of promotional materials and procedures targeted at HCPs, 
clinical trial design and knowledge, and FDA approval status. We will 
also take this opportunity to ask HCPs briefly about their knowledge of 
abuse-deterrent formulations for opioid products.
    To educate themselves about prescription drugs, HCPs sometimes rely 
on professionally directed promotional information (Refs. 4-8). In 
2012, pharmaceutical companies spent more than $24 billion on marketing 
to physicians (Ref. 9). The industry exposes health care professionals 
to promotional materials through a variety of mechanisms, including 
communication with pharmaceutical representatives, journal ads, 
prescribing software, presentations at sponsored meetings, and direct 
mail ads (Ref. 10). Several studies indicate that data presented in 
promotional materials may not be fully comprehended and may even 
potentially be misleading due to a variety of causes, such as 
insufficient information, unsupported claims, or a failure to disclose 
limitations of the information presented (Refs. 11-15).
    Although HCPs are learned intermediaries, like most people, they 
may rely on heuristics in making decisions and may have cognitive 
biases in the type of information they attend to at any given time. 
They may be persuaded by strong statements and may not have the time to 
ascertain accuracy of such information (Ref. 16). The proposed survey 
will provide further insights about how professionally targeted 
prescription drug promotion might influence health care professionals' 
decision-making processes and practices and how

[[Page 11541]]

information may be communicated more effectively. It is important to 
note that FDA does not regulate the practice of medicine. However, as 
previously mentioned, FDA does regulate prescription drug promotion. 
This survey is designed to inform FDA of various responses to and 
impacts of prescription drug promotion of prescription drugs.
    The general research questions in the survey are as follows:
    1. What methods and/or channels are used to disseminate 
prescription drug promotional information to health care professionals/
prescribers?
    2. How knowledgeable and interested are HCPs in clinical trial data 
and its presence in prescription drug promotion?
    3. How familiar are HCPs with the FDA approval of prescription 
drugs and how does this translate into practice?
    In addition, given the critical nature of the opioid situation in 
the United States at this time, we plan to ask several questions about 
prescription drug promotion of opioid products.
    HCPs who fall into one of four categories will be recruited online 
through WebMD's Medscape subscriber network. We propose to complete 700 
primary care physician, 600 specialist, 350 nurse practitioner, and 350 
physician assistant surveys. HCPs will be included if they see patients 
at least 50 percent of the time. Both Doctors of Medicine and Doctors 
of Osteopathy will be included. Primary care physicians will include 
those who indicate they work in general, family, or internal medicine. 
Specialties were chosen based on prevalence in the United States and 
prescription drug promotional activity. Specialists will include 
cardiologists, dermatologists, endocrinologists, neurologists, 
obstetrician/gynecologists, oncologists, ophthalmologists, 
psychiatrists, rheumatologists, and urologists. The data will be 
weighted to adjust for differential coverage of select characteristics 
such as region and respondent age and gender. Pretesting with 25 
respondents will take place before the main study to evaluate the 
procedures and measures used in the main study.
    FDA estimates the burden of this collection of information as 
follows:

                                 Table 1--Estimated Annual Reporting Burden \1\
----------------------------------------------------------------------------------------------------------------
                                                   Number of
           Activity                Number of     responses per   Total annual    Average burden     Total hours
                                  respondents     respondent       responses      per response
----------------------------------------------------------------------------------------------------------------
                                                  Pretest Study
----------------------------------------------------------------------------------------------------------------
HCP screener..................              63               1              63  0.08 (5 minutes)               5
Informed Consent..............              25               1              25  0.08 (5 minutes)               2
HCP Survey....................              25               1              25  0.33 (20                       8
                                                                                 minutes).
----------------------------------------------------------------------------------------------------------------
                                                   Main Study
----------------------------------------------------------------------------------------------------------------
HCP screener..................           5,037               1           5,037  0.08 (5 minutes)             403
Informed Consent..............           2,000               1           2,000  0.08 (5 minutes)             160
HCP Survey....................           2,000               1           2,000  0.33 (20                     660
                                                                                 minutes).
                               ---------------------------------------------------------------------------------
    Total.....................  ..............  ..............  ..............  ................           1,238
----------------------------------------------------------------------------------------------------------------
\1\ There are no capital costs and maintenance costs associated with this collection of information.

II. References

    The following references are on display in the Dockets Management 
Staff (see ADDRESSES) and are available for viewing by interested 
persons between 9 a.m. and 4 p.m., Monday through Friday; they are also 
available electronically at https://www.regulations.gov. FDA has 
verified the website addresses, as of the date this document publishes 
in the Federal Register, but websites are subject to change over time.

