BILL ANALYSIS                                                                                                                                                                                                    �







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        |Hearing Date:June 23, 2014         |Bill No:AB                         |
        |                                   |2605                               |
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                      SENATE COMMITTEE ON BUSINESS, PROFESSIONS 
                               AND ECONOMIC DEVELOPMENT
                              Senator Ted W. Lieu, Chair
                                           

                         Bill No:        AB 2605Author:Bonilla
                         As Amended:June 17, 2014 Fiscal:  Yes

        
        SUBJECT:  Pharmacy: third-party logistics providers. 
        
        SUMMARY:  Requires third party logistic providers who provide storage,  
        handling, or distribution services, to be licensed by the California  
        Board of Pharmacy.

        Existing law:
        
        1)Establishes the practice of pharmacy and provides for the licensing  
          and regulation of pharmacies and pharmacists by the Board of  
          Pharmacy (Board).  (Business and Professions Code (BPC) � 4000 et  
          seq.)

        2)Defines "wholesaler" to mean a person who acts as a wholesale  
          merchant, broker, jobber, customs broker, reverse distributor,  
          agent, or a nonresident wholesaler who sells for resale, or  
          negotiates for distribution, or takes possession of, any dangerous  
          drug or device.  
        (BPC � 4043)

        3)Defines "third party logistic provider" (3PL) or "reverse third  
          party logistics provider" (reverse 3PL) to mean an entity licensed  
          as a wholesaler that contracts with a dangerous drug manufacturer to  
          provide or coordinate warehousing, distribution, or other similar  
          services on behalf of a manufacturer, but for which there is no  
          change of ownership in the dangerous drugs. (BPC � 4045)     

        4)Requires wholesalers and nonresident wholesalers to have a  
          designated representative in charge, maintain a surety bond, and  
          adhere to certain distribution, administrative, and storage  





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          requirements as specified.    (BPC �� 4160 - 4169) 

        This bill:

        1)Defines "facility manager" as an individual licensed by the Board  
          who oversees the operations of a 3PL with respect to dangerous drugs  
          and dangerous devices received by, stored in or shipped from the  
          licensed place of business of the 3PL.

        2)Defines "facility manager in charge" as a facility manager licensed  
          by the Board designated by a 3PL and approved by the Board to  
          oversee a licensed place of business of the 3PL.


        3)Provides that the facility manager in charge is responsible for  
          ensuring the compliance of the licensed place of business with state  
          and federal laws and with the 3PL customer specifications.

        4)Repeals and recasts the definition of 3PL to mean an entity that  
          provides or coordinates warehousing or other logistics services of a  
          product in interstate commerce, on behalf of a manufacturer,  
          wholesaler or dispenser of a product but does not take ownership of  
          the products, nor have responsibility to direct the sale or  
          disposition of the product.

        5)Defines "reverse 3PL" as an entity that processes or manages the  
          disposition of an outdated or nonsaleable dangerous drug or  
          dangerous device on behalf of a manufacturer, wholesaler or  
          dispenser of the dangerous drug or dangerous device but does not  
          take ownership of the dangerous drug or dangerous device nor have  
          the responsibility to direct its sale or disposition.  Specifies  
          that provisions under Pharmacy Law that apply to a 3PL shall also  
          apply to a reverse 3PL.

        6)Authorizes the Board to issue a license to a qualified individual as  
          a facility manager to provide sufficient and qualified supervision  
          of a 3PL's place of business.  Provides that the facility manager  
          shall protect the public health and safety in the handling, storage,  
          warehousing, distribution and shipment of dangerous drugs and  
          dangerous devices in the 3PL's place of business.  

        7)Requires the facility manager applicant to meet the same  
          requirements as those set forth for a designated representative  
          under current law.  Prohibits a 3PL from operating without at least  
          one facility manager present at each of its licensed places of  
          business.





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        8)Provides that a facility manager may take charge of and act as the  
          facility manager in charge of a 3PL upon application by the 3PL and  
          with Board approval.  Requires Board notification within 30 days in  
          writing if a facility manager in charge is no longer operating in  
          that capacity.

        9)Provides that if a manufacturer, wholesaler, 3PL or pharmacy has  
          reasonable cause to believe that a dangerous drug or dangerous  
          device that has been sold or distributed in California that is in or  
          has been in its possession is counterfeit or the subject of a  
          fraudulent transaction, the manufacturer, wholesaler, 3PL or  
          pharmacy shall notify the Board within 
        72 hours.

        10)Requires a 3PL to keep records of the manufacture, acquisition, or  
          disposition of dangerous drugs, and current inventory, as specified.  


        11)Requires a 3PL that is not government owned and operated to post a  
          surety bond of 
        $90 thousand.

        12)Establishes fees for a 3PL and nonresident 3PL license, as  
          specified. 

        13)Makes other conforming and technical changes, as specified.

