83_FR_63885 83 FR 63648 - The Food and Drug Administration's Proposed Current Good Manufacturing Practice Policies for Outsourcing Facilities: Considerations Regarding Access to Office Stock; Public Meeting; Request for Comments

83 FR 63648 - The Food and Drug Administration's Proposed Current Good Manufacturing Practice Policies for Outsourcing Facilities: Considerations Regarding Access to Office Stock; Public Meeting; Request for Comments

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 83, Issue 237 (December 11, 2018)

Page Range63648-63651
FR Document2018-26725

The Food and Drug Administration (FDA, the Agency, or we) is announcing a public meeting entitled ``FDA's Proposed Current Good Manufacturing Practice Policies for Outsourcing Facilities: Considerations Regarding Access to Office Stock.'' Stakeholders, including healthcare providers (HCPs) and medical specialty groups, have expressed concerns regarding the availability of certain compounded drug products from outsourcing facilities that they would like to have on-hand as in-office supplies of non-patient-specific compounded drugs (``office stock''). The purpose of the public meeting is to provide HCPs, outsourcing facilities, entities considering becoming outsourcing facilities, and other interested parties with an opportunity to present to FDA their perspectives concerning access to office stock from outsourcing facilities in light of FDA's enforcement policies as proposed in the revised draft guidance on current good manufacturing practice (CGMP) for human drug compounding outsourcing facilities.

Federal Register, Volume 83 Issue 237 (Tuesday, December 11, 2018)
[Federal Register Volume 83, Number 237 (Tuesday, December 11, 2018)]
[Notices]
[Pages 63648-63651]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-26725]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

[Docket No. FDA-2018-N-4087]


The Food and Drug Administration's Proposed Current Good 
Manufacturing Practice Policies for Outsourcing Facilities: 
Considerations Regarding Access to Office Stock; Public Meeting; 
Request for Comments

AGENCY: Food and Drug Administration, HHS.

ACTION: Notice of public meeting; request for comments.

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

SUMMARY: The Food and Drug Administration (FDA, the Agency, or we) is 
announcing a public meeting entitled ``FDA's Proposed Current Good 
Manufacturing Practice Policies for Outsourcing Facilities: 
Considerations Regarding Access to Office Stock.'' Stakeholders, 
including healthcare providers (HCPs) and medical specialty groups, 
have expressed concerns regarding the availability of certain 
compounded drug products from outsourcing facilities that they would 
like to have on-hand as in-office supplies of non-patient-specific 
compounded drugs (``office stock''). The purpose of the public meeting 
is to provide HCPs, outsourcing facilities, entities considering 
becoming outsourcing facilities, and other interested parties with an 
opportunity to present to FDA their perspectives concerning access to 
office stock from outsourcing facilities in light of FDA's enforcement 
policies as proposed in the revised draft guidance on current good 
manufacturing practice (CGMP) for human drug compounding outsourcing 
facilities.

DATES: The public meeting will be held on May 21, 2019, from 9 a.m. to 
5 p.m. Submit either electronic or written comments on this public 
meeting by June 21, 2019. See the SUPPLEMENTARY INFORMATION section for 
registration date and information.

ADDRESSES: The public meeting will be held at FDA's White Oak Campus, 
10903 New Hampshire Ave., Bldg. 31 Conference Center, the Great Room 
(Rm. 1503), Silver Spring, MD 20993-0002. Entrance for the public 
meeting participants (non-FDA employees) is through Building 1 where 
routine security check procedures will be performed. For parking and 
security information, please refer to https://www.fda.gov/AboutFDA/WorkingatFDA/BuildingsandFacilities/WhiteOakCampusInformation/ucm241740.htm.
    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 June 21, 2019. The https://www.regulations.gov 
electronic filing system will accept comments until 11:59 p.m. Eastern 
Time at the end of June 21, 2019. 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 Docket No. FDA-
2018-N-4087 for ``FDA's Proposed Current Good Manufacturing Practice 
Policies for Outsourcing Facilities: Considerations Regarding Access to 
Office Stock.'' Received comments, those filed in a timely manner (see 
ADDRESSES), will be placed in the docket and, except for those 
submitted as ``Confidential Submissions,'' are 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

[[Page 63649]]

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: Bronwen Blass, Center for Drug 
Evaluation and Research, Food and Drug Administration, 10903 New 
Hampshire Ave., Bldg. 51, Silver Spring, MD 20993-0002, 301-796-5092.

SUPPLEMENTARY INFORMATION: 

I. Background

A. Drug Compounding

    Drug compounding is often regarded as the process of combining, 
mixing, or altering ingredients to create a medication tailored to the 
needs of an individual patient. Compounded drug products serve an 
important role for patients whose clinical needs cannot be met by an 
FDA-approved drug product, such as for a patient who has an allergy to 
a certain dye contained in an FDA-approved drug product and needs a 
medication compounded without that dye, or an elderly patient or a 
child who cannot swallow a pill and needs a medicine in a liquid form 
that is not available in an approved product. Drug products can be 
compounded consistent with section 503A of the Federal Food, Drug, and 
Cosmetic Act (FD&C Act) (21 U.S.C. 353a) by licensed pharmacists in 
State-licensed pharmacies and Federal facilities, or by licensed 
physicians, or consistent with section 503B of the FD&C Act (21 U.S.C. 
353b) by compounders known as outsourcing facilities.
    Sometimes, it is necessary for HCPs in hospitals, clinics, offices, 
or other settings to have a certain compounded drug product on hand, so 
they can administer it to a patient who presents with an immediate need 
for the compounded drug product. Such drug products are often known as 
``office stock,'' and outsourcing facilities are uniquely permitted to 
supply these compounded products in accordance with the law.
    For example, if a patient presents at an ophthalmologist's office 
with a fungal eye infection, timely administration of a compounded 
antifungal medication may be critical to preventing vision loss. In 
such a case, the ophthalmologist may need to inject the patient with a 
compounded drug product immediately, rather than writing a prescription 
and waiting for the drug product to be compounded and shipped to the 
prescriber. In other cases, compounded drug products may need to be 
administered by a healthcare practitioner in his or her office because 
it would not be safe for the patient to take the drug home for self-
administration, and it would be preferable for the physician to have 
the drug in his or her office to administer immediately upon diagnosis, 
rather than asking the physician to order the drug and have the patient 
return to the healthcare practitioner for administration.
    Although compounded drugs can serve an important role for certain 
patients in cases such as these, they also can pose a higher risk to 
patients than FDA-approved drugs. Compounded drug products are not FDA-
approved, which means they have not undergone FDA premarket review for 
safety, effectiveness, and quality. Because compounded drug products 
are subject to a lower regulatory standard than FDA-approved drug 
products, they present a greater risk to patients and should not be 
administered to patients unless their medical needs cannot be met by 
FDA-approved drug products.