1. Available at: https://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDER/ucm090276.htm. Last accessed 
January 26, 2018.
2. Betts, K.R., A.C. O'Donoghue, K.J. Aikin, et al. (2016). 
``Healthcare Professional Social Media Membership and Participation: 
Findings From a Nationally Representative Sample,'' Journal of the 
American Association of Nurse Practitioners. Doi: 10.1002/2327-
6924.12383.
3. O'Donoghue, A.C., V. Boudewyns, K.J. Aikin, et al. (2015). 
``Awareness of FDA's Bad Ad Program and Education Regarding 
Pharmaceutical Advertising: A National Survey of Prescribers in 
Ambulatory Care Settings,'' Journal of Health Communication, vol. 
20(11), pp. 1330-1336.
4. Crigger, N.J. (2005). ``Pharmaceutical Promotions and Conflict of 
Interest in Nurse Practitioner's Decision Making: The Undiscovered 
Country,'' Journal of the American Academy of Nurse Practitioners, 
vol. 17(6), pp. 207-212.
5. Fischer, M.A., M.E. Keough, J.L. Baril, et al. (2009). 
``Prescribers and Pharmaceutical Representatives: Why Are We Still 
Meeting?'' Journal of General Internal Medicine, vol. 24(7), pp. 
795-801.
6. C. Robertson, S. Rose, and A.S. Kesselheim. (2012). ``Effect of 
Financial Relationships on the Behaviors of Health Care 
Professionals: A Review of the Evidence,'' The Journal of Law, 
Medicine & Ethics, vol. 40(3), pp. 452-466.
7. Srivastava, V., M. Handa, and A. Vohra. (2014). ``Promotional 
Tools: Do Physicians Really Bite the Hook?'' Drishtikon: A 
Management Journal, vol. 5(2).
8. Austad, K.E., J. Avorn, J.M. Franklin, et al. (2014). 
``Association of Marketing Interactions With Medical Trainees' 
Knowledge About Evidence-Based Prescribing: Results From a National 
Survey,'' JAMA Internal Medicine, vol. 174(8), pp. 1283-1290.
9. Cegedim Strategic Data. (2013). ``2012 U.S. Pharmaceutical 
Company Promotion Spending.'' Available at: http://www.skainfo.com/health_care_market_reports/2012_promotional_spending.pdf.
10. Spurling, G.K., P.R. Mansfield, B.D. Montgomery, et al. (2010). 
``Information From Pharmaceutical Companies and the Quality, 
Quantity, and Cost of Physicians' Prescribing: A Systematic 
Review,'' PLoS Medicine, vol. 7(10), e1000352. doi: 10.1371/
jounal.pmed. 1000352.
11. Villanueva, P., S. Peir[oacute], J. Librero, et al. (2003). 
``Accuracy of Pharmaceutical Advertisements in Medical Journals,'' 
Lancet, vol. 361(9351), pp. 27-32.
12. Cooper, R.J. and D.L. Schriger. (2005). ``The Availability of 
References and the Sponsorship of Original Research Cited in 
Pharmaceutical Advertisements,'' Canadian Medical Association 
Journal, vol. 172(4), pp. 487-491.
13. Jureidini, J.N., L.B. McHenry, and P.R. Mansfield. (2008). 
``Clinical Trials and Drug Promotion: Selective Reporting of

[[Page 11542]]

Study 329,'' International Journal of Risk & Safety in Medicine, 
vol. 20(1-2), pp. 73-81.
14. Garcia-Retamero, R. and M. Galesic. (2010). ``Who Profits From 
Visual Aids: Overcoming Challenges in People's Understanding of 
Risks,'' Social Science & Medicine, vol. 70(7), pp. 1019-1025.
15. Cooper, R.J., D.L. Schriger, R.C. Wallace, et al. (2003). ``The 
Quantity and Quality of Scientific Graphs in Pharmaceutical 
Advertisements,'' Journal of General Internal Medicine, vol. 18(4), 
pp. 294-297.
16. Sah, S. and A. Fugh-Berman. (2013). ``Physicians Under the 
Influence: Social Psychology and Industry Marketing Strategies,'' 
The Journal of Law, Medicine & Ethics, vol. 41(3), pp. 665-672. doi: 
10.1111/jlme.12076.

    Dated: March 9, 2018.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2018-05235 Filed 3-14-18; 8:45 am]
 BILLING CODE 4164-01-P



                                                                             Federal Register / Vol. 83, No. 51 / Thursday, March 15, 2018 / Notices                                           11539