        

        FISCAL EFFECT:  This bill is keyed "fiscal"l by Legislative Counsel.   
        According to the Assembly Committee on Appropriations analysis dated  
        May 14, 2014, this bill will result in one-time costs of $20,000 to  
        add a new license type to the DCA licensing and enforcement system  
        information technology system (BreEZe).  The analysis also cites minor  
        revenue loss to the Controlled Substance Utilization Review and  
        Evaluation System (CURES) Fund since currently, wholesalers are  
        assessed a $6 per year fee on each license or at renewal and the new  
        3PL licensees, who were previously licensed as wholesalers, would not  
        be subject to this fee.  According to the analysis, oversight workload  
        for the Board should remain at a similar level, as the bill does not  
        add new regulatory duties.  

        
        COMMENTS:
        





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        1. Purpose.  This bill is sponsored by the  Board of Pharmacy  .   
           According to the  Author , California has regulated 3PLs as drug  
           wholesalers for years, but recent federal legislation, the Drug  
           Quality and Security Act (DQSA), preempts California law and  
           requires that if California wants to license 3PLs, they must be  
           licensed as a distinct entity.  The Author notes that DQSA permits  
           states or the FDA to license 3PLs.  However, regulations  
           implementing a federal licensing program are not anticipated until  
           late 2015, and will likely be completed later than that.  The  
           Author notes that until then, 3PLs which are not state licensed are  
           "deemed" federally licensed unless FDA finds that a specific 3PL  
           provider is practicing unsafely.  This means that there are no  
           safety, storage, handling, or recordkeeping standards for 3PLs to  
           adhere to until FDA develops regulations.  According to the Author,  
           3PLs are essentially unregulated until either California or FDA  
           develops a licensing scheme.  

        2. Drug Supply Regulation.  The Food, Drug and Cosmetic Act (FDCA) was  
           passed by Congress to ensure public confidence in our drug  
           distribution system and to require that drugs are both safe and  
           effective.  The FDCA requires FDA to regulate drug manufacturers  
           and to approve drugs for sale but also requires state governments  
           to regulate the drug distribution system by licensing and  
           regulating drug wholesalers.  In the simplest situation, a  
           manufacturer sells drugs directly to one of the major wholesalers  
           who then sell the drugs to a hospital or pharmacy.  However, this  
           simple distribution pattern is not the only distribution route  
           taken through the supply chain.  Typically, there is more than one  
           wholesaler who receives the drugs before they reach the pharmacy.   
           These transactions include transfers between separate facilities  
           owned by major wholesalers and transfers between the major  
           wholesalers and the large drug store chains that have their own  
           wholesale facilities in the company distribution system.  Common  
           carriers may transport the drugs between licensed entities and in  
           some cases will store, select and then ship products to pharmacies  
           at the direction of manufacturers.

           The distribution system is further complicated by the practice of  
           "repackaging."  Unlike European countries and Canada, most drugs in  
           the United States are not packaged in a "unit of use" size by the  
           drug manufacturers.  Instead, many drugs are sold by the  
           manufacturers in large bulk containers and then are repackaged by  
           additional companies into smaller containers for resale to the  
           pharmacy.  And the distribution system is complicated yet again by  
           the existence of a "secondary" wholesale market.  "Secondary"  
           wholesalers are smaller companies (often regional down to small  





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           family owned companies) that focus their business on selling drugs  
           to other wholesalers and serving smaller niche clients that are not  
           routinely served by the major wholesalers (individual  
           practitioners, small clinics, rural locations, etc.).   
           Drugs routinely move between both primary and secondary wholesalers  
           and from pharmacies to secondary wholesalers as well.  These  
           intermediate steps pose the greatest opportunities for compromising  
           the integrity of the drug distribution system.  The primary threat  
           to system integrity is the introduction of counterfeit products.   
           Counterfeit drugs are most likely to be introduced into a  
           distribution system that involves multiple wholesalers because  
           drugs are largely untraceable unless they are only handled by a  
           major wholesaler who purchases directly from the manufacturer.   
           Without being able to trace a drug back, there is no assurance to  
           the consumer that the drug has been stored and handled  
           appropriately to preserve its potency and safety.

