27/05/2015 ellaOnevägen till receptfritt för ett centralt godkänt läkemedel Receptfritt – en klass för sig 2 juni 2015 Victoria Inestam Regulatory Affairs Manager, Takeda Pharma AB [email protected] 1 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 Takeda - a research based company with a global presence #15 700+ products Precence in 70+ Largest global pharma company countries #1 Pharma company Japan/Asia* 100+ approx Research partnerships 30,000 #7 employees in the world largest pipeline pharmaceuticals *IMS Health 2013, ϯCiteline Pharma R&D Annual Review 2012 2 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 1 27/05/2015 HRA Pharma France - MAH Products sold in 80+ countries Innovation oriented 9 products in women’s health & endocrinology Leader in emergency contraception in Europe 7 subsidiaries and many partners (Takeda in Nordics) 70m€ 3 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 What is ellaOne 30 mg ulipristal acetate, tablet Contraception within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure Approved in Europe as Rx through centralized procedure (2009) Marketed in 72 countries 4 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 2 27/05/2015 What were the initial challenges • Not been widespread used for five years, in medicinal products subjected to a medical prescription • Pending Follow-Up Measures at time of application • Pharmacy practice varying across Europe • Controversial area • Need for educational material? 5 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 What were the initial challenges Identification of areas of concerns • Need for clinical data to address items such as: – efficacy / safety study in adolescents – PD / safety repeat use study – safety in pregnancy: pan-European pregnancy registry to facilitate webbased reporting of pregnancy cases • Benefit – Risk model – Switch guidance only looking at risk considerations… – Brass model useful tool to get and defend Company’s position on a global overview of benefits vs. risks of transition to OTC • In depth investigation to understand national procedures post-EC decision 6 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 3 27/05/2015 A shift in thinking from: ”Pharmaceuticals for the Consumer” Towards: Consumer products about health & wellnes …applying patient/sufferer based thinking and involving the whole organisation R&D, regulatory, production, logistics Ims: OTC Conference 2013 7 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 …and our strenghts • Indication already non-Rx in 21 (+2) countries • Clear demonstrated benefits 1. Need of rapid access for best effectiveness 2. Superior efficacy vs. existing option 3. Strong public health rationale • Single use indication • Very good safety data 8 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 4 27/05/2015 Rx-to-OTC switch of ellaOne - objectives • 4th compound approved as OTC through central procedure (after pantoprazole, orlistat, esomeprazole) • 1st hormonal product as OTC • 1st time switch from Rx to OTC via type II-variation - same strength - same pack size - same indication - same name ellaOne Rx ellaOne non-Rx 9 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 Key steps of ellaOne switch 2010/11 2012 • Gap analysis against EU guidance • Additional studies launch • Assessment of options for regulatory pathway • Meetings with EMA, Rapporteurs and 8 National Agencies (Spain, Ireland, UK, Estonia, France, CZ, Portugal, Belgium) 2013 • Submission of switch application (Feb) • RfSI #1 (Apr), MAH response (Sept), RfSI#2 (Nov) 10 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 5 27/05/2015 Key steps of ellaOne swithc cont. 2014 • Procedure on hold during referral on impact of weight on efficacy of emergency contraceptives (Jan‐Jul) • MAH response (Sept), oral explanation & CHMP positive opinion (Nov) 2015 • EC Decision Jan 2015 11 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 QR code = Patient Information Leaflet 12 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 6 27/05/2015 Objectives reached? YES!! and additionally… • 1 year data exclusivity – Exclusivity starts at time of switch 13 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 Switch of ellaOne in key figures 23 months of procedure (after many more of preparation!) CHMP opinion granted 1 5 years after Rx launch year of data exclusivity granted >3 >65,000 million doses used at time of switch unwanted pregnancies expected to be prevented each year 14 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 7 27/05/2015 Lessons learned from our experience THINK AHEAD!! • Have in mind a possible request for an OTC switch during Rx development program • Consider possibility to request OTC switch when deciding for initial regulatory strategy • Allocate resources 15 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 Lessons learned from our experience THINK OUT OF THE BOX • Ex: 5 years: no definitive rule – Many MS ready to grant switch after 4 years …and be prepared for anything! 