                                                concerning each proposed collection of                  covered outpatient drugs. This pricing                considered. Electronic comments must
                                                information, including each proposed                    benchmark is based on drug acquisition                be submitted on or before May 14, 2018.
                                                extension or reinstatement of an existing               costs collected directly from pharmacies              The https://www.regulations.gov
                                                collection of information, before                       through a nationwide survey process.                  electronic filing system will accept
                                                submitting the collection to OMB for                    This survey is conducted on a monthly                 comments until midnight Eastern Time
                                                approval. To comply with this                           basis to ensure that the NADAC                        at the end of May 14, 2018. Comments
                                                requirement, CMS is publishing this                     reference file remains current and up-to-             received by mail/hand delivery/courier
                                                notice.                                                 date. Form Number: CMS–10241 (OMB                     (for written/paper submissions) will be
                                                Information Collection                                  control number 0938–1041); Frequency:                 considered timely if they are
                                                                                                        Monthly; Affected Public: Private sector              postmarked or the delivery service
                                                   1. Type of Information Collection                    (Business or other for-profits); Number               acceptance receipt is on or before that
                                                Request: Revision of a currently                        of Respondents: 30,000; Total Annual                  date.
                                                approved collection; Title of                           Responses: 30,000; Total Annual Hours:
                                                Information Collection: Annual Report                                                                         Electronic Submissions
                                                                                                        15,000. (For policy questions regarding
                                                on Home and Community Based                             this collection contact: Lisa Shochet at                Submit electronic comments in the
                                                Services Waivers and Supporting                         410–786–5445.)                                        following way:
                                                Regulations; Use: We use this report to                                                                         • Federal eRulemaking Portal:
                                                compare actual data to the approved                        Dated: March 12, 2018.
                                                                                                                                                              https://www.regulations.gov. Follow the
                                                waiver estimates. In conjunction with                   William N. Parham, III,                               instructions for submitting comments.
                                                the waiver compliance review reports,                   Director, Paperwork Reduction Staff, Office           Comments submitted electronically,
                                                the information provided will be                        of Strategic Operations and Regulatory                including attachments, to https://
                                                compared to that in the Medicaid                        Affairs.
                                                                                                                                                              www.regulations.gov will be posted to
                                                Statistical Information System (MSIS)                   [FR Doc. 2018–05296 Filed 3–14–18; 8:45 am]           the docket unchanged. Because your
                                                (CMS–R–284; OMB control number                          BILLING CODE 4120–01–P                                comment will be made public, you are
                                                0938–0345) report and FFP claimed on                                                                          solely responsible for ensuring that your
                                                a state’s Quarterly Expenditure Report                                                                        comment does not include any
                                                (CMS–64; OMB control number 0938–                       DEPARTMENT OF HEALTH AND                              confidential information that you or a
                                                1265), to determine whether to continue                 HUMAN SERVICES                                        third party may not wish to be posted,
                                                the state’s home and community-based                                                                          such as medical information, your or
                                                services waiver. States’ estimates of cost              Food and Drug Administration
                                                                                                                                                              anyone else’s Social Security number, or
                                                and utilization for renewal purposes are                [Docket No. FDA–2018–N–0215]                          confidential business information, such
                                                based upon the data compiled in the                                                                           as a manufacturing process. Please note
                                                CMS–372(S) reports. Form Number:                        Agency Information Collection                         that if you include your name, contact
                                                CMS–372(S) (OMB control number:                         Activities; Proposed Collection;                      information, or other information that
                                                0938–0272); Frequency: Yearly; Affected                 Comment Request; Health Care                          identifies you in the body of your
                                                Public: State, Local, or Tribal                         Professional Survey of Professional                   comments, that information will be
                                                Governments; Number of Respondents:                     Prescription Drug Promotion                           posted on https://www.regulations.gov.
                                                47; Total Annual Responses: 282; Total
                                                                                                        AGENCY:    Food and Drug Administration,                • If you want to submit a comment
                                                Annual Hours: 12,126. (For policy                                                                             with confidential information that you
                                                                                                        HHS.
                                                questions regarding this collection                                                                           do not wish to be made available to the
                                                contact Ralph Lollar at 410–786–0777).                  ACTION:   Notice.
                                                                                                                                                              public, submit the comment as a
                                                   2. Type of Information Collection                                                                          written/paper submission and in the
                                                                                                        SUMMARY:   The Food and Drug
                                                Request: Extension of a currently                                                                             manner detailed (see ‘‘Written/Paper
                                                                                                        Administration (FDA, Agency, or we) is
                                                approved collection; Title of                                                                                 Submissions’’ and ‘‘Instructions’’).
                                                                                                        announcing an opportunity for public
                                                Information Collection: Survey of Retail
                                                                                                        comment on the proposed collection of                 Written/Paper Submissions
                                                Prices; Use: This information collection
                                                                                                        certain information by the Agency.
                                                request provides for a survey of the                                                                            Submit written/paper submissions as
                                                                                                        Under the Paperwork Reduction Act of
                                                average acquisition costs of all covered                                                                      follows:
                                                                                                        1995 (PRA), Federal Agencies are
                                                outpatient drugs purchased by retail                                                                            • Mail/Hand delivery/Courier (for
                                                community pharmacies. CMS may                           required to publish notice in the
                                                                                                                                                              written/paper submissions): Dockets
                                                contract with a vendor to conduct                       Federal Register concerning each
                                                                                                                                                              Management Staff (HFA–305), Food and
                                                monthly surveys of retail prices for                    proposed collection of information,
                                                                                                                                                              Drug Administration, 5630 Fishers
                                                covered outpatient drugs. Such prices                   including each proposed extension of an
                                                                                                                                                              Lane, Rm. 1061, Rockville, MD 20852.
                                                represent a nationwide average of                       existing collection of information, and                 • For written/paper comments
                                                consumer purchase prices, net of                        to allow 60 days for public comment in                submitted to the Dockets Management
                                                discounts and rebates. The contractor                   response to the notice. This notice                   Staff, FDA will post your comment, as
                                                shall provide notification when a drug                  solicits comments on ‘‘Health Care                    well as any attachments, except for
                                                product becomes generally available                     Professional Survey of Professional                   information submitted, marked and
                                                and that the contract include such terms                Prescription Drug Promotion.’’ This                   identified, as confidential, if submitted
                                                and conditions as the Secretary shall                   study will examine how health care                    as detailed in ‘‘Instructions.’’
                                                specify, including a requirement that                   professionals experience and perceive                   Instructions: All submissions received
                                                the vendor monitor the marketplace.                     prescription drug promotion directed to               must include the Docket No. FDA–
sradovich on DSK3GMQ082PROD with NOTICES