B. Compounding Under the FD&C Act

    Sections 503A and 503B of the FD&C Act address human drug 
compounding. Section 503A, added to the FD&C Act by the Food and Drug 
Administration Modernization Act of 1997 (Pub. L. 105-115), describes 
the conditions that must be satisfied for human drug products 
compounded by a licensed pharmacist in a State-licensed pharmacy or 
Federal facility, or by a licensed physician, to be exempt from the 
following three sections of the FD&C Act:
     Section 501(a)(2)(B) (21 U.S.C. 351(a)(2)(B)) (concerning 
CGMP requirements);
     section 502(f)(1) (21 U.S.C. 352(f)(1)) (concerning the 
labeling of drugs with adequate directions for use); and
     section 505 (21 U.S.C. 355) (concerning the approval of 
drugs under new drug applications or abbreviated new drug 
applications).
    A compounded drug product may be eligible for the exemptions under 
section 503A of the FD&C Act only if it is, among other things, 
compounded for an identified individual patient based on the receipt of 
a valid prescription order or a notation, approved by the prescribing 
practitioner, on the prescription order that a compounded product is 
necessary for the identified patient. Among other conditions, to 
qualify for the exemptions under section 503A, the drug product must be 
compounded by a licensed pharmacist in a State-licensed pharmacy or a 
Federal facility, or by a licensed physician (section 503A(a)).
    New section 503B, added to the FD&C Act by the Drug Quality and 
Security Act in 2013, created a new category of compounders called 
outsourcing facilities. Section 503B defines outsourcing facility, in 
part, as a facility that is engaged in the compounding of sterile drugs 
(section 503B(d)(4)(A)(i)). An outsourcing facility may engage in 
nonsterile compounding provided that it also engages in the compounding 
of sterile drugs, and provided that it compounds all of its drugs (both 
sterile and nonsterile) in accordance with the conditions of section 
503B.
    Section 503B of the FD&C Act describes the conditions that must be 
satisfied for human drug products compounded by or under the direct 
supervision of a licensed pharmacist in an outsourcing facility to 
qualify for exemptions from three sections of the FD&C Act:
     Section 502(f)(1);
     section 505; and
     section 582 (21 U.S.C. 360eee-1) (concerning drug supply 
chain security requirements).
    In contrast to compounders compounding in accordance with section 
503A of the FD&C Act, outsourcing facilities may, but need not, obtain 
prescriptions for identified individual patients for their

[[Page 63650]]

compounded drug products (section 503B(d)(4)(C)). Outsourcing 
facilities are subject to CGMP requirements in section 501(a)(2)(B). 
They must also be inspected by FDA according to a risk-based schedule 
and are subject to specific adverse event reporting requirements and 
other conditions that help to mitigate the risks of the drug products 
they compound.

C. CGMP Requirements for Outsourcing Facilities

    Elsewhere in this issue of the Federal Register, FDA announced the 
availability of a revised draft guidance for industry entitled 
``Current Good Manufacturing Practice--Guidance for Human Drug 
Compounding Outsourcing Facilities Under Section 503B of the FD&C 
Act.'' (revised draft guidance). FDA previously issued a draft guidance 
for industry on this subject in July 2014 (79 FR 37743). This guidance, 
once final, will provide for conditions under which FDA generally does 
not intend to take regulatory action against an outsourcing facility 
regarding certain CGMP requirements in 21 CFR parts 210 and 211 during 
the interim period before FDA issues regulations specific to 
outsourcing facilities. In developing policies pertaining to CGMP 
requirements for outsourcing facilities, FDA seeks to recognize the 
differences between outsourcing facilities and conventional drug 
manufacturers and to develop policies that reflect the specific 
compounding operations conducted by outsourcing facilities. The revised 
draft guidance proposes a risk-based approach to enforcement of CGMP 
requirements, tailored to the size and scope of outsourcing facilities' 
operations. The policies are aimed at making it more feasible for 
entities to register as outsourcing facilities to compound drugs for 
office stock in accordance with CGMP requirements, while maintaining 
the minimum standards necessary to protect patients from the risks of 
contaminated or otherwise substandard drug products.
    In the revised draft guidance, FDA made a number of revisions to 
address comments submitted on the 2014 draft. For example, the revised 
draft guidance differentiates between CGMP requirements applicable to 
sterile drug products and nonsterile drug products where appropriate. 
Among other changes, FDA made revisions to address comments on (1) 
stability testing, including the assignment of a beyond use date (BUD) 
as an expiration date; (2) a clear definition of ``in-use time,'' 
distinguishing it from ``BUD'' and ``expiration date''; (3) testing 
batches before release for distribution; and (4) collection and use of 
samples retained from distributed batches, known as reserve samples. 
For a more comprehensive discussion of the policies proposed in the 
revised draft guidance, please see the revised draft guidance 
(available at: https://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/default.htm or 
https://www.regulations.gov) and associated notice of availability, 
which FDA is publishing elsewhere in this issue of the Federal 
Register. In the docket for the revised draft guidance, FDA is seeking 
comment on whether the conditions outlined appropriately balance the 
risks and needs associated with compounded drugs produced for office 
stock.

