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...the Nevada Department of Corrections is preparing to use fentanyl in a three-part drug combination for an upcoming execution....The combination includes the sedative diazepam...the muscle relaxant cisatracurium; and fentanyl...Nevada turned to fentanyl for an execution because the state had no other drugs to carry out a lethal injection after "pharmaceutical industry opposition to the use of their products in executions,"..This fentanyl drug combination is to be used in the execution of 46-year-old Scott Raymond Dozier on November 14 at Ely State Prison in Ely, Nevada...Dozier was sentenced to death after a first-degree murder conviction for the 2002 killing and dismemberment of Jeremiah Miller, 22...The concern is that this specific chemical cocktail that they have proposed has never been used in this way before. It's not like they can point to some success or result. This will be the first time...

Defying U.S. safety protections for human trials, an American university and a group of wealthy libertarians...are backing the offshore testing of an experimental herpes vaccine...Peter Thiel, invested $7 million in the ongoing vaccine research...Southern Illinois University also trumpeted the research and the study’s lead researcher...Neither the Food and Drug Administration nor a safety panel known as an institutional review board..monitored the testing of a vaccine its creators say prevents herpes outbreaks. Most of the 20 participants were Americans with herpes who were flown to the island several times to be vaccinated, according to Rational Vaccines...“What they’re doing is patently unethical,” said Jonathan Zenilman, chief of Johns Hopkins Bayview Medical Center’s Infectious Diseases Division. “There’s a reason why researchers rely on these protections. People can die.”...The risks are real. Experimental trials with live viruses could lead to infection if not handled properly or produce side effects in those already infected...

Regulation can be a tool to strengthen competition and address important health and safety concerns, but it can also be abused to limit access to the market...lawmakers and regulators must regulate wisely and be careful of unintended consequences...what happens when important safety regulations can be gamed by bad actors seeking to preserve their monopoly profits?...This has been happening in the market for generic drugs, where some dominant brand name pharmaceutical companies are trying to shut out low cost generic competitors by manipulating the regulations originally designed to keep people safe. And this is not a small problem, either…The problem comes from a conflict that arises between...Risk Evaluation and Mitigation Strategy, and the approval process a generic company needs to go through to enter the market once a drug patent expires. Generics must get a sample of the brand name drug they want to compete with to prove to the FDA that their product is exactly the same...the REMS program greatly restricts access of certain drugs unless proper safety protocols, unique to each drug, are met. This can leave generic companies with no choice but to ask for samples directly from the manufacturer...It is not surprising that these drug makers are denying generics access to these samples. However, the FDA currently does not have the tools necessary to discipline these bad actors and force the distribution of samples to generic companies...Congress is now paying attention...

Centers for Medicare & Medicaid Services shocked everyone with a proposal altering a small part of the 340B Drug Pricing Program. CMS proposed reducing reimbursement for certain Medicare Part B drugs purchased by 340B-eligible hospitals: from Average Sales Price plus 6% to ASP minus 22.5%. Hospitals will also have to identify 340B claims with a new modifier...CMS explains its rationale for reducing reimbursement to hospitals. It references key studies from the Office of Inspector General, the Government Accountability Office, and the Medicare Payment Advisory Commission...The new ASP-22.5% reimbursement figure is based on a MedPAC study. It estimated that hospitals in the 340B program receive a minimum discount of 22.5% of the Average Sales price (ASP) for drugs paid under the outpatient prospective payment system…Three important items to note:

• The proposal would reduce patients’ coinsurance obligations.
• Manufacturers would not gain from this proposal. CMS designed the proposal to be budget neutral.
• The proposal does not address contract pharmacies.

The Food and Drug Administration is stepping up its enforcement of the existing rules covering stem cell therapies in order to protect patients from unproven or potentially dangerous treatments...Under "a comprehensive policy framework" that will be put into place next quarter, individual providers and companies will be able to gain approval for products and procedures through a lower-cost and more streamlined process...A new working group will pursue unscrupulous clinics through legally enforceable means in order to protect public health...Patients desperately seeking solutions for potentially fatal diseases can get to a point that they will clutch at any solution offered...FDA Commissioner Scott Gottlieb's statement shows an awareness of the potential for "unscrupulous actors" in the field, and their impact both on vulnerable people and on the reputation of sound researchers and companies..."These dishonest actors exploit the sincere reports of the significant clinical potential of properly developed products as a way of deceiving patients and preying on the optimism of patients facing bad illnesses. This puts the entire field at risk. Products that are reliably and carefully developed will be harder to advance if bad actors are able to make hollow claims and market unsafe science. To make sure the agency is separating the promise from the unscrupulous hype, we are stepping up our enforcement activity in this area," said Gottlieb...