                                                CMS has developed a National Average                    them.                                                 2018–N–0215 for ‘‘Agency Information
                                                Drug Acquisition Cost (NADAC) for                       DATES: Submit either electronic or                    Collection Activities; Proposed
                                                states to consider when developing                      written comments on the collection of                 Collection; Comment Request; Health
                                                reimbursement methodology. The                          information by May 14, 2018.                          Care Professional Survey of Professional
                                                NADAC is a pricing benchmark that is                    ADDRESSES: You may submit comments                    Prescription Drug Promotion.’’ Received
                                                based on the national average costs that                as follows. Please note that late,                    comments, those filed in a timely
                                                pharmacies pay to acquire Medicaid                      untimely filed comments will not be                   manner (see ADDRESSES), will be placed


                                           VerDate Sep<11>2014   17:34 Mar 14, 2018   Jkt 244001   PO 00000   Frm 00052   Fmt 4703   Sfmt 4703   E:\FR\FM\15MRN1.SGM   15MRN1


                                                11540                        Federal Register / Vol. 83, No. 51 / Thursday, March 15, 2018 / Notices

                                                in the docket and, except for those                     information they conduct or sponsor.                  Constitution. To inform current and
                                                submitted as ‘‘Confidential                             ‘‘Collection of information’’ is defined              future policies, and to seek to enhance
                                                Submissions,’’ publicly viewable at                     in 44 U.S.C. 3502(3) and 5 CFR                        audience comprehension, the Office of
                                                https://www.regulations.gov or at the                   1320.3(c) and includes Agency requests                Prescription Drug Promotion conducts
                                                Dockets Management Staff between 9                      or requirements that members of the                   research focusing on (1) advertising
                                                a.m. and 4 p.m., Monday through                         public submit reports, keep records, or               features including content and format,
                                                Friday.                                                 provide information to a third party.                 (2) target populations, and (3) research
                                                   • Confidential Submissions—To                        Section 3506(c)(2)(A) of the PRA (44                  quality. This proposed research focuses
                                                submit a comment with confidential                      U.S.C. 3506(c)(2)(A)) requires Federal                on the physician target population. FDA
                                                information that you do not wish to be                  Agencies to provide a 60-day notice in                surveyed physicians about their
                                                made publicly available, submit your                    the Federal Register concerning each                  attitudes toward DTC advertising and its
                                                comments only as a written/paper                        proposed collection of information,                   role in their relationships with their
                                                submission. You should submit two                       including each proposed extension of an               patients in 2002 (Ref. 1) and again in
                                                copies total. One copy will include the                 existing collection of information,                   2013 (Refs. 2 and 3). The 2013 survey
                                                information you claim to be confidential                before submitting the collection to OMB               included multiple types of prescribers:
                                                with a heading or cover note that states                for approval. To comply with this                     Primary care physicians, specialists,
                                                ‘‘THIS DOCUMENT CONTAINS                                requirement, FDA is publishing notice                 nurse practitioners, and physician
                                                CONFIDENTIAL INFORMATION.’’ The                         of the proposed collection of                         assistants. Whereas the focus of both
                                                Agency will review this copy, including                 information set forth in this document.               previous FDA surveys was on DTC
                                                the claimed confidential information, in                   With respect to the following                      advertising and promotion, the current
                                                its consideration of comments. The                      collection of information, FDA invites                study is designed to address issues
                                                second copy, which will have the                        comments on these topics: (1) Whether                 related to professional prescription drug
                                                claimed confidential information                        the proposed collection of information                promotion. The goal is to query a
                                                redacted/blacked out, will be available                 is necessary for the proper performance               representative sample of health care
                                                for public viewing and posted on                        of FDA’s functions, including whether                 professionals (HCPs) about their
                                                https://www.regulations.gov. Submit                     the information will have practical                   opinions of promotional materials and
                                                both copies to the Dockets Management                   utility; (2) the accuracy of FDA’s                    procedures targeted at HCPs, clinical
                                                Staff. If you do not wish your name and                 estimate of the burden of the proposed                trial design and knowledge, and FDA
                                                contact information to be made publicly                 collection of information, including the              approval status. We will also take this
                                                available, you can provide this                         validity of the methodology and                       opportunity to ask HCPs briefly about
                                                information on the cover sheet and not                  assumptions used; (3) ways to enhance                 their knowledge of abuse-deterrent
                                                in the body of your comments and you                    the quality, utility, and clarity of the              formulations for opioid products.
                                                must identify this information as                       information to be collected; and (4)                     To educate themselves about
                                                ‘‘confidential.’’ Any information marked                ways to minimize the burden of the                    prescription drugs, HCPs sometimes
                                                as ‘‘confidential’’ will not be disclosed               collection of information on                          rely on professionally directed
                                                except in accordance with 21 CFR 10.20                  respondents, including through the use                promotional information (Refs. 4–8). In
                                                and other applicable disclosure law. For                of automated collection techniques,                   2012, pharmaceutical companies spent
                                                more information about FDA’s posting                    when appropriate, and other forms of                  more than $24 billion on marketing to
                                                of comments to public dockets, see 80                   information technology.                               physicians (Ref. 9). The industry
                                                FR 56469, September 18, 2015, or access                                                                       exposes health care professionals to
                                                                                                        Health Care Professional Survey of                    promotional materials through a variety
                                                the information at: https://www.gpo.gov/
                                                                                                        Professional Prescription Drug                        of mechanisms, including
                                                fdsys/pkg/FR-2015-09-18/pdf/2015-
                                                                                                        Promotion                                             communication with pharmaceutical
                                                23389.pdf.
                                                   Docket: For access to the docket to                  OMB Control Number 0910—NEW                           representatives, journal ads, prescribing
                                                read background documents or the                                                                              software, presentations at sponsored
                                                                                                           Section 1701(a)(4) of the Public                   meetings, and direct mail ads (Ref. 10).
                                                electronic and written/paper comments                   Health Service Act (42 U.S.C.
                                                received, go to https://                                                                                      Several studies indicate that data
                                                                                                        300u(a)(4)) authorizes FDA to conduct                 presented in promotional materials may
                                                www.regulations.gov and insert the                      research relating to health information.
                                                docket number, found in brackets in the                                                                       not be fully comprehended and may
                                                                                                        Section 1003(d)(2)(C) of the Federal                  even potentially be misleading due to a
                                                heading of this document, into the                      Food, Drug, and Cosmetic Act (FD&C                    variety of causes, such as insufficient
                                                ‘‘Search’’ box and follow the prompts                   Act) (21 U.S.C. 393(d)(2)(C)) authorizes              information, unsupported claims, or a
                                                and/or go to the Dockets Management                     FDA to conduct research relating to                   failure to disclose limitations of the
                                                Staff, 5630 Fishers Lane, Rm. 1061,                     drugs and other FDA regulated products                information presented (Refs. 11–15).
                                                Rockville, MD 20852.                                    in carrying out the provisions of the                    Although HCPs are learned
                                                FOR FURTHER INFORMATION CONTACT: Ila                    FD&C Act.                                             intermediaries, like most people, they
                                                S. Mizrachi, Office of Operations, Food                    As part of its federal mandate, FDA                may rely on heuristics in making
                                                and Drug Administration, Three White                    regulates whether direct-to-consumer                  decisions and may have cognitive biases
                                                Flint North, 10A–12M, 11601                             (DTC) advertising of prescription drug                in the type of information they attend to
                                                Landsdown St., North Bethesda, MD                       products is truthful, balanced, and                   at any given time. They may be
                                                20852, 301–796–7726, PRAStaff@                          accurately communicated (see 21 U.S.C.                persuaded by strong statements and may
                                                fda.hhs.gov.                                            352(n)). Similarly, the FD&C Act
sradovich on DSK3GMQ082PROD with NOTICES