II. Topics for Discussion at the Public Meeting

    FDA is seeking public input regarding outsourcing facilities 
supplying compounded drugs for office stock in light of the CGMP 
policies described in the revised draft guidance, if finalized as 
written. FDA has developed a list of topics to facilitate a productive 
discussion at the public meeting. This list is not intended to be 
exhaustive, and FDA encourages comments on the potential implications 
of the policies pertaining to compliance with CGMP requirements 
described in the revised draft CGMP guidance, if finalized as written, 
for outsourcing facilities supplying drugs compounded for office stock. 
Policies include, but are not limited to, those related to stability 
studies, beyond use dating, and release testing. Issues that are of 
specific interest to the Agency include the following:
     Perspectives related to demand and supply of office stock, 
including:
    [cir] Ways in which HCPs seek to identify outsourcing facilities 
that compound the drugs they want for office stock, as well as issues, 
if any, with this process.
    [cir] Communications between HCPs and outsourcing facilities to 
address potential issues related to requested formulations, timing, and 
order size.
    [cir] Coordination or consolidation of orders among providers for 
same or similar compounded drug products.
    [cir] HCPs' experiences with the availability of office stock 
products from outsourcing facilities.
     Perspectives related to orders for drug products that an 
outsourcing facility has not made or does not routinely make.
    [cir] Factors outsourcing facilities consider before deciding 
whether to fill an order for a requested compounded drug product that 
it has not previously made or does not routinely make.
    [cir] The impact that FDA's policies proposed in the revised draft 
guidance would have on outsourcing facilities filling orders for 
requested products not previously or routinely made.
     Perspectives related to small volume orders of office 
stock products, including:
    [cir] HCPs' experiences seeking small volume orders from 
outsourcing facilities.
    [cir] Factors outsourcing facilities consider before determining 
whether to produce small batches of compounded drug products for office 
stock.
    [cir] The impact that FDA's policies proposed in the revised draft 
guidance would have on outsourcing facilities' decisions regarding 
filling small volume orders and/or producing small batches of 
compounded drug products for office stock.
    [cir] Whether/how the revisions proposed in the revised draft 
guidance would affect registration of compounders engaged in smaller-
scale production as outsourcing facilities.
     Perspectives related to beyond use dating for office stock 
products, including:
    [cir] How long HCPs seek to keep office stock drug products before 
use.
    [cir] The impact that FDA's policies proposed in the revised draft 
guidance would have on outsourcing facilities' production of compounded 
drug products for office stock with beyond use dating desired by HCPs.
    FDA will post the agenda and other meeting materials at least 5 
days before the meeting on the public meeting website. More information 
regarding the meeting, including the public meeting website address, 
will be posted at: https://www.fda.gov/Drugs/NewsEvents/ucm132703.htm.

III. Participating in the Public Meeting

    Registration: Persons interested in attending this public meeting 
must register online by May 7, 2019. Please provide complete contact 
information for each attendee, including name, title, affiliation, 
address, email, and telephone. More information regarding the meeting, 
including the public meeting website address and registration 
instructions, will be posted at: https://www.fda.gov/Drugs/NewsEvents/ucm132703.htm.
    Registration is free and in-person attendance is based on space 
availability, with priority given to early registrants. Early 
registration is recommended because seating is limited; therefore, FDA 
may limit the number of participants from each

[[Page 63651]]

organization. Registrants will receive confirmation when they have been 
accepted. If time and space permit, onsite registration on the day of 
the public meeting will be provided beginning at 8:30 a.m. We will post 
information at https://www.fda.gov/Drugs/NewsEvents/ucm132703.htm if 
registration closes before the day of the public meeting.
    If you need special accommodations due to a disability, please 
contact [email protected] no later than May 14, 
2019.
    Requests for Oral Presentations: During online registration you may 
indicate if you wish to present during a public comment session and 
which topic(s) you wish to address. All requests to make oral 
presentations must be received by March 1, 2019. You will also be asked 
to send [email protected] a brief summary your 
comments by March 1, 2019. Individuals and organizations with common 
interests are urged to consolidate or coordinate their presentations, 
and request time for a joint presentation, or submit requests for 
designated representatives to present. For more information on oral 
presentation requests, visit https://www.fda.gov/Drugs/NewsEvents/ucm132703.htm. Following the close of registration, we will determine 
the amount of time allotted to each presenter and the approximate time 
each oral presentation is to begin. We will do our best to accommodate 
all stakeholders who wish to speak; however, the duration of comments 
may be limited by time constraints, including time allowances for each 
topic. Presenters will be notified of their selection no later than May 
7, 2019. If selected for presentation, any presentation materials must 
be emailed to the [email protected] no later than 
May 14, 2019. No commercial or promotional material will be permitted 
to be presented or distributed at the public meeting.
    Streaming Webcast of the Public Meeting: This public meeting will 
also be webcast. Further information regarding the webcast, including 
the address for the webcast, will be made available at least 2 days in 
advance of the meeting on the public meeting website. More information 
regarding the meeting, including the public meeting website address, 
will be posted at: https://www.fda.gov/Drugs/NewsEvents/ucm132703.htm. 
FDA has verified the website addresses in this document, as of the date 
this document publishes in the Federal Register, but websites are 
subject to change over time.

