Drug preclusion: Consider the source

On Sept. 10, Congresswoman Diana Harshbarger (R-TN) introduced the Dietary Supplement Innovation Act, legislation to modernize the Food and Drug Administration’s (FDA) drug preclusion provision.
On Sept. 10, Congresswoman Diana Harshbarger (R-TN) introduced the Dietary Supplement Innovation Act, legislation to modernize the Food and Drug Administration’s (FDA) drug preclusion provision. (Douglas Rissing / Getty Images)

CRN, CHPA and AHPA are celebrating H.R. 10336 as a balanced compromise. But in the pursuit of regulatory certainty, has part of the supplement industry agreed to permanently enshrine the very pharmaceutical gatekeeping mechanism it has spent years fighting?

Washington loves a compromise. Sometimes compromise produces lasting policy. Other times it simply makes a bad idea easier to administer. H.R. 10336, the Dietary Supplement Innovation Act, deserves to be examined through exactly that lens.

Introduced, the bill attempts to resolve the supplement industry’s long-running fight over drug preclusion. It would replace today’s ambiguous “substantial clinical investigations” standard with a Phase 2 or Phase 3 trigger, create relief for long-inactive drug programs, direct FDA to consider differences in dose, route, concentration, and composition, and provide additional judicial-review protections.

But the bill obscures a much bigger question:

Why would those who claim to represent the dietary supplement industry agree that pharmaceutical development should be able to close the supplement market in the first place?

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H.R. 10336 would move the operative drug-preclusion framework directly and expressly into Section 301 of the Federal Food, Drug, and Cosmetic Act, the statute’s prohibited-acts section, and specifically apply it to dietary supplements.

Section 201 tells companies what a product is. Section 301 identifies conduct that is prohibited. Section 303 supplies penalties for violating Section 301. Simply put, Section 201 is the dictionary, Section 301 is the rulebook, and Section 303 supplies the sanctions.

The concern, therefore, is not that Congress is clarifying an uncertain definition. It is that disputes over who reached the market first, what constitutes the same article, and when a clinical investigation began could become predicates for prohibited conduct.

That is an extraordinary concession for the supplement industry to make.

CRN, CHPA and AHPA have embraced H.R. 10336, describing it as legislation that provides regulatory certainty while balancing dietary supplement access with pharmaceutical research incentives. Their joint statement specifically praises the bill for protecting pharmaceutical research while expanding certainty for supplement companies. The policy concession is in plain sight for all to see.

These collective groups negotiating position accepts pharmaceutical research incentives as a boundary around which supplement market access must be designed. Why?

Mind you some of these players have in the past few years have: introduced mandatory product listing, which only advances the narrative that the industry is un- or under-regulated, which is the same message STRIPED is carrying in the states; supported legislation to have THC (formerly a schedule I substance) at 5 mg a day as a dietary ingredient; carried a cardboard cutout around Capitol Hill; and specific to this matter, all had the same opportunity as NPA to emerge victorious on NAC and NMN and either missed the target completely or sat it out on drug preclusion and adjacent issues. Now they want to tell you that a new prohibited act is in the industry’s best interests as far as fixing those problems? As the title says consider the source(s) and what would motivate an industry advocate to negotiate against the industry as a starting point? We at NPA believe and our track record shows, taking NAC and NMN as examples and experience on the matter, effectiveness matters more than anything.

A pharmaceutical company can continue studying a substance, seek FDA approval, and ultimately market a drug even if a supplement reaches consumers first. But if pharmaceutical development reaches the relevant statutory trigger first, the supplement pathway can potentially close even if the drug never reaches the market. A genuine race to market should reward whoever gets to market first, not whoever begins researching a pharmaceutical application first.

This becomes particularly troubling when you examine H.R. 10336’s Phase 2 trigger.

“Phase 2” sounds like an advanced pharmaceutical milestone. It isn’t drug approval. It isn’t an NDA. It isn’t even Phase 3.

FDA describes Phase 2 as early controlled clinical studies designed to obtain preliminary effectiveness data and identify common short-term risks and side effects, generally involving no more than several hundred subjects. That means Congress would potentially allow a relatively early stage of pharmaceutical experimentation to become the trigger for supplement preclusion. The industry doesn’t have to imagine how that could play out; look at NMN.

Metro International Biotech’s MIB-626, a proprietary crystalline NAD+ booster related to NMN, is currently in multiple Phase 2 clinical trials.

Meanwhile, NMN became perhaps the defining drug-preclusion battle of the last several years. FDA initially concluded that NMN was excluded from the dietary supplement definition because drug investigation preceded qualifying supplement marketing. NPA challenged that determination, and FDA ultimately reversed course after concluding that evidence established earlier supplement marketing.

Under H.R. 10336, if FDA determined that the relevant drug and supplement products constituted the same article, that the Phase 2 trigger had been satisfied and that qualifying supplement marketing had not occurred first, the dispute could land directly inside Section 301’s prohibited-acts framework.

The supplement industry via NPA just spent years fighting FDA over NMN. MetroBiotech reached Phase 2. Now other supplement trade associations want Congress to make Phase 2 the statutory trigger that can start that fight. The industry should be asking whether that is a bargain worth making, especially now.

The politics surrounding health, wellness and consumer choice have changed dramatically. Populist skepticism of institutional gatekeeping, growing attention to chronic disease and political emphasis on giving consumers greater control over their health have created a once-in-a-generation environment for arguments traditionally associated with the supplement industry.

Yet at precisely the moment political winds may be at its back, part of the industry appears to be negotiating from a defensive crouch and ensuring pharmaceutical interests remain protected in the process. We don’t believe pharma should be writing our rules for us, do you?

There is a cleaner alternative: investigation alone should not reserve a substance for the pharmaceutical pathway.

If Congress wants a genuine race to market, it should turn on actual commercial marketing, not the initiation of pharmaceutical research. Why wouldn’t we, as the industry, ask for a genuine race to market? Congress can preserve FDA’s existing authorities over unsafe products, adulteration, misbranding, and unlawful disease claims without giving a Phase 2 trial the power to determine whether an otherwise lawful supplement may reach consumers.

Regulatory certainty has value, compromise has value, pharmaceutical innovation has value. But none requires the dietary supplement industry to negotiate away its own regulatory independence. The question isn’t merely whether H.R. 10336 improves drug preclusion. It’s whether those that claim to represent the industry should be attempting to cement pharmaceutical preclusion into law at the very moment it may finally have the political leverage to challenge it. More importantly why do they want to permanently tilt the table pharma’s way versus our position of championing a true race to market?