2005N-0345 Drug Approvals: Circumstances under which an active ingredient may be simultaneously marketed in both a prescription drug product and an over-the-counter drug product
FDA Comment Number : EC1786
Submitter : Dr. Rhonda Wright Date & Time: 10/31/2005 03:10:40
Organization : Dr. Rhonda Wright
Category : Health Professional
Issue Areas/Comments
1
A. Should FDA initiate a rulemaking to codify its interpretation of section 503(b) of the action regarding when an active ingredient can be simultaneously marketed in both prescription drug product and an OTC drug product?
As a physician, I think that the The Food and Drug Administration should approve without further delay over-the-counter (OTC) sale of emergency contraception with no prescriptions required for any age group. This eliminates the need for any new rulemaking. The two advisory FDA committees that exhaustively reviewed data in December 2003 found that emergency contraception was safe and effective and consequently recommended OTC approval.

More than 70 professional medical and public health associations including the American Medical Association, the American College of Obstetricians and Gynecologists and the Society for Adolescent Medicine have endorsed EC access for women of all ages. The American Academy of Pediatrics has urged its members to "help ensure that all adolescents have knowledge of and access to contraception, including barrier methods and EC supplies.

When the age restriction was suggested at the December Advisory Committee meetings, the FDA staff noted then that it has been the policy of the Division of Reproductive and Urologic Drug Products to make no distinction between post-pubescent adolescents and adult women insofar as contraceptive use is concerned. The Advisory Committee members then rejected the age restriction proposal.

The apparent move by the agency to restrict access to young women, 16 years of age and younger, therefore flies in the face of the recommendations of the majority of respected medical professional associations and the government's own stated policy.

1.
B. Is there significant confusion regarding FDA's interpretation of section 503(b) of the act?
Yes. The Food and Drug Administration's apparent intent to limit access by age has muddled what should have been a clear- cut decision to approve over-the-counter sale of this safe and effective emergency contraception.
C. If so, would a rulemaking on this issue help dispet that confusion?
No. A proposed rule with its lengthy comment and review process will only delay the time for a final decision on EC - OTC to be made. It is completely unnecessary.
2
A. If FDA limited sale of an OTC product to a particular subpopulation, e.g., by making the product available to the subpopulation by prescription only, would FDA be able to enforce such a limitation as a matter of law?
No. Asking for identification is an unacceptable intrusion on personal privacy with regard to medical care. Limiting sale of emergency contraception to the youngest women is a particularly bad idea; they are the most likely to suffer adverse physical and emotional consequences to themselves and their babies. It is grossly inappropriate to deny young women the means to prevent pregnancy.
B. If it could, would it be able to do so as practical matter and, if so, how?
No. Such a move would be intrusive for all young women who would be required to show personal identification as a proof of age. The suggestion of federal enforcement brings to mind federal agents pursuing 16 year olds concerned about an unintended pregnancy who in the act of obtaining emergency contraception are breaking a federal law. The absurdity is hard to exaggerate.
3
A. Assuming it is legal to market the same active ingredient in both a prescription and OTC product, may the different products be legally sold in the same package?
Making EC universally available would obviate the need for separate packaging.
B. If the two products may be lawfully sold in a single package, under what circumstances would it be inappropriate to do so?
There would not be any circumstances that would be inappropriate for a single package.
GENERAL
GENERAL
Making emergency contraception available over the counter would have immediate and far reaching favorable effects by decreasing abortion rates and improving maternal and child health - the latter especially if access is not denied to young teenagers who are particularly ill-equipped physically, emotionally, and financially to bear and raise healthy children. It must not be further delayed by interest groups who seek to confuse birth control with abortion, reliable science with religious agenda, and sound public policy with punishment of women for sexual activity.