    Dated: December 4, 2018.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2018-26725 Filed 12-10-18; 8:45 am]
 BILLING CODE 4164-01-P



                                              63648                      Federal Register / Vol. 83, No. 237 / Tuesday, December 11, 2018 / Notices

                                              Health Insurance Coverage Final Rule                    SUMMARY:    The Food and Drug                         Electronic Submissions
                                              published March 21, 2012 (77 FR                         Administration (FDA, the Agency, or                     Submit electronic comments in the
                                              16453), student health insurance                        we) is announcing a public meeting                    following way:
                                              coverage is a type of individual health                 entitled ‘‘FDA’s Proposed Current Good                  • Federal eRulemaking Portal:
                                              insurance coverage provided pursuant                    Manufacturing Practice Policies for                   https://www.regulations.gov. Follow the
                                              to a written agreement between an                       Outsourcing Facilities: Considerations                instructions for submitting comments.
                                              institution of higher education (as                     Regarding Access to Office Stock.’’                   Comments submitted electronically,
                                              defined in the Higher Education Act of                  Stakeholders, including healthcare                    including attachments, to https://
                                              1965) and a health insurance issuer, and                providers (HCPs) and medical specialty                www.regulations.gov will be posted to
                                              provided to students who are enrolled                   groups, have expressed concerns                       the docket unchanged. Because your
                                              in that institution and their dependents.               regarding the availability of certain                 comment will be made public, you are
                                              The Patient Protection and Affordable                   compounded drug products from                         solely responsible for ensuring that your
                                              Care Act; HHS Notice of Benefit and                     outsourcing facilities that they would                comment does not include any
                                              Payment Parameters for 2017 Final Rule                  like to have on-hand as in-office                     confidential information that you or a
                                              provided that, for policy years                         supplies of non-patient-specific                      third party may not wish to be posted,
                                              beginning on or after July 1, 2016,                     compounded drugs (‘‘office stock’’). The              such as medical information, your or
                                              student health insurance coverage is                                                                          anyone else’s Social Security number, or
                                                                                                      purpose of the public meeting is to
                                              exempt from the actuarial value (AV)                                                                          confidential business information, such
                                                                                                      provide HCPs, outsourcing facilities,
                                              requirements under section 1302(d) of                                                                         as a manufacturing process. Please note
                                                                                                      entities considering becoming
                                              the Affordable Care Act, but must                                                                             that if you include your name, contact
                                              provide coverage with an AV of at least                 outsourcing facilities, and other
                                                                                                      interested parties with an opportunity to             information, or other information that
                                              60 percent. This provision also requires                                                                      identifies you in the body of your
                                              issuers of student health insurance                     present to FDA their perspectives
                                                                                                      concerning access to office stock from                comments, that information will be
                                              coverage to specify in any plan                                                                               posted on https://www.regulations.gov.
                                              materials summarizing the terms of the                  outsourcing facilities in light of FDA’s
                                                                                                      enforcement policies as proposed in the                 • If you want to submit a comment
                                              coverage the AV of the coverage and the                                                                       with confidential information that you
                                              metal level (or the next lowest metal                   revised draft guidance on current good
                                                                                                      manufacturing practice (CGMP) for                     do not wish to be made available to the
                                              level) the coverage would otherwise                                                                           public, submit the comment as a
                                              satisfy under § 156.140. This disclosure                human drug compounding outsourcing
                                                                                                                                                            written/paper submission and in the
                                              will provide students with information                  facilities.
                                                                                                                                                            manner detailed (see ‘‘Written/Paper
                                              that allows them to compare the student                                                                       Submissions’’ and ‘‘Instructions’’).
                                              health coverage with other available                    DATES: The public meeting will be held
                                              coverage options. Form Number: CMS–                     on May 21, 2019, from 9 a.m. to 5 p.m.                Written/Paper Submissions
                                              10377 (OMB control number 0938–                         Submit either electronic or written
                                                                                                      comments on this public meeting by                      Submit written/paper submissions as
                                              1157); Frequency: Annually; Affected                                                                          follows:
                                                                                                      June 21, 2019. See the SUPPLEMENTARY
                                              Public: Private Sector; Number of                                                                               • Mail/Hand Delivery/Courier (for
                                              Respondents: 52; Total Annual                           INFORMATION section for registration date
                                                                                                                                                            written/paper submissions): Dockets
                                              Responses: 1,176,235; Total Annual                      and information.
                                                                                                                                                            Management Staff (HFA–305), Food and
                                              Hours: 52. (For policy questions                        ADDRESSES:   The public meeting will be               Drug Administration, 5630 Fishers
                                              regarding this collection contact Russell               held at FDA’s White Oak Campus,                       Lane, Rm. 1061, Rockville, MD 20852.
                                              Tipps at 301–492–4371.)                                 10903 New Hampshire Ave., Bldg. 31                      • For written/paper comments
                                                 Dated: December 6, 2018.                             Conference Center, the Great Room (Rm.                submitted to the Dockets Management
                                              William N. Parham, III,                                 1503), Silver Spring, MD 20993–0002.                  Staff, FDA will post your comment, as
                                              Director, Paperwork Reduction Staff, Office             Entrance for the public meeting                       well as any attachments, except for
                                              of Strategic Operations and Regulatory                  participants (non-FDA employees) is                   information submitted, marked and
                                              Affairs.                                                through Building 1 where routine                      identified, as confidential, if submitted
                                              [FR Doc. 2018–26790 Filed 12–10–18; 8:45 am]            security check procedures will be                     as detailed in ‘‘Instructions.’’
                                              BILLING CODE 4120–01–P                                  performed. For parking and security                     Instructions: All submissions received
                                                                                                      information, please refer to https://                 must include Docket No. FDA–2018–N–
                                                                                                      www.fda.gov/AboutFDA/                                 4087 for ‘‘FDA’s Proposed Current Good
                                              DEPARTMENT OF HEALTH AND                                WorkingatFDA/BuildingsandFacilities/                  Manufacturing Practice Policies for
                                              HUMAN SERVICES                                          WhiteOakCampusInformation/                            Outsourcing Facilities: Considerations
                                                                                                      ucm241740.htm.                                        Regarding Access to Office Stock.’’
                                              Food and Drug Administration                                                                                  Received comments, those filed in a
                                                                                                         You may submit comments as                         timely manner (see ADDRESSES), will be
                                              [Docket No. FDA–2018–N–4087]                            follows. Please note that late, untimely              placed in the docket and, except for
                                                                                                      filed comments will not be considered.                those submitted as ‘‘Confidential
                                              The Food and Drug Administration’s                      Electronic comments must be submitted                 Submissions,’’ are publicly viewable at
                                              Proposed Current Good Manufacturing                     on or before June 21, 2019. The https://              https://www.regulations.gov or at the
                                              Practice Policies for Outsourcing                       www.regulations.gov electronic filing                 Dockets Management Staff between 9
                                              Facilities: Considerations Regarding                    system will accept comments until                     a.m. and 4 p.m., Monday through
amozie on DSK3GDR082PROD with NOTICES1