                                                                                                                                                              not have the time to ascertain accuracy
                                                SUPPLEMENTARY INFORMATION:                              prohibits the dissemination of false or               of such information (Ref. 16). The
                                                                                                        misleading information about                          proposed survey will provide further
                                                I. Background                                           medications in consumer-directed and                  insights about how professionally
                                                   Under the PRA (44 U.S.C. 3501–                       professional prescription drug                        targeted prescription drug promotion
                                                3520), Federal Agencies must obtain                     promotion. FDA regulates within the                   might influence health care
                                                approval from the Office of Management                  framework of free speech and due                      professionals’ decision-making
                                                and Budget (OMB) for each collection of                 process principles of the United States               processes and practices and how


                                           VerDate Sep<11>2014   17:34 Mar 14, 2018   Jkt 244001   PO 00000   Frm 00053   Fmt 4703   Sfmt 4703   E:\FR\FM\15MRN1.SGM   15MRN1


                                                                                      Federal Register / Vol. 83, No. 51 / Thursday, March 15, 2018 / Notices                                                                                               11541

                                                information may be communicated                                           3. How familiar are HCPs with the                                          indicate they work in general, family, or
                                                more effectively. It is important to note                               FDA approval of prescription drugs and                                       internal medicine. Specialties were
                                                that FDA does not regulate the practice                                 how does this translate into practice?                                       chosen based on prevalence in the
                                                of medicine. However, as previously                                       In addition, given the critical nature                                     United States and prescription drug
                                                mentioned, FDA does regulate                                            of the opioid situation in the United                                        promotional activity. Specialists will
                                                prescription drug promotion. This                                       States at this time, we plan to ask                                          include cardiologists, dermatologists,
                                                survey is designed to inform FDA of                                     several questions about prescription                                         endocrinologists, neurologists,
                                                various responses to and impacts of                                     drug promotion of opioid products.                                           obstetrician/gynecologists, oncologists,
                                                prescription drug promotion of                                            HCPs who fall into one of four                                             ophthalmologists, psychiatrists,
                                                prescription drugs.                                                     categories will be recruited online                                          rheumatologists, and urologists. The
                                                  The general research questions in the                                 through WebMD’s Medscape subscriber                                          data will be weighted to adjust for
                                                survey are as follows:                                                  network. We propose to complete 700                                          differential coverage of select
                                                  1. What methods and/or channels are                                   primary care physician, 600 specialist,                                      characteristics such as region and
                                                used to disseminate prescription drug                                   350 nurse practitioner, and 350                                              respondent age and gender. Pretesting
                                                promotional information to health care                                  physician assistant surveys. HCPs will                                       with 25 respondents will take place
                                                professionals/prescribers?                                              be included if they see patients at least                                    before the main study to evaluate the
                                                  2. How knowledgeable and interested                                   50 percent of the time. Both Doctors of                                      procedures and measures used in the
                                                are HCPs in clinical trial data and its                                 Medicine and Doctors of Osteopathy                                           main study.
                                                presence in prescription drug                                           will be included. Primary care                                                 FDA estimates the burden of this
                                                promotion?                                                              physicians will include those who                                            collection of information as follows:

                                                                                                           TABLE 1—ESTIMATED ANNUAL REPORTING BURDEN 1
                                                                                                                                      Number of
                                                                                                           Number of                                            Total annual
                                                                    Activity                                                        responses per                                              Average burden per response                              Total hours
                                                                                                          respondents                                            responses
                                                                                                                                      respondent

                                                                                                                                                 Pretest Study

                                                HCP screener ...................................                             63                           1                       63      0.08 (5 minutes) ...............................                            5
                                                Informed Consent .............................                               25                           1                       25      0.08 (5 minutes) ...............................                            2
                                                HCP Survey ......................................                            25                           1                       25      0.33 (20 minutes) .............................                             8

                                                                                                                                                   Main Study

                                                HCP screener ...................................                        5,037                             1                  5,037        0.08 (5 minutes) ...............................                       403
                                                Informed Consent .............................                          2,000                             1                  2,000        0.08 (5 minutes) ...............................                       160
                                                HCP Survey ......................................                       2,000                             1                  2,000        0.33 (20 minutes) .............................                        660

                                                     Total ...........................................   ........................   ........................   ........................   ...........................................................          1,238
                                                   1 There   are no capital costs and maintenance costs associated with this collection of information.


                                                II. References                                                               Bad Ad Program and Education                                                 Interactions With Medical Trainees’
                                                                                                                             Regarding Pharmaceutical Advertising: A                                      Knowledge About Evidence-Based
                                                  The following references are on                                            National Survey of Prescribers in                                            Prescribing: Results From a National
                                                display in the Dockets Management                                            Ambulatory Care Settings,’’ Journal of                                       Survey,’’ JAMA Internal Medicine, vol.
                                                Staff (see ADDRESSES) and are available                                      Health Communication, vol. 20(11), pp.                                       174(8), pp. 1283–1290.
                                                for viewing by interested persons                                            1330–1336.                                                              9. Cegedim Strategic Data. (2013). ‘‘2012 U.S.
                                                between 9 a.m. and 4 p.m., Monday                                       4. Crigger, N.J. (2005). ‘‘Pharmaceutical                                         Pharmaceutical Company Promotion
                                                                                                                             Promotions and Conflict of Interest in                                       Spending.’’ Available at: http://
                                                through Friday; they are also available
                                                                                                                             Nurse Practitioner’s Decision Making:                                        www.skainfo.com/health_care_market_
                                                electronically at https://                                                   The Undiscovered Country,’’ Journal of                                       reports/2012_promotional_spending.pdf.
                                                www.regulations.gov. FDA has verified                                        the American Academy of Nurse                                           10. Spurling, G.K., P.R. Mansfield, B.D.
                                                the website addresses, as of the date this                                   Practitioners, vol. 17(6), pp. 207–212.                                      Montgomery, et al. (2010). ‘‘Information
                                                document publishes in the Federal                                       5. Fischer, M.A., M.E. Keough, J.L. Baril, et                                     From Pharmaceutical Companies and the
                                                Register, but websites are subject to                                        al. (2009). ‘‘Prescribers and                                                Quality, Quantity, and Cost of
                                                change over time.                                                            Pharmaceutical Representatives: Why                                          Physicians’ Prescribing: A Systematic
                                                                                                                             Are We Still Meeting?’’ Journal of                                           Review,’’ PLoS Medicine, vol. 7(10),
                                                1. Available at: https://www.fda.gov/                                        General Internal Medicine, vol. 24(7), pp.                                   e1000352. doi: 10.1371/jounal.pmed.
                                                    AboutFDA/CentersOffices/Officeof                                         795–801.                                                                     1000352.
                                                    MedicalProductsandTobacco/CDER/                                     6. C. Robertson, S. Rose, and A.S.                                           11. Villanueva, P., S. Peiró, J. Librero, et al.
                                                    ucm090276.htm. Last accessed January                                     Kesselheim. (2012). ‘‘Effect of Financial                                    (2003). ‘‘Accuracy of Pharmaceutical
                                                    26, 2018.                                                                Relationships on the Behaviors of Health                                     Advertisements in Medical Journals,’’
                                                2. Betts, K.R., A.C. O’Donoghue, K.J. Aikin,                                 Care Professionals: A Review of the                                          Lancet, vol. 361(9351), pp. 27–32.
                                                    et al. (2016). ‘‘Healthcare Professional                                 Evidence,’’ The Journal of Law, Medicine                                12. Cooper, R.J. and D.L. Schriger. (2005).
sradovich on DSK3GMQ082PROD with NOTICES




