This presentation provides an overview of the Government's response to the Expert Panel Review of Medicines and Medical Devices, with an emphasis on complementary medicines changes.

1. What’s happening in regulation?
John Skerritt
Deputy Secretary for Health Products Regulation
Commonwealth Department of Health
CMA Annual Conference – September 2016

2. Health Products Regulation Group Structure
Medicines
Regulation
Medical Devices
and Compliance
Prescription Medicines
Authorisation
Complementary and
OTC Medicines
Pharmacovigilance and
Special Access
Medical Devices
Laboratories
Manufacturing Quality
Regulatory Engagement
and Planning
Regulatory Services and
Improvement
Regulatory Practice,
Education and
Compliance
Office of Drug
Control
Medicinal Cannabis
Drug Control
Scientific Evaluation
Health Products Regulation
Group
Deputy Secretary
Principal Medical
Adviser
Principal Legal and
Policy Adviser
Department of Health
Secretary
Regulatory
Reforms
Regulatory
Practice and
Support
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3. TGA stakeholder survey 2016
• A requirement for the Government’s Regulator Performance Framework
• 2810 responses: 449 health professionals, 65 consumers, 1628 from industry
• Results remarkably positive in terms of trust and confidence in the regulator
– 79 % of industry have high/very high confidence in TGA safeguards
– 61 % of community/ consumer groups with 27 % ambivalent/ unsure
• Users satisfied or very satisfied with TGA consultations (63%), exhibitions
(75%) and information sessions (82%) respectively.
• Main area for work is to TGA to engage more actively with consumers
– They are aware of, and have a generally favourable perception of the TGA, but many unsure
– Consumers also felt least engaged in TGA policy consultations
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6. The review process
• Two reports on medicines and devices and complementary
medicines and advertising released during 2015
• Review process included discussion papers, submissions and
interviews with key stakeholders. Followed by stakeholder workshops
and other meetings to get feedback
• Department considered stakeholder feedback and advised Minister
took her preferred position to Cabinet
• Government intent released in May 2016 budget, and full response
released in September 2016
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7. Overarching principles for regulation
as endorsed by Government
• The Australian Government retain responsibility for
approving the inclusion of therapeutic goods in the ARTG
– Rather than automatically accepting international approvals
– However need to make much greater use of overseas evaluations
• Need to introduce greater flexibility in approval pathways
• TGA could more appropriately align level regulation with the
actual risk posed by the products in certain areas
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8. Seven bundles of work agreed and costed
1. Increasing Flexibility for Registration and Post-Market Processes for
Medicines
2. Increasing Flexibility for Approval and Enhanced Post-Market
Monitoring of Medical Devices
3. Increasing Flexibility for Pre-Market Approval and Increased Evidence
of Efficacy of Complementary Medicines for Consumers
4. Simplified and More Effective Regulation of Advertising
5. Streamlined Regulation of Patient Access to Therapeutic Products
6. Further Reviews
7. Rationalisation of TGA Statutory Advisory Committees
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9. Complementary Medicines changes
1. Streamline transparency and predictability of regulation:
– Better regulatory guidance materials
– Catalogue of approved ingredients
– Introduce permitted indications for Complementary Medicines
– Adopt/ develop evidence monographs
– Right of review for applicant of TGA decisions on ingredients
– Establish ingredient assessment timeframes
– Continue stakeholder input through an advisory committee
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10. 2. Increasing the transparency of evidence of efficacy for
particular indications
– Sponsors encouraged but not mandated to publish efficacy evidence
– Greater education on what AUST-L means, but sponsors not required
to publish a label disclaimer
– A new class of complementary medicines with efficacy assessed by
TGA prior to market authorisation. Sponsors would be allowed to make
higher-level claims than listed CMs.
– Closer linkage to advertising claims
3. More use of overseas assessments for new ingredients
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11. 4. Increased postmarket monitoring and compliance
• More products to be subject to random and targeted post-market review
• Timely information on products subject to post-market review
• Intent of R 34 (TGA being able to refuse to list particular products) is
able to be achieved through current mechanisms (allowing CMs to
contain only permitted ingredients and targeted reviews by TGA of
products immediately post-listing)
5. Improving the competitiveness of the complementary
medicines industry by providing incentives for innovation
• Could include consideration of data protection; use of “listed-plus”
pathway; and advice service for SMEs 11

12. Increase use of risk-based approaches
to manage medicine variations
• Notification of variations to TGA where the variation does not
impact quality, safety or efficacy of the product
– Harmonise with the EMA approach
• Assessment of the variation by TGA if the variation could
impact safety, quality or efficacy
– Focus specifically on the impacts of the variation
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13. Strengthening of post market monitoring:
recommendations accepted
• Better integration and timely analysis of available datasets
(including matched de-identified data from PBS and MBS)
• Electronic reporting of adverse events
• Issue of potential Complementary Medicine interactions
with prescription medicines highlighted
• Enhanced information-sharing with overseas regulators
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14. Further reviews to be undertaken
• Medicines Scheduling Policy Framework
• Schedule 3 medicine advertising Guidelines
• Review regulation of lower-risk medicines
– Should low-risk products such as homeopathic
and aromatherapy products be regulated as
general consumer goods?
– What about vitamins and mineral
supplements?
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15. SME regulatory assistance and
clearer regulatory guidance
• Aim is to help small business navigate
the “regulatory maze” through advice,
guidance documents and workshops
• Builds on work by TGA Regulatory Assistance
Team
• Would not replace detailed product-specific
advice provided by regulatory consultants
Source: Freeimages.com (Steven Goodwin)
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16. Other Recommendations
• Comprehensive review of the Therapeutic Goods Act and Regs -
deferred
• The Government review and enhance TGA’s funding model –
deferred
• CMO to become decision maker (rather than TGA delegate) for all
medicines and devices decisions – not accepted
• Complementary medicines advisory committee - maintained
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17. Advertising of therapeutic goods
• Advertising of therapeutic goods to the public continues to be regulated
by TGA under a framework which includes an advertising code
• Abolish mandatory pre-approvals of advertising, and move to a self-
regulatory regime
• New mechanism for managing complaints managed in a streamlined
process through a single agency
• Investigation and enforcement powers around advertising to be broadened
• TGA to run sponsor education programs to assist in achieving compliance
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18. How will we pay for the reforms?
• Government agreed that we could use TGA
reserves (and 2015/16 surplus) to pay for cost
of design of reforms and implementation of
new systems
• Separately a systematic evaluation of
appropriate fees and charges will be needed:
– For new (e.g. enhanced comp meds
compliance) and existing activities
– So fees and charges may change
Source: Freeimages.com (Adrian van Leen)
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19. A great opportunity to implement some important
reforms… but with some big challenges for TGA
Source: Freeimages.com (Schalk Bergh) 19

20. Having a wider variety of medicines and
devices approval pathways available will
add to complexity
Source: Freeimages.com (Jeff Prieb) Source: Freeimages.com (78thelem)
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21. We are required to utilise international
assessments much more widely… but what if
other regulators are less driven to share?
Source: Freeimages.com (Ned Horton) Source: Freeimages.com (Joe Zlomek)
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22. Yet… Stakeholder expectations are very
high after years of waiting for reform
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23. Implementation and Governance
• A broad plan for implementation over the next 2 years has been
agreed by Government
• We will also consult closely with stakeholders in developing the finer
detail on implementation, including assessment of regulatory impacts
and fees and charges
• TGA has been empowered to work out much of the detail on how
specific changes could be implemented
– But we will need to go back to government for approval, in particular
where changes to the TGA Act or Regulations are needed
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