                                              Access to Office Stock; Public                          11:59 p.m. Eastern Time at the end of                 Friday.
                                              Meeting; Request for Comments                           June 21, 2019. Comments received by                     • Confidential Submissions—To
                                              AGENCY:    Food and Drug Administration,                mail/hand delivery/courier (for written/              submit a comment with confidential
                                              HHS.                                                    paper submissions) will be considered                 information that you do not wish to be
                                                                                                      timely if they are postmarked or the                  made publicly available, submit your
                                              ACTION: Notice of public meeting;
                                                                                                      delivery service acceptance receipt is on             comments only as a written/paper
                                              request for comments.
                                                                                                      or before that date.                                  submission. You should submit two


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                                                                         Federal Register / Vol. 83, No. 237 / Tuesday, December 11, 2018 / Notices                                             63649

                                              copies total. One copy will include the                 with section 503A of the Federal Food,                115), describes the conditions that must
                                              information you claim to be confidential                Drug, and Cosmetic Act (FD&C Act) (21                 be satisfied for human drug products
                                              with a heading or cover note that states                U.S.C. 353a) by licensed pharmacists in               compounded by a licensed pharmacist
                                              ‘‘THIS DOCUMENT CONTAINS                                State-licensed pharmacies and Federal                 in a State-licensed pharmacy or Federal
                                              CONFIDENTIAL INFORMATION.’’ The                         facilities, or by licensed physicians, or             facility, or by a licensed physician, to be
                                              Agency will review this copy, including                 consistent with section 503B of the                   exempt from the following three
                                              the claimed confidential information, in                FD&C Act (21 U.S.C. 353b) by                          sections of the FD&C Act:
                                              its consideration of comments. The                      compounders known as outsourcing                         • Section 501(a)(2)(B) (21 U.S.C.
                                              second copy, which will have the                        facilities.                                           351(a)(2)(B)) (concerning CGMP
                                              claimed confidential information                           Sometimes, it is necessary for HCPs in             requirements);
                                              redacted/blacked out, will be available                 hospitals, clinics, offices, or other                    • section 502(f)(1) (21 U.S.C.
                                              for public viewing and posted on                        settings to have a certain compounded                 352(f)(1)) (concerning the labeling of
                                              https://www.regulations.gov. Submit                     drug product on hand, so they can                     drugs with adequate directions for use);
                                              both copies to the Dockets Management                   administer it to a patient who presents               and
                                              Staff. If you do not wish your name and                 with an immediate need for the                           • section 505 (21 U.S.C. 355)
                                              contact information to be made publicly                 compounded drug product. Such drug                    (concerning the approval of drugs under
                                              available, you can provide this                         products are often known as ‘‘office                  new drug applications or abbreviated
                                              information on the cover sheet and not                  stock,’’ and outsourcing facilities are               new drug applications).
                                              in the body of your comments and you                    uniquely permitted to supply these                       A compounded drug product may be
                                              must identify this information as                       compounded products in accordance                     eligible for the exemptions under
                                              ‘‘confidential.’’ Any information marked                with the law.                                         section 503A of the FD&C Act only if it
                                              as ‘‘confidential’’ will not be disclosed                  For example, if a patient presents at              is, among other things, compounded for
                                              except in accordance with 21 CFR 10.20                  an ophthalmologist’s office with a                    an identified individual patient based
                                              and other applicable disclosure law. For                fungal eye infection, timely                          on the receipt of a valid prescription
                                              more information about FDA’s posting                    administration of a compounded                        order or a notation, approved by the
                                              of comments to public dockets, see 80                   antifungal medication may be critical to              prescribing practitioner, on the
                                              FR 56469, September 18, 2015, or access                 preventing vision loss. In such a case,               prescription order that a compounded
                                              the information at: https://www.gpo.gov/                the ophthalmologist may need to inject                product is necessary for the identified
                                              fdsys/pkg/FR-2015-09-18/pdf/2015-                       the patient with a compounded drug                    patient. Among other conditions, to
                                              23389.pdf.                                              product immediately, rather than                      qualify for the exemptions under section
