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Roumyana SharenkovaRegulatory Affairs Director
Actavis EAD
Maria Traikova, MDDeputy Director Medical and Regulatory
affairsSOPHARMA PLC
Managing variationsCurrent situation &
Perspective
Rossen KazakovExecutive DirectorBGPharmA
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BGPharmAn Bulgarian Generic Pharmaceutical Association is
the national representative body for the wholeGeneric industry
in Bulgaria.
n BGPharmA aims at:n Consolidating the Generic industry in its
efforts to
develop and provide affordable medicines for allpatient groups,
and
n Developing and assisting for the adoption andimplementation of
a Coherent Generic MedicinesPolicy by the government and health
careinstitutions.
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Challenges – past andfuture
n New rules for price setting and getting reimbursementstatus:n
Two commissions (Pricing and PDL), two prices, no
negotiation with MoH or NHIFn Lowest max. retail price from 9
countries, 20% price
linkage for PDL (50% in draft)n Strong opposition from ABPhM and
EGA re 50% price
linkage draft clause– letters to Prime Ministern Lack of
capacity in MoH to implement new PDL on time
(April 2007) – delay to Jan 2009? – YESn Delay to April 2009? –
YES/NO
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Challenges – past andfuture
n Generics Bulletin, 10 January 2008 Issue 196n “Bulgarian firms
win pricing concession”
n Generic drugs in Bulgaria will be eligible forreimbursement
provided they are priced at no more than80% of the reference
brand's cost, according to apositive list ordinance just published
in the country'sofficial gazette. A previous draft ordinance had
proposedprice linkage at 50%.
n While the ABPhM remained opposed in principle tolinking the
price of generics to the price of referenceproducts, the 80% limit
at least provided a framework inwhich generics could compete.
Price linkage recent case:
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Challenges – past andfuture
n SCRIP, February 1st No 3332n “…It has been agreed that generic
medicines whose
prices are no higher than 80% of their brand referenceprices
will be entitled to reimbursement. The ministryinitially decided
that the maximum price should be 50%of the reference price, but
this was opposed by theindustry led by the association of
Bulgarianpharmaceutical manufacturers (ABPhM).
n It received support from the European Genericmedicines
Association which wrote a letter to Bulgaria'sprime minister and
said the 50% restriction wasanticompetitive and gave market
advantages toproducers of original drugs.
Price linkage recent case:
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Challenges – past andfuture
n Companies still have to wait up to 90 days to havethe prices
of their Rx products approved by thehealth ministry's Pricing
Commission and another90 days before a reimbursement decision is
madeby the PDL Commission.
n Term too long and delays products entering themarket, as price
applications could only besubmitted after receiving marketing
authorizations.
n Immediate inclusion of Gx medicines in the PDL,after obtaining
MA is needed – time and costsaved by government and patients!
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Pharma Forum – barriers toGeneric medicines
n Eric Gorka (Sandoz) – EGA president:n “Over €20 billion in
savings is being secured for
patients and healthcare systems by genericmedicines competition,
but this can only beeffective, increased and sustainable on
conditionthat generic medicines are ensured rapid marketentry. A
quick look at the market entrance of thetop 35 off-patent molecules
shows that in somecases the first generic medicine only entered
themarket up to 20 months after the patent expired.”
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Highly cost-containmentpolicy environment
n Lack of budget resources continues – 4.3%from GDP.
n Global Economic Crisis appeals more thanever to the rational
and optimal use ofmedicines and resources!
n Still no incentives from the state to promotegeneric
consumption, which can bring moresavings to the budget and the
healthcaresystem.
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Highly cost-containmentpolicy environment
n Policy and healthcare financing in CEE
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Highly cost-containmentpolicy environment
n No free pricing for non-reimbursed drugs,except OTCs (G10 Rec.
6)
n Reference pricing system – good or bad?n Co-payment increases
by lowering levels of
reimbursement.n Pressure on prices of both generics and
brand medicines.n No price/volume negotiations.
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Final Recommendations of theHigh Level Pharmaceutical Forum
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Communication from theCommission - A Call for Action
Brussels, 1.7.2003
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The situation today
n EGA WELCOMES THE ADOPTION OF THEREVISED VARIATIONS
REGULATION:
n Considering it a “positive step” toward simplifyingand
optimising the system of changes to MarketingAuthorisations, the
EGA welcomes the EuropeanCommission’s adoption of the EU Regulation
onthe examination of amendments to the terms ofmarketing
authorisations for medicinal products forhuman use and veterinary
medicinal products.
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The situation todayn Bulgarian pharmaceutical act fully
harmonized with
the EU legislationn Bulgaria is EU member since 1 Jan 2007n
Since mid 2006 the industry is in constant process
of:n Changing the API suppliersn Upgrading the production
facilitiesn Improving the quality managementn Optimizing the
product portfolion Improving the dossiers (CMC) via variations
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Variations –clearly the very difficult part
n For old products with deficiency of API supplyn For transition
to validated API suppliersn For related variations (more than one
at a time)n For different compositions on different marketsn For
administrative purposes (packs, PIL, blisters)n For further
harmonization (readability, Braile,
blisters in BG etc.)n For whatever reasons
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Actavis BulgariaVariations 2006-2008
165
531
700
0
100
200
300
400
500
600
700
2006 2007 E 2008
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Actavis BulgariaVariations split 2007-2008
308 305 380
81 80 90144 142 157
050
100150200250300350400
Type IA Type IB Type II
2007Jan-Oct 2008E 2008
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Variations splitDomestic-Imported products
151 154
40 40
52 90
0 100 200 300 400
Type IA
Type IB
Type II
BalkanpharmaActavis Group hf.
