PRIA, Government Policy, Made Personal

Summary

Allows certain very sick patients to get access to unapproved drugs outside a clinical trial when specific rules are met. An eligible patient must have a life‑threatening illness, have no approved treatment options and be unable to join a trial (a licensed doctor must confirm this and not be paid by the drug maker for that confirmation), and must give written informed consent or have a legal representative do so. An eligible investigational drug must have finished a Phase 1 trial, not be approved for any use, be under active development or investigation toward approval (including having an application filed or an active investigational application), and not be discontinued or on clinical hold. A Phase 1 trial means the early human safety study under FDA rules. Drugs given this way are exempt from many usual approval and clinical‑trial rules, as long as the sponsor and others follow certain investigational‑drug requirements in FDA regulations. The FDA generally cannot use patient outcomes from these uses to slow or hurt the drug’s approval unless those outcomes are essential to safety or the sponsor asks to use them; if the FDA decides they are essential, it must give written notice and a public health reason, approved by the center director or higher. Drug sponsors must send an annual summary of use (doses, patients, uses, and serious adverse events), and the FDA will post an annual report about how such outcomes were used in reviews.

Title 21, §360bbb–0a

Food and Drugs, Source: USLM XML via OLRC

(a)For purposes of this section—

(1)the term “eligible patient” means a patient—

(A)who has been diagnosed with a life-threatening disease or condition (as defined in section 312.81 of title 21, Code of Federal Regulations (or any successor regulations));

(B)who has exhausted approved treatment options and is unable to participate in a clinical trial involving the eligible investigational drug, as certified by a physician, who—

(i)is in good standing with the physician’s licensing organization or board; and

(ii)will not be compensated directly by the manufacturer for so certifying; and

(C)who has provided to the treating physician written informed consent regarding the eligible investigational drug, or, as applicable, on whose behalf a legally authorized representative of the patient has provided such consent;

(2)the term “eligible investigational drug” means an investigational drug (as such term is used in section 360bbb of this title)—

(A)for which a Phase 1 clinical trial has been completed;

(B)that has not been approved or licensed for any use under section 355 of this title or section 351 of the Public Health Service Act [42 U.S.C. 262];

(C)(i)for which an application has been filed under section 355(b) of this title or section 351(a) of the Public Health Service Act [42 U.S.C. 262(a)]; or

(ii)that is under investigation in a clinical trial that—

(I)is intended to form the primary basis of a claim of effectiveness in support of approval or licensure under section 355 of this title or section 351 of the Public Health Service Act [42 U.S.C. 262]; and

(II)is the subject of an active investigational new drug application under section 355(i) of this title or section 351(a)(3) of the Public Health Service Act [42 U.S.C. 262(a)(3)], as applicable; and

(D)the active development or production of which is ongoing and has not been discontinued by the manufacturer or placed on clinical hold under section 355(i) of this title; and

(3)the term “phase 1 trial” means a phase 1 clinical investigation of a drug as described in section 312.21 of title 21, Code of Federal Regulations (or any successor regulations).

(b)Eligible investigational drugs provided to eligible patients in compliance with this section are exempt from section 352(f), 353(b)(4), 355(a), and 355(i) of this title, section 351(a) of the Public Health Service Act [42 U.S.C. 262(a)], and parts 50, 56, and 312 of title 21, Code of Federal Regulations (or any successor regulations), provided that the sponsor of such eligible investigational drug or any person who manufactures, distributes, prescribes, dispenses, introduces or delivers for introduction into interstate commerce, or provides to an eligible patient an eligible investigational drug pursuant to this section is in compliance with the applicable requirements set forth in section 312.6, 312.7, and 312.8(d)(1) of title 21, Code of Federal Regulations (or any successor regulations) that apply to investigational drugs.

(c)(1)Notwithstanding any other provision of this chapter, the Public Health Service Act [42 U.S.C. 201 et seq.], or any other provision of Federal law, the Secretary may not use a clinical outcome associated with the use of an eligible investigational drug pursuant to this section to delay or adversely affect the review or approval of such drug under section 355 of this title or section 351 of the Public Health Service Act [42 U.S.C. 262] unless—

(A)the Secretary makes a determination, in accordance with paragraph (2), that use of such clinical outcome is critical to determining the safety of the eligible investigational drug; or

(B)the sponsor requests use of such outcomes.

(2)If the Secretary makes a determination under paragraph (1)(A), the Secretary shall provide written notice of such determination to the sponsor, including a public health justification for such determination, and such notice shall be made part of the administrative record. Such determination shall not be delegated below the director of the agency center that is charged with the premarket review of the eligible investigational drug.

(d)(1)The manufacturer or sponsor of an eligible investigational drug shall submit to the Secretary an annual summary of any use of such drug under this section. The summary shall include the number of doses supplied, the number of patients treated, the uses for which the drug was made available, and any known serious adverse events. The Secretary shall specify by regulation the deadline of submission of such annual summary and may amend section 312.33 of title 21, Code of Federal Regulations (or any successor regulations) to require the submission of such annual summary in conjunction with the annual report for an applicable investigational new drug application for such drug.

(2)The Secretary shall post an annual summary report of the use of this section on the internet website of the Food and Drug Administration, including the number of drugs for which clinical outcomes associated with the use of an eligible investigational drug pursuant to this section was—

(A)used in accordance with subsection (c)(1)(A);

(B)used in accordance with subsection (c)(1)(B); and

(C)not used in the review of an application under section 355 of this title or section 351 of the Public Health Service Act [42 U.S.C. 262].

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Public Health Service Act, referred to in subsec. (c)(1), is act July 1, 1944, ch. 373, 58 Stat. 682, which is classified generally to chapter 6A (§ 201 et seq.) of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see

Short Title

note set out under section 201 of Title 42 and Tables.

Statutory Notes and Related Subsidiaries

Limitation of Liability Pub. L. 115–176, § 2(b), May 30, 2018, 132 Stat. 1374, provided that: “(1) Alleged acts or omissions.—With respect to any alleged act or omission with respect to an eligible investigational drug provided to an eligible patient pursuant to section 561B of the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 360bbb–0a] and in compliance with such section, no liability in a cause of action shall lie against—“(A) a sponsor or manufacturer; or “(B) a prescriber, dispenser, or other individual entity (other than a sponsor or manufacturer), unless the relevant conduct constitutes reckless or willful misconduct, gross negligence, or an intentional tort under any applicable State law. “(2) Determination not to provide drug.—No liability shall lie against a sponsor manufacturer, prescriber, dispenser or other individual entity for its determination not to provide access to an eligible investigational drug under section 561B of the Federal Food, Drug, and Cosmetic Act. “(3) Limitation.—Except as set forth in paragraphs (1) and (2), nothing in this section shall be construed to modify or otherwise affect the right of any person to bring a private action under any State or Federal product liability, tort, consumer protection, or warranty law.”

§360bbb–0a Investigational Drugs for Use by Eligible Patients