                                                 Docket: For access to the docket to                  writing a prescription and waiting for                503A, the drug product must be
                                              read background documents or the                        the drug product to be compounded and                 compounded by a licensed pharmacist
                                              electronic and written/paper comments                   shipped to the prescriber. In other cases,            in a State-licensed pharmacy or a
                                              received, go to https://                                compounded drug products may need to                  Federal facility, or by a licensed
                                              www.regulations.gov and insert the                      be administered by a healthcare                       physician (section 503A(a)).
                                              docket number, found in brackets in the                 practitioner in his or her office because                New section 503B, added to the FD&C
                                              heading of this document, into the                      it would not be safe for the patient to               Act by the Drug Quality and Security
                                              ‘‘Search’’ box and follow the prompts                   take the drug home for self-                          Act in 2013, created a new category of
                                              and/or go to the Dockets Management                     administration, and it would be                       compounders called outsourcing
                                              Staff, 5630 Fishers Lane, Rm. 1061,                     preferable for the physician to have the              facilities. Section 503B defines
                                              Rockville, MD 20852.                                    drug in his or her office to administer               outsourcing facility, in part, as a facility
                                              FOR FURTHER INFORMATION CONTACT:                        immediately upon diagnosis, rather than               that is engaged in the compounding of
                                              Bronwen Blass, Center for Drug                          asking the physician to order the drug                sterile drugs (section 503B(d)(4)(A)(i)).
                                              Evaluation and Research, Food and                       and have the patient return to the                    An outsourcing facility may engage in
                                              Drug Administration, 10903 New                          healthcare practitioner for                           nonsterile compounding provided that
                                              Hampshire Ave., Bldg. 51, Silver Spring,                administration.                                       it also engages in the compounding of
                                              MD 20993–0002, 301–796–5092.                               Although compounded drugs can                      sterile drugs, and provided that it
                                                                                                      serve an important role for certain                   compounds all of its drugs (both sterile
                                              SUPPLEMENTARY INFORMATION:
                                                                                                      patients in cases such as these, they also            and nonsterile) in accordance with the
                                              I. Background                                           can pose a higher risk to patients than               conditions of section 503B.
                                                                                                      FDA-approved drugs. Compounded                           Section 503B of the FD&C Act
                                              A. Drug Compounding
                                                                                                      drug products are not FDA-approved,                   describes the conditions that must be
                                                 Drug compounding is often regarded                   which means they have not undergone                   satisfied for human drug products
                                              as the process of combining, mixing, or                 FDA premarket review for safety,                      compounded by or under the direct
                                              altering ingredients to create a                        effectiveness, and quality. Because                   supervision of a licensed pharmacist in
                                              medication tailored to the needs of an                  compounded drug products are subject                  an outsourcing facility to qualify for
                                              individual patient. Compounded drug                     to a lower regulatory standard than                   exemptions from three sections of the
                                              products serve an important role for                    FDA-approved drug products, they                      FD&C Act:
                                              patients whose clinical needs cannot be                 present a greater risk to patients and                   • Section 502(f)(1);
                                              met by an FDA-approved drug product,                    should not be administered to patients                   • section 505; and
                                              such as for a patient who has an allergy                unless their medical needs cannot be                     • section 582 (21 U.S.C. 360eee–1)
                                              to a certain dye contained in an FDA-                   met by FDA-approved drug products.                    (concerning drug supply chain security
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                                              approved drug product and needs a                                                                             requirements).
                                              medication compounded without that                      B. Compounding Under the FD&C Act                        In contrast to compounders
                                              dye, or an elderly patient or a child who                 Sections 503A and 503B of the FD&C                  compounding in accordance with
                                              cannot swallow a pill and needs a                       Act address human drug compounding.                   section 503A of the FD&C Act,
                                              medicine in a liquid form that is not                   Section 503A, added to the FD&C Act by                outsourcing facilities may, but need not,
                                              available in an approved product. Drug                  the Food and Drug Administration                      obtain prescriptions for identified
                                              products can be compounded consistent                   Modernization Act of 1997 (Pub. L. 105–               individual patients for their