           In response to a growing threat to the pharmaceutical supply chain  
           from counterfeit, misbranded, adulterated or diverted drugs,  
           California enacted  SB 1307  (Figueroa, Chapter 857, Statutes of  
           2004) which made comprehensive changes to the drug distribution  
           system to protect the integrity of the pharmaceutical supply chain.  
            That legislation enacted the nation's strongest pharmaceutical  
           consumer protection measure and included provisions pertaining to  
           the licensure and qualifications of wholesalers, restrictions on  
           furnishing and the requirement, beginning January 1, 2007, of an  
           electronic pedigree (e-pedigree) to accompany and validate drug  
           distributions for the purpose of tracking each prescription drug at  
           the saleable unit (item) level through the distribution system.   
           Subsequent Board sponsored legislation,  SB1476  (Figueroa, Chapter  
           658, Statutes of 2006) delayed the implementation date for the 
           e-pedigree component to January 1, 2009 and granted the Board the  
           authority to extend the deadline an additional two years to allow  
           the industry additional time to implement technologies necessary  
           for electronic pedigrees.  In 2008, the Board sponsored  SB 1307   
           (Ridley-Thomas, Chapter 713, Statutes of 2008), which amended the  
           law to resolve implementation issues, specifically staggering and  
           extending the implementation dates for 
           e-pedigree compliance, establishing grandfathering of existing  
           stock in the supply chain, allowing the Board to establish criteria  
           for inference, and preempting California's requirements in the  
           event federal legislation is enacted in this area.  Per SB 1307,  
           California's e-pedigree requirements for prescription drugs would  
           have taken effect on a staggered basis from January 1, 2015 through  
           July 1, 2017: 50 percent of a manufacturer's products by 2015 would  
           have had to have an e-pedigree; the remaining 50 percent of the  





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           manufacturer's products would have had to have an e-pedigree by  
           2016; wholesalers and repackagers would have had to accept and  
           forward products with the e-pedigree by July 1, 2016 and; pharmacy  
           and pharmacy warehouses would have had to accept and pass  
           e-pedigrees by July 1, 2017.

           In 2013, Congress passed and President Obama signed H.R. 3034, the  
           DQSA.  Among other provisions, the bill created a national set of  
           standards to track pharmaceuticals through the distribution chain,  
           aimed at curbing illegal importation and patient harm caused by  
           counterfeit drugs and devices.  The new law requires the FDA to  
           implement an electronic system to trace pharmaceuticals throughout  
           the supply chain at the unit level and, as a result, preempts  
           California's E-pedigree law established in 2005.  DQSA also defines  
           a 3PL as "an entity that provides or coordinates warehousing, or  
           other logistics services of a product in interstate commerce on  
           behalf of a manufacturer, wholesale distributor, or disperser of a  
           product, but does not take ownership of the product, nor have  
           responsibility to direct the sale or disposition of the product."   
           Major companies, such as UPS, DHL, and others provide these  
           services.  

           The duties of a 3PL can vary from contract to contract, but the  
           comment element is that a 3PL never holds title to the product it  
           is contracted to manage.  DQSA authorizes states to continue  
           licensing programs for wholesale distributors and 3PLs, although it  
           explicitly states that "No State shall regulate 3PLs as wholesale  
           distributors." 

           This bill creates a separate licensing system for 3PLs to be in  
           conformance with DQSA.  While DQSA does provide for a federal  
           licensing system for 3PLs beginning in late 2015, until that time,  
           3PLs will be unregulated unless the FDA makes a specific finding  
           that a 3PL does not utilize good handling and distribution  
           practices.  This bill will provide for ongoing licensing of 3PLs  
           according to California law to maintain the integrity of the drug  
           supply system.           

        3. Related Legislation This Year.   SB 600  (Lieu) of 2014 conforms to  
           DQSA by repealing California's E-pedigree law, strengthening  
           definitions for misbranded drugs and devices under California's  
           Sherman, Food, Drug and Cosmetics Act and ensuring appropriate  
           penalties for purchasing a foreign dangerous drug or medical  
           device, illegitimate product, or suspect product.  (  Status :  This  
           measure is pending a hearing in Assembly Business, Professions and  
           Consumer Protection Committee.)





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        4. Prior Related Legislation.   SB 294  (Emmerson, Chapter 565, Statutes  
           of 2013), expanded the types of sterile compounded drugs for which  
           a license is required and requires inspection of nonresident  
           sterile compounding pharmacies by the Board.

            SB 1307  (Ridley-Thomas, Chapter 713, Statutes of 2008) extended the  
           implementation dates for e-pedigree compliance, establishing  
           grandfathering of existing stock in the supply chain, allowing the  
           Board to establish criteria for inference, and preempted  
           California's requirements in the event federal legislation is  
           enacted in this area.  

           SB 1476  (Figueroa, Chapter 658, Statutes of 2006) delayed the  
           implementation date for the e-pedigree component to January 1, 2009  
           and granted the Board the authority to extend the deadline an  
           additional two years to allow the industry additional time to  
           implement technologies necessary for electronic pedigrees.

            SB 1307  (Figueroa, Chapter 857, Statutes of 2004) required,  
           beginning January 1, 2007, an electronic pedigree to accompany and  
           validate drug distributions for the purpose of tracking each  
           prescription drug at the saleable unit level through the  
           distribution system.

        
        SUPPORT AND OPPOSITION:
        
         Support:  

        Board of Pharmacy

         Opposition:  

        None on file as of June 18, 2014.


        Consultant:Sarah Mason