                                                    Social Media Membership and                                              & Ethics, vol. 40(3), pp. 452–466.                                           ‘‘The Availability of References and the
                                                    Participation: Findings From a                                      7. Srivastava, V., M. Handa, and A. Vohra.                                        Sponsorship of Original Research Cited
                                                    Nationally Representative Sample,’’                                      (2014). ‘‘Promotional Tools: Do                                              in Pharmaceutical Advertisements,’’
                                                    Journal of the American Association of                                   Physicians Really Bite the Hook?’’                                           Canadian Medical Association Journal,
                                                    Nurse Practitioners. Doi: 10.1002/2327–                                  Drishtikon: A Management Journal, vol.                                       vol. 172(4), pp. 487–491.
                                                    6924.12383.                                                              5(2).                                                                   13. Jureidini, J.N., L.B. McHenry, and P.R.
                                                3. O’Donoghue, A.C., V. Boudewyns, K.J.                                 8. Austad, K.E., J. Avorn, J.M. Franklin, et al.                                  Mansfield. (2008). ‘‘Clinical Trials and
                                                    Aikin, et al. (2015). ‘‘Awareness of FDA’s                               (2014). ‘‘Association of Marketing                                           Drug Promotion: Selective Reporting of



                                           VerDate Sep<11>2014       17:34 Mar 14, 2018        Jkt 244001      PO 00000         Frm 00054       Fmt 4703       Sfmt 4703       E:\FR\FM\15MRN1.SGM                15MRN1


                                                11542                               Federal Register / Vol. 83, No. 51 / Thursday, March 15, 2018 / Notices

                                                     Study 329,’’ International Journal of Risk                       ACTION: Announcing Budget Period                                         Nearly 26 million people received
                                                     & Safety in Medicine, vol. 20(1–2), pp.                          Extensions with Funding for the Health                                   accessible, affordable, quality primary
                                                     73–81.                                                           Center Program.                                                          health care services through the Health
                                                14. Garcia-Retamero, R. and M. Galesic.                                                                                                        Center Program award recipients in
                                                     (2010). ‘‘Who Profits From Visual Aids:                          SUMMARY:   HRSA provided additional                                      2016.
                                                     Overcoming Challenges in People’s                                grant funds during extended budget
                                                     Understanding of Risks,’’ Social Science                         periods to prevent interruptions in the                                     Approximately one-third of Health
                                                     & Medicine, vol. 70(7), pp. 1019–1025.                           provision of critical health care services                               Center Program award recipients’
                                                15. Cooper, R.J., D.L. Schriger, R.C. Wallace,                        for funded service areas until new                                       service areas are competed each year,
                                                     et al. (2003). ‘‘The Quantity and Quality                        awards could be made to eligible                                         and each competition has the potential
                                                     of Scientific Graphs in Pharmaceutical                           Service Area Competition (SAC)                                           to result in a change in award recipient.
                                                     Advertisements,’’ Journal of General                             applicants or HRSA could conduct an                                      SACs are also held prior to the current
                                                     Internal Medicine, vol. 18(4), pp. 294–                          orderly phase-out of Health Center                                       grant’s project period end date when (1)
                                                     297.                                                             Program activities by the current award                                  a grant is voluntarily relinquished, or (2)
                                                16. Sah, S. and A. Fugh-Berman. (2013).                               recipients.                                                              a program noncompliance enforcement
                                                     ‘‘Physicians Under the Influence: Social                         SUPPLEMENTARY INFORMATION:                                               action taken by HRSA terminates the
                                                     Psychology and Industry Marketing                                   Recipients of the Award: Health                                       grant. If the SAC draws no fundable
                                                     Strategies,’’ The Journal of Law,                                Center Program award recipients for                                      applications, HRSA may extend the
                                                     Medicine & Ethics, vol. 41(3), pp. 665–                          service areas that were threatened with                                  current award recipient’s budget period
                                                     672. doi: 10.1111/jlme.12076.                                    a lapse in services due to service area re-                              to ensure primary health care services
                                                  Dated: March 9, 2018.                                               announcement or transitioning award                                      remain available while a new
                                                Leslie Kux,                                                           recipients, as listed in Table 1.                                        competition is conducted for the service
                                                                                                                         Amount of Non-Competitive Awards:                                     area.
                                                Associate Commissioner for Policy.
                                                                                                                      33 awards for $17,248,966.                                                  The amount of additional grant funds
                                                [FR Doc. 2018–05235 Filed 3–14–18; 8:45 am]
                                                                                                                         Period of Supplemental Funding:                                       is calculated by pro-rating HRSA’s
                                                BILLING CODE 4164–01–P                                                Fiscal years 2016 and 2017.                                              annual funding commitment to the
                                                                                                                         CFDA Number: 93.224                                                   service area. Approximately 6 months is
                                                DEPARTMENT OF HEALTH AND                                                Authority: Section 330 of the Public                                   required to announce and conduct a
                                                                                                                      Health Service Act, as amended (42 U.S.C.                                SAC and select a new award recipient.
                                                HUMAN SERVICES                                                        254b, as amended).                                                       In all cases, current fiscal year funds are
                                                Health Resources and Services                                           Justification: Targeting the nation’s                                  used to extend the award recipient’s
                                                Administration                                                        high need populations and geographic                                     existing budget period award. Through
                                                                                                                      areas, the Health Center Program                                         these actions, award recipients receive
                                                Health Center Program                                                 currently funds nearly 1,400 health                                      consistent levels of funding to support
                                                                                                                      centers that operate more than 11,000                                    uninterrupted primary health care
                                                AGENCY: Health Resources and Services                                 service delivery sites in every state, the                               services to the nation’s underserved
                                                Administration (HRSA), Department of                                  District of Columbia, Puerto Rico, the                                   populations and communities during
                                                Health and Human Services (HHS).                                      Virgin Islands, and the Pacific Basin.                                   service area award recipient transition.