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In our case
n No of registered products in Bulgaria – 155n No of countries
with market presence – over 25,
incl:n EU countriesn Russian Ukrainen Ex-Soviet Union countriesn
RoW (Tunnisie, Vietnam, Algerien etc.)
n Therefore – diverse picture with many icebergs
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No of variations (BG only)
0
100
200
300
400
500
600
700
800
number
2006 2007 2008 Totalyear
Total No 2006-2008 Variations by category - 2007
41; 17%
116; 49%
50; 21%
12; 5%18; 8%
I A I Б II NC NV
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Most common reasons forvariations
n Minor variations IAIA1 – Change in the name and/or address of
the MAHIA 15 - Submission of a new or updated CEP for an
active substanceIA 25b – Change to comply with an update of
the
relevant monograph of PhEurIA 36b – Change in the shape of
container/closureIA 38a – Minor change to an approved test
procedure
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Most common reasons forvariations
n Minor variations IBIA 18 – Replacement of an excipient with
a
comparable excipientIB 26 & 27- Changes in the
specifications/test
procedures of the immediate packaging of thefinished product
IB 33 – Minor change in the manufacture of thefinished
product
IB 37 & 38 – Change in the specification/testprocedure of
the finished product
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Most common reasons forvariations
n Major variations - Type IISafety reasons – update of SPC &
PILChanges in module 3 referring to:- API supplier- manufacturing
in-process control- release & shelf-life specifications-
composition, etc.
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Main reasons for variations
n Process optimisation variationsbatch size, manufacturing
process, specifications
(implementing the design space concept)n Administrative
variationsname, address, CEP updates
(annual reporting system)n Flexibility Increasing variationsAPI
sources, bulk manufacturing sites
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The worst - related variations
n Variation uponvariation
n Champion productsn Related variationsn Etc.
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Variation upon variationchampions in variations 2007
SEDALGIN NEO
10 X Type IA
1 X Type IB
4 X Type II
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Variation upon variationchampions in variations 2007
LISINOPRIL3 x Type IB
2 x Type II
8 x Type IA
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Variation upon variationchampions in variations 2008
Trimezol 480 mg
(Sulfamethoxazole & Trimetoprim)
7 x IA
3 x Type IB
3 x Type II
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Do we manage this?
n Workload?n Resources?n Internal co-ordination?n Uniformity
across markets?n Expenses?
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VariationsAdministrative & financial burden
n Cir. 3,5 variation applications filed everyworking day
Expenditures per yearn 2007 – BGN 324,500n Jan-Oct 2008 – BGN
466,000
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Conclusions
n National MAs represent the vast majority ofauthorizations in
the EEA (more than 80%)
n Community rules not harmonized
n Administrative burden for both agencies &industrial
operators
n Logistic complications
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n Both agencies and companies will benefit fromfacilitating the
preparation and review of thevariations
n Tell & do approach for minor variationsrequiring immediate
reporting
n Introduction of annual reporting system forminor variations
that should not require anyprior approval and be notified within
twelvemonths following implementation (do & tellapproach)
Conclusions
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Conclusions
n Transitional period to be allowed forimplementation of Type II
variations
n Introduction of grouping of variations in case ofseveral
variations for one MA or more than oneMA affected by the exact same
group ofvariations
n Worksharing procedure will be beneficial forglobally operating
companies
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Our part
n Optimization of the internal communicationn Specialized task
force for managing
variations (different from new submissions)n Better planningn
Uniform approachn Time ruling
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Hence our support
n For revision of the variation regulationn For “DO and Tell”
concept (type IA)n For default variations (type IB)n For grouping
of variations into single submissionn For optimizing the workload
of the agencies:
n Common rules with national variationsn Work sharing in CMDn
Application for extension in the scope of variations
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Variations systemGermany
n Variations of national German MAs follow a nationalsystem,
different from the EU one
n The majority of the national German Type IAvariations does not
need official approval
n Transition period for implementation of Type IIvariation
announced in the application form
n Grouping of variations belonging to one and the sameMA in one
application form – for example changing oftest procedure, batch
size increase, shelf-lifeextension and inclusion of new ADR in the
SPC/PILwould be one application form only
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Variations systemThe Netherlands
n Type IA are implemented after confirmation ofreceipt and
validation by the authorities
n Type IB - transition period for implementation isindicated by
the applicant in terms of productionafter approval
n Type II – if not related to specific batches – 6month
transition period for implementation; ifrelated to specific batches
- than indicated bythe authorities;
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Variations systemPortugal
n Type IA – tacitly approved in 20 days, noofficial approval
issued
n Type IB – implementation period pointedout in the application
form
n Type II – the same as IB’s
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Variations systemRomania
n Type IA – official approval is issued
n Type IB – implementation period pointedout in the application
form
n Changes in printed materials must beimplemented within 6
months followingapproval