The US Food and Drug Administration's Center for Drug Evaluation and Research and Office of Regulatory Affairs will soon launch an effort to streamline the two offices' inspection and facility evaluation efforts...CDER Director Janet Woodcock and Associate Commissioner for Regulatory Affairs Melinda Plaisier said it is vital that the two offices quickly implement the plan in order to meet commitments under the recently reauthorized user fee agreements, specifically citing the agency's promise to communicate final inspection classifications to generic drugmakers within 90 days of an inspection beginning in October 2018...We plan to operationalize the plan in the fall of 2017 for nearly all human drugs...FDA details the plan—which includes specific operating models for pre- and post-approval inspections, surveillance inspections and for-cause inspections—in a 20-page white paper obtained by Focus entitled Integration of FDA Facility Evaluation and Inspection Program for Human Drugs: A Concept of Operations...

The Institute for Clinical and Economic Review is seeking public comments on its recently released outline of proposed adaptations involving the assessment of certain treatments for ultra-rare conditions, also known as orphan drugs...The proposed changes are intended to provide information for decision makers regarding the practical and ethical challenges involved in potential major advances for ultra-rare conditions. The adaptations are also intended to complement the ICER’s recent update to its value assessment framework...In order to be considered for an adapted approach, a treatment must be expected to be used in a population of less than 10,000 with a minimal chance of future indication, and must demonstrate potential to majorly improve the quality of life or the length of life for the patient...The key statements and proposed changes in the proposal include:

• ICER will continue with the same standard of evidence when rating comparative clinical effectiveness, but will offer context regarding the challenges of producing evidence for the treatments and for identifying data for long-term safety.
• ICER will continue developing cost-effective models for new treatments, but models for ultra-rare conditions will have a broader range of cost-effectiveness results—from $50,000 per quality-adjusted life year (QALY) to $500,000 per QALY—and will calculate a value-based price benchmark from the standard range. However, these reports will indicate that decision-makers often give special weighting to other benefits, causing coverage and funding decisions at higher price—resulting in higher cost-effective ratios for the treatments.
• The report sections "other benefits and disadvantages" and "contextual considerations" will include evidence and perspectives of the potential positive treatment effects on family and the community.
• ICER will conduct a collaborative process to develop a template for information in reports on research, development, and relative costs for ultra-rare condition treatments.

The US Food and Drug Administration has stopped a California company from continuing to inject the smallpox vaccine into the tumors of cancer patients...US marshals seized five vials of the smallpox vaccine from San Diego-based StemImmune Inc, which was using them as part of an unproven method for treating tumors...he vaccine is not commercially available and is only reserved for people who are at very high risk for developing smallpox, so it’s not clear how StemImmune got the vials to begin with. Luckily, the vaccine is not made from the actual smallpox virus and cannot give anyone the disease...It was...not meant to be used the way StemImmune was doing so, which was by mixing it with stem cells that come from body fat and injecting it into the tumors of patients at California Stem Cell Treatment Centers in Beverly Hills and Rancho Mirage...The FDA is encouraging consumers who have tried the treatment and had bad effects to use its MedWatch Adverse Event Reporting program.

The King Review has failed to acknowledge the role of hospital pharmacists, says the SHPA...The interim report of the Review of Pharmacy Remuneration and Regulation’s failure to acknowledge or leverage the “pivotal” role of hospital pharmacists in ensuring Australians have appropriate and convenient access to medicines, the Society of Hospital Pharmacists of Australia says...In its formal response to the interim report, SHPA highlighted managing transitions of care between hospitals and the community and prioritising the development of HMRs (Home Medicine Reviews) as key aspects of the King Review...It also reaffirmed what it sees as the “crucial” value of including SHPA in Agreement negotiations and decisions...SHPA Chief Executive Kristin Michaels says SHPA’s response to the King Review was driven by the position of hospital pharmacists as progressive advocates for clinical excellence and committed to evidence-based practice...Ms Michaels says hospital pharmacists are equipped to influence a reduction in the 230,000 medicine-related hospital admissions per year in Australia, which cost the health budget $1.2bn annually...

An ‘unorderly’ Brexit could risk the supply of life-saving medicines to patients because the drugs are held at border checks, piled up in warehouses, or subject to ‘extensive retesting’, the British and European pharmaceutical industries have jointly warned...a disorderly Brexit could result in ‘severe disruption’ of most companies’ supply chains, as the flow of medicines from the UK to the continent and back could stall..."ongoing cooperation" between the UK and EU on medicines as "the best way of ensuring that patients across Europe and the UK are able to continue to access safe and effective medicines and to ensure that there is no adverse impact on public health"...Current European marketing authorisations that apply across the EU, and continued cooperation between national competent authorities that are facilitated by the European Medicines Agency and the European Commission will be important in maintaining effective ties...any changes to the UK–EU trading relationship should not affect the research, development, manufacture and supply of medicines across Europe, including for clinical trials.