                                                                                                                 TABLE 1—RECIPIENTS AND AWARD AMOUNTS
                                                                                                                                                                                                                     Extension    Award amount
                                                            Grant number                                                                   Award recipient name                                                     award date         ($)

                                                H80CS06641       ...................................   Ko’olauloa Community Health and Wellness Center, Inc .........................                                  12/01/15         235,116
                                                H80CS26606       ...................................   Horizon Health and Wellness, Inc .............................................................                  12/23/15         182,771
                                                H80CS26604       ...................................   Neighborhood Outreach Access to Health ...............................................                          12/23/15         192,815
                                                H80CS00851       ...................................   Duval County Health Department .............................................................                    01/11/16         480,066
                                                H80CS26560       ...................................   East Central Missouri Behavioral Health Services, Inc. ...........................                              01/15/16         281,845
                                                H80CS00048       ...................................   Santa Cruz County ....................................................................................          01/15/16         672,655
                                                H80CS00001       ...................................   City of Springfield, Massachusetts ............................................................                 01/15/16         606,761
                                                H80CS00384       ...................................   Monroe County Health Center ..................................................................                  01/15/16         640,737
                                                H80CS26631       ...................................   La Casa de Salud, Inc ..............................................................................            01/15/16         563,753
                                                H80CS00400       ...................................   Circle Family Healthcare Network, Inc ......................................................                    01/22/16         501,296
                                                H80CS00013       ...................................   Covenant House (Under 21) .....................................................................                 02/03/16         279,116
                                                H80CS26632       ...................................   Whitman-Walker Clinic, Inc .......................................................................              02/06/16         423,273
                                                H80CS00054       ...................................   Metropolitan Development Council ...........................................................                    02/06/16         457,843
                                                H80CS00055       ...................................   White Bird Clinic ........................................................................................      02/10/16         412,985
                                                H80CS26587       ...................................   Saint Hope Foundation .............................................................................             02/10/16         229,491
                                                H80CS26620       ...................................   Korean Health, Education, Information and Research Center .................                                     02/12/16         504,386
                                                H80CS26513       ...................................   FirstMed Health and Wellness Center ......................................................                      02/12/16         596,025
                                                H80CS08770       ...................................   Health Center of Southeast Texas ............................................................                   02/12/16         737,066
                                                H80CS00872       ...................................   Madison County Community Health Center .............................................                            03/01/16         467,855
                                                H80CS00622       ...................................   The Hunter Health Clinic, Inc ....................................................................              03/08/16         450,569
sradovich on DSK3GMQ082PROD with NOTICES




                                                H80CS10606       ...................................   St. Vincent de Paul Village, Inc ................................................................               04/06/16         334,418
                                                H80CS06078       ...................................   Yakima Neighborhood Health Services ....................................................                        04/06/16       1,025,892
                                                H80CS17251       ...................................   Upper Room Aids Ministry, Inc. Health Care Center ................................                              04/06/16         738,043
                                                H80CS00722       ...................................   Community Clinic of Maui, Inc ..................................................................                04/06/16         570,042
                                                H80CS01443       ...................................   Lane County ..............................................................................................      05/15/16         649,218
                                                H80CS00054       ...................................   Metropolitan Development Council ...........................................................                    06/14/16         228,922
                                                H80CS00299       ...................................   Brazos Valley Community Action Agency, Inc ..........................................                           01/17/17       1,520,645
                                                H80CS00814       ...................................   Kalihi-Palama Health Center .....................................................................               01/17/17       1,105,506



                                           VerDate Sep<11>2014    17:34 Mar 14, 2018          Jkt 244001      PO 00000       Frm 00055       Fmt 4703      Sfmt 4703      E:\FR\FM\15MRN1.SGM             15MRN1



Document Created: 2018-03-15 02:37:43
Document Modified: 2018-03-15 02:37:43
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.
DatesSubmit either electronic or written comments on the collection of information by May 14, 2018.
ContactIla S. Mizrachi, Office of Operations, Food and Drug Administration, Three White Flint North, 10A-12M, 11601 Landsdown St., North Bethesda, MD 20852, 301-796-7726, [email protected]
FR Citation83 FR 11539 

2024 Federal Register | Disclaimer | Privacy Policy
USC | CFR | eCFR