16 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 8 27/05/2015 Key success factors Early start of project Identification of areas of concerns e.g clinical data Interactions with regulators • Identification of supporters and challengers • Clarification meetings systematically Collaboration with pharmacy profession Team work – RA, MED, PV, Supply, Marketing Knowledgeable of regulations and guidelines Use available knowledge – e.g. AESGP, NCA Passion and commitment 17 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 National implementation – initial challenges • Unknown situation for NCA – No precedent via type II variation – Difficult to get clarity until Opinion / EC decision • Grey zone between EMA and NCA responsibilities (ex: validation of blue box) • National procedures handled differently by NCAs (ex: publication in official journal) • Various rules (most often unwritten) for grace period for Rx packs 18 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 9 27/05/2015 Initial challenges - Sweden • How and when will the EC-decision be enforced by MPA? • Immediately? • Grace period? • Local switch date? • Need for recall of Rx-packs? • Distribution and supply • Pharmacy launch periods • Who does what – MPA/e-hälsomyndigheten/distributor… 19 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 …and strengths • Sweden as MS was supporting the application • Indication already accepted as OTC • The MPA a cooperative authority • Established cross-functional meetings 20 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 10 27/05/2015 Scandinavia – various approaches to implementation Implementation grace period Parallel distribution Recall Comment Finland 6 months Yes, limited time period Yes Internal decision to recall after 6 months Norway 6 months - No Rx may be sold until launch of OTC Sweden No No Yes MPA was expecting guidance from EMA. 21 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 National switch - objectives • A smooth transition from Rx to OTC from a patient perspective • Control of all steps in the various systems • Agree with the MPA on the implementation date 22 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 11 27/05/2015 Key steps of the national switch 2013 2014 2015 • Initial contacts with the MPA on how to implement (Sep) • CHMP positive opinion (Nov) • Application for new VNR • Linguistic review and validation of art works (Nov‐Dec) • EC Decision and Initial talks with MPA (Jan) • MPA asks EMA for centralised guidance (Jan) • EPAR published (Feb) • Web based pregnancy register to be launched 23 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 Key steps of the national switch 2015 2015 • Internal decision on switch date and planning for recall • Partnership with distributor (Feb) • Talks with MPA (Inspection, PI, RA, NPL) and e‐ hälsomyndigheten (Feb‐Apr) • Agreement with MPA on switch date • Information to customers about planned recall • Recall executed on the same day as OTC switch (13 April) 24 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 12 27/05/2015 Objectives reached? Parallel distribution of Rx and OTC packs not possible. Sequential transfer of information between systems does not allow implementation of change in LVIS/NPL to be effective in pharmacy ITsystems. Consequently, from the switch date it took at least 2 days before pharmacies could actually order ellaOne. Switch date = date for recall of Rx packs from pharmacies Date was agreed with the MPA (13 April) MPA initiated recall of parallel distributed ellaOne General Sales List !! 25 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 Lessons learned from our experience - Sweden MAPPING, PLANNING… THINK AHEAD Initiate dialogue with partners early, especially if no precedential cases. Consider F2F meetings. Investigate alternatives Keep track of VNR, national requirements/Blue box etc. and IT If recall, to what extent 26 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 13 27/05/2015 Key success factors - Sweden Set the objectives Be aware of time lines in the procedure Regular team meetings and status checks - RA, Marketing, Medical, Supply, PV Dedicated team members 27 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 Tack för er uppmärksamhet! 14 27/05/2015 ellaOne Lästips & länkar • Förordning 726/2004 • Direktiv 2001/83/EC • Guideline on changing the classification for the supply of a medicinal product for human use (EC) • Guideline on legal status for the supply to the patient of centrally authorised medicinal products (EC) • www.lakemedelsverket.se • www.ema.europa.eu/ema/ • www.aesgp.eu 29 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 Glossary BTC – behind the counter EC – European commission MA – marketing authorisation MED – medical (department) MPA – Medical Products Agency (LV) MS - member state NCA – national competent authorities NCE – new chemical entity OTC – over the counter/without prescription PD - farmakodynamik PV – pharmacovigilance RA – regulatory affairs (department) RfSI – request for supplementary information 30 ellaOne - vägen till receptfritt för ett centralt godkänt läkemedel | 2015-06-02 15
© Copyright 2024