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                                              63650                      Federal Register / Vol. 83, No. 237 / Tuesday, December 11, 2018 / Notices

                                              compounded drug products (section                       collection and use of samples retained                drug product that it has not previously
                                              503B(d)(4)(C)). Outsourcing facilities are              from distributed batches, known as                    made or does not routinely make.
                                              subject to CGMP requirements in                         reserve samples. For a more                              Æ The impact that FDA’s policies
                                              section 501(a)(2)(B). They must also be                 comprehensive discussion of the                       proposed in the revised draft guidance
                                              inspected by FDA according to a risk-                   policies proposed in the revised draft                would have on outsourcing facilities
                                              based schedule and are subject to                       guidance, please see the revised draft                filling orders for requested products not
                                              specific adverse event reporting                        guidance (available at: https://                      previously or routinely made.
                                              requirements and other conditions that                  www.fda.gov/Drugs/Guidance                               • Perspectives related to small
                                              help to mitigate the risks of the drug                  ComplianceRegulatoryInformation/                      volume orders of office stock products,
                                              products they compound.                                 Guidances/default.htm or https://                     including:
                                                                                                      www.regulations.gov) and associated                      Æ HCPs’ experiences seeking small
                                              C. CGMP Requirements for Outsourcing                                                                          volume orders from outsourcing
                                              Facilities                                              notice of availability, which FDA is
                                                                                                      publishing elsewhere in this issue of the             facilities.
                                                 Elsewhere in this issue of the Federal               Federal Register. In the docket for the                  Æ Factors outsourcing facilities
                                              Register, FDA announced the                             revised draft guidance, FDA is seeking                consider before determining whether to
                                              availability of a revised draft guidance                comment on whether the conditions                     produce small batches of compounded
                                              for industry entitled ‘‘Current Good                    outlined appropriately balance the risks              drug products for office stock.
                                              Manufacturing Practice—Guidance for                     and needs associated with compounded                     Æ The impact that FDA’s policies
                                              Human Drug Compounding Outsourcing                      drugs produced for office stock.                      proposed in the revised draft guidance
                                              Facilities Under Section 503B of the                                                                          would have on outsourcing facilities’
                                              FD&C Act.’’ (revised draft guidance).                   II. Topics for Discussion at the Public               decisions regarding filling small volume
                                              FDA previously issued a draft guidance                  Meeting                                               orders and/or producing small batches
                                              for industry on this subject in July 2014                  FDA is seeking public input regarding              of compounded drug products for office
                                              (79 FR 37743). This guidance, once                      outsourcing facilities supplying                      stock.
                                              final, will provide for conditions under                compounded drugs for office stock in                     Æ Whether/how the revisions
                                              which FDA generally does not intend to                  light of the CGMP policies described in               proposed in the revised draft guidance
                                              take regulatory action against an                       the revised draft guidance, if finalized              would affect registration of
                                              outsourcing facility regarding certain                  as written. FDA has developed a list of               compounders engaged in smaller-scale
                                              CGMP requirements in 21 CFR parts 210                   topics to facilitate a productive                     production as outsourcing facilities.
                                              and 211 during the interim period                       discussion at the public meeting. This                   • Perspectives related to beyond use
                                              before FDA issues regulations specific to               list is not intended to be exhaustive, and            dating for office stock products,
                                              outsourcing facilities. In developing                   FDA encourages comments on the                        including:
                                              policies pertaining to CGMP                             potential implications of the policies                   Æ How long HCPs seek to keep office
                                              requirements for outsourcing facilities,                pertaining to compliance with CGMP                    stock drug products before use.
                                              FDA seeks to recognize the differences                                                                           Æ The impact that FDA’s policies
                                                                                                      requirements described in the revised
                                              between outsourcing facilities and                                                                            proposed in the revised draft guidance
                                                                                                      draft CGMP guidance, if finalized as
                                              conventional drug manufacturers and to                                                                        would have on outsourcing facilities’
                                                                                                      written, for outsourcing facilities
                                              develop policies that reflect the specific                                                                    production of compounded drug
                                                                                                      supplying drugs compounded for office
                                              compounding operations conducted by                                                                           products for office stock with beyond
                                                                                                      stock. Policies include, but are not
                                              outsourcing facilities. The revised draft                                                                     use dating desired by HCPs.
                                                                                                      limited to, those related to stability
                                              guidance proposes a risk-based                                                                                   FDA will post the agenda and other
                                                                                                      studies, beyond use dating, and release
                                              approach to enforcement of CGMP                                                                               meeting materials at least 5 days before
                                                                                                      testing. Issues that are of specific
                                              requirements, tailored to the size and                                                                        the meeting on the public meeting
                                                                                                      interest to the Agency include the
                                              scope of outsourcing facilities’                                                                              website. More information regarding the
                                                                                                      following:
                                              operations. The policies are aimed at                                                                         meeting, including the public meeting
                                              making it more feasible for entities to                    • Perspectives related to demand and               website address, will be posted at:
                                              register as outsourcing facilities to                   supply of office stock, including:                    https://www.fda.gov/Drugs/NewsEvents/
                                              compound drugs for office stock in                         Æ Ways in which HCPs seek to                       ucm132703.htm.
                                              accordance with CGMP requirements,                      identify outsourcing facilities that
                                                                                                      compound the drugs they want for                      III. Participating in the Public Meeting
                                              while maintaining the minimum
                                              standards necessary to protect patients                 office stock, as well as issues, if any,                 Registration: Persons interested in
                                              from the risks of contaminated or                       with this process.                                    attending this public meeting must
                                              otherwise substandard drug products.                       Æ Communications between HCPs                      register online by May 7, 2019. Please
                                                 In the revised draft guidance, FDA                   and outsourcing facilities to address                 provide complete contact information
                                              made a number of revisions to address                   potential issues related to requested                 for each attendee, including name, title,
                                              comments submitted on the 2014 draft.                   formulations, timing, and order size.                 affiliation, address, email, and
                                              For example, the revised draft guidance                    Æ Coordination or consolidation of                 telephone. More information regarding
                                              differentiates between CGMP                             orders among providers for same or                    the meeting, including the public
                                              requirements applicable to sterile drug                 similar compounded drug products.                     meeting website address and
                                              products and nonsterile drug products                      Æ HCPs’ experiences with the                       registration instructions, will be posted
                                              where appropriate. Among other                          availability of office stock products from            at: https://www.fda.gov/Drugs/
                                              changes, FDA made revisions to address                  outsourcing facilities.                               NewsEvents/ucm132703.htm.
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                                              comments on (1) stability testing,                         • Perspectives related to orders for                  Registration is free and in-person
                                              including the assignment of a beyond                    drug products that an outsourcing                     attendance is based on space
                                              use date (BUD) as an expiration date; (2)               facility has not made or does not                     availability, with priority given to early
                                              a clear definition of ‘‘in-use time,’’                  routinely make.                                       registrants. Early registration is
                                              distinguishing it from ‘‘BUD’’ and                         Æ Factors outsourcing facilities                   recommended because seating is
                                              ‘‘expiration date’’; (3) testing batches                consider before deciding whether to fill              limited; therefore, FDA may limit the
                                              before release for distribution; and (4)                an order for a requested compounded                   number of participants from each


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                                                                         Federal Register / Vol. 83, No. 237 / Tuesday, December 11, 2018 / Notices                                          63651

