Ethex reaches the end of the road

KV Pharmaceuticals has announced that it is ceasing the operations of its generics subsidiary, Ethex. The move came as a result of a settlement agreement with the US Department of Justice and the US Attorney for the Eastern District of Missouri, which saw Ethex plead guilty to two felony charges, earning a fine of nearly US$26 million. However, KV noted that Ethex was a distribution operation, whilst KV owns all manufacturing and related intellectual property, meaning that KV will be able to continue to operate in the generics sphere in time.

The legal moves should herald the end of a very difficult period for KV, which has threatened to end the firm's existence. In May 2008, KV received complaints from a pharmacy in California and a distributor in Canada of oversized morphine sulphate products. In response, KV recalled specific lots in June 2008; that month Health Canada also issued a warning to consumers not to use the ratiopharm product, ratio-morphine, which was supplied by KV. KV's production began to unravel; in December 2008, the firm voluntarily suspended all shipments of FDA-approved drug products in tablet form, in order to allow the firm to review its manufacturing and quality systems. As part of this, Ethex recalled a single lot of hydromorphone tablets; as with the May 2008 complaint, the issue was one of oversized tablets. The FDA announced an inspection the same month.

This was followed by an announcement in January 2009 that the firm had voluntarily suspended the manufacturing and shipping of all of its products, with most products being recalled. The recall was initiated because the products may not have been manufactured under cGMP conditions. Adding to the firm's problems, in February 2009 it announced the loss of 700 jobs, as KV's lack of income began to bite. However, the situation began to stabilise in March 2009, when the firm announced it had entered into a consent decree with the FDA, giving KV an avenue to restart production once the conditions of the consent decree had been met.

The charges Ethex faced revealed more to the situation. When the May 2008 complaints arose, Ethex was required to submit Field Alerts to the FDA, which are required whenever a manufacturer receives information concerning a significant chemical change in a distributed product. KV did indeed issue a Field Alert for the morphine product, but the Department of Justice alleged that in the internal investigation sparked by this, the firm discovered incidences of other oversized drugs, including dextroamphetamine sulphate and propafenone. The DoJ alleged that these did not lead to Field Alerts being raised, a charge that Ethex has accepted.

In total, Ethex has been fined US$25.8 million in response to its guilty plea, and KV has announced that Ethex will cease operations. The firm is clearly hoping that ending Ethex will put a line under the issues it has faced, and give the firm a clean break to rebuild its operations and reputation. The manufacturing issues that ultimately led to the felony charges are still in the process of being resolved; but the FDA's consent decree should see the firm emerge from under this cloud in time. The news that Ethex wilfully hid the extent of the problems from the FDA, and thus from the public, was a more difficult stain to remove, and so terminating Ethex was perhaps KV's only real option to restore public confidence in its products once production restarts. The firm has sailed perilously close to disaster, but the settlement now announced should hopefully see it move it towards calmer waters.

Ian Platts – Editor, World Generic Markets

FDA pushes for generic drug user fees

FDA Commissioner, Dr Margaret Hamburg, has made an appeal for the introduction of generic drug user fees in order to bring new funding to the FDA's Office of Generic Drugs (OGD). Speaking at the Generic Pharmaceutical Association (GPHA)'s Annual Meeting, Dr Hamburg admitted that the backlog of pending applications was not acceptable, acknowledging that it would soon hit the 2,000 mark, and argued that the situation could only be resolved with the introduction of user fees. In its budget request for FY2011, the FDA proposed that introducing generic drug user fees would add just over US$38 million to its coffers. This, the FDA believes, would go a long way to reducing review times. By the end of the first five years following the introduction of user fees, the additional money would enable a complete review and response for an estimated 80% of applications within 12 months of receipt.

The GPhA responded to the plea for a user fee programme by saying it would welcome re-engaging in negotiations over the issue. The GPhA has generally been cool on the proposal, as its latest response shows. This is not really surprising, as the user fee proposal would of course mean hitting generic firms financially, with firms then having to try to either pass the costs on to consumers by raising prices in an already highly competitive market, or else absorbing the costs themselves, leading to reduced margins and profitability on sales. However, a particular sticking point has always been getting value for money, and ensuring that the increased costs will actually lead to faster approval times and a regulatory process that flows smoothly. The branded industry already has a user fee programme in place; in previous years when the idea of generic drug user fees has been mooted, the GPhA and others have responded by pointing out that unlike the branded industry, the generic industry faces other delays in the form of legal challenges from the branded industry. As a result, introducing user fees may not make a difference to approval times, as generic companies will still have to fight time consuming legal battles. The GPhA has said in the past that it would be willing to go down the user fee route if there was certainty that it would lead to reduced delays. This is a concern that Dr Hamburg has picked up on; in her address, she noted that a fee programme would have to include measurable results, something which has certainly been received positively by the GPhA. Of course, what those measurable results may be, and whether the generic industry agrees with them, remains to be seen.

One criticism that has been raised about a user fee programme in general is that it blurs the line between the industry and its regulators, a criticism that has been levelled at the branded industry's user fee programme. If the industry is paying the regulators, the danger will always be that with the money will lead to undue influence, especially if the regulators need to show they can provide value for money. Whether it is possible to safeguard against this is a particularly tricky issue.

The issue of introducing generic user fees is not new, and has been rattling around the federal government for some years. It is as uncertain now as it has ever been whether or not such a programme will be introduced. Of course, the US is currently in the throes of a bitterly divisive battle over reforming the healthcare system as a whole, which has so far resulted in a stalemate with the legislative bills introduced to Congress thus far unlikely to be passed. Given the political atmosphere in Washington at the moment, any attempt at reform may have to be scaled back and introduced in piecemeal fashion. It is quite possible that a user fee programme may get lost in the process.

Ian Platts – Editor, World Generic Markets