                                              organization. Registrants will receive                    Dated: December 4, 2018.                            www.regulations.gov will be posted to
                                              confirmation when they have been                        Leslie Kux,                                           the docket unchanged. Because your
                                              accepted. If time and space permit,                     Associate Commissioner for Policy.                    comment will be made public, you are
                                              onsite registration on the day of the                   [FR Doc. 2018–26725 Filed 12–10–18; 8:45 am]          solely responsible for ensuring that your
                                              public meeting will be provided                         BILLING CODE 4164–01–P                                comment does not include any
                                              beginning at 8:30 a.m. We will post                                                                           confidential information that you or a
                                              information at https://www.fda.gov/                                                                           third party may not wish to be posted,
                                              Drugs/NewsEvents/ucm132703.htm if                       DEPARTMENT OF HEALTH AND                              such as medical information, your or
                                              registration closes before the day of the               HUMAN SERVICES                                        anyone else’s Social Security number, or
                                              public meeting.                                                                                               confidential business information, such
                                                If you need special accommodations                    Food and Drug Administration                          as a manufacturing process. Please note
                                              due to a disability, please contact                     [Docket No. FDA–2014–D–0779]                          that if you include your name, contact
                                              CompoundingPublicMeeting@                                                                                     information, or other information that
                                              fda.hhs.gov no later than May 14, 2019.                 Current Good Manufacturing                            identifies you in the body of your
                                                Requests for Oral Presentations:                      Practice—Guidance for Human Drug                      comments, that information will be
                                              During online registration you may                      Compounding Outsourcing Facilities                    posted on https://www.regulations.gov.
                                              indicate if you wish to present during a                Under Section 503B of the FD&C Act;                     • If you want to submit a comment
                                              public comment session and which                        Draft Guidance for Industry;                          with confidential information that you
                                              topic(s) you wish to address. All                       Availability                                          do not wish to be made available to the
                                              requests to make oral presentations                                                                           public, submit the comment as a
                                              must be received by March 1, 2019. You                  AGENCY:    Food and Drug Administration,              written/paper submission and in the
                                              will also be asked to send                              HHS.                                                  manner detailed (see ‘‘Written/Paper
                                              CompoundingPublicMeeting@                               ACTION:   Notice of availability.                     Submissions’’ and ‘‘Instructions’’).
                                              fda.hhs.gov a brief summary your
                                              comments by March 1, 2019.                              SUMMARY:    The Food and Drug                         Written/Paper Submissions
                                              Individuals and organizations with                      Administration (FDA or the Agency) is                    Submit written/paper submissions as
                                              common interests are urged to                           announcing the availability of a revised              follows:
                                              consolidate or coordinate their                         draft guidance entitled ‘‘Current Good                   • Mail/Hand Delivery/Courier (for
                                              presentations, and request time for a                   Manufacturing Practice—Guidance for                   written/paper submissions): Dockets
                                              joint presentation, or submit requests for              Human Drug Compounding Outsourcing                    Management Staff (HFA–305), Food and
                                              designated representatives to present.                  Facilities Under Section 503B of the                  Drug Administration, 5630 Fishers
                                              For more information on oral                            FD&C Act.’’ This revised draft guidance               Lane, Rm. 1061, Rockville, MD 20852.
                                              presentation requests, visit https://                   describes FDA’s policies regarding                       • For written/paper comments
                                              www.fda.gov/Drugs/NewsEvents/ucm13                      compounders registered under section                  submitted to the Dockets Management
                                              2703.htm. Following the close of                        503B of the Federal Food, Drug, and                   Staff, FDA will post your comment, as
                                              registration, we will determine the                     Cosmetic Act (FD&C Act) as outsourcing                well as any attachments, except for
                                              amount of time allotted to each                         facilities and the current good                       information submitted, marked and
                                              presenter and the approximate time                      manufacturing practice (CGMP)                         identified, as confidential, if submitted
                                              each oral presentation is to begin. We                  requirements in FDA regulations. Based                as detailed in ‘‘Instructions.’’
                                              will do our best to accommodate all                     on feedback from stakeholders and                        Instructions: All submissions received
                                              stakeholders who wish to speak;                         comments received on the initial draft                must include the Docket No. FDA–
                                              however, the duration of comments may                   guidance, the guidance is being revised,              2014–D–0779 for ‘‘Current Good
                                              be limited by time constraints,                         in part, to reflect further consideration             Manufacturing Practice—Guidance for
                                              including time allowances for each                      of how CGMP requirements should be                    Human Drug Compounding Outsourcing
                                              topic. Presenters will be notified of their             applied in light of the size and scope of             Facilities Under Section 503B of the
                                              selection no later than May 7, 2019. If                 an outsourcing facility’s operations.                 FD&C Act.’’ Received comments will be
                                              selected for presentation, any                          DATES: Submit either electronic or                    placed in the docket and, except for
                                              presentation materials must be emailed                  written comments on the revised draft                 those submitted as ‘‘Confidential
                                              to the CompoundingPublicMeeting@                        guidance by February 11, 2019 to ensure               Submissions,’’ publicly viewable at
                                              fda.hhs.gov no later than May 14, 2019.                 that the Agency considers your                        https://www.regulations.gov or at the
                                              No commercial or promotional material                   comment on this draft guidance before                 Dockets Management Staff between 9
                                              will be permitted to be presented or                    it begins work on the final version of the            a.m. and 4 p.m., Monday through
                                              distributed at the public meeting.                      guidance. Submit either electronic or                 Friday.
                                                Streaming Webcast of the Public                       written comments concerning the                          • Confidential Submissions—To
                                              Meeting: This public meeting will also                  collection of information under the                   submit a comment with confidential
                                              be webcast. Further information                         Paperwork Reduction Act of 1995 (PRA)                 information that you do not wish to be
                                              regarding the webcast, including the                    proposed in the revised draft guidance                made publicly available, submit your
                                              address for the webcast, will be made                   by February 11, 2019.                                 comments only as a written/paper
                                              available at least 2 days in advance of                 ADDRESSES: You may submit comments                    submission. You should submit two
                                              the meeting on the public meeting                       on any guidance at any time as follows:               copies total. One copy will include the
                                              website. More information regarding the                                                                       information you claim to be confidential
                                              meeting, including the public meeting                   Electronic Submissions                                with a heading or cover note that states
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                                              website address, will be posted at:                       Submit electronic comments in the                   ‘‘THIS DOCUMENT CONTAINS
                                              https://www.fda.gov/Drugs/NewsEvents/                   following way:                                        CONFIDENTIAL INFORMATION.’’ The
                                              ucm132703.htm. FDA has verified the                       • Federal eRulemaking Portal:                       Agency will review this copy, including
                                              website addresses in this document, as                  https://www.regulations.gov. Follow the               the claimed confidential information, in
                                              of the date this document publishes in                  instructions for submitting comments.                 its consideration of comments. The
                                              the Federal Register, but websites are                  Comments submitted electronically,                    second copy, which will have the
                                              subject to change over time.                            including attachments, to https://                    claimed confidential information


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Document Created: 2018-12-11 01:06:25
Document Modified: 2018-12-11 01:06:25
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 of public meeting; request for comments.
DatesThe public meeting will be held on May 21, 2019, from 9 a.m. to 5 p.m. Submit either electronic or written comments on this public meeting by June 21, 2019. See the SUPPLEMENTARY INFORMATION section for registration date and information.
ContactBronwen Blass, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 51, Silver Spring, MD 20993-0002, 301-796-5092.
FR Citation83 FR 63648 

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