Professionals and Patients for Customized Care v. Shalala

56 F.3d 592, 1995 WL 360384
CourtCourt of Appeals for the Fifth Circuit
DecidedJune 16, 1995
Docket94-20402
StatusPublished
Cited by41 cases

This text of 56 F.3d 592 (Professionals and Patients for Customized Care v. Shalala) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Professionals and Patients for Customized Care v. Shalala, 56 F.3d 592, 1995 WL 360384 (5th Cir. 1995).

Opinion

WIENER, Circuit Judge:

In this challenge brought pursuant to the Administrative Procedure Act (APA), 1 Plaintiff-Appellant Professionals and Patients for Customized Care (P2C2) contends that the district court erred in concluding that Food & Drug Administration (FDA) Compliance Policy Guide 7132.16 (CPG 7132.16) is not a substantive rule and thus is not subject to the APA’s notice-and-comment requirement. Finding no reversible error, we affirm.

I

FACTS AND PROCEEDINGS

In 1992, the FDA promulgated CPG 7132.16 to address what the agency perceived to be a burgeoning problem in the pharmaceutical industry — the manufacture of drugs by establishments with retail pharmacy licenses. Pharmacies have long engaged in the practice of traditional compounding, the process whereby a pharmacist combines ingredients pursuant to a physician’s prescription to create a medication for an individual patient. This type of compounding is commonly used to prepare medications that are not commercially available, such as diluted doses for children and altered forms of medications for easier consumption.

Pharmacies that practice traditional compounding are regulated primarily by state law, 2 and the drugs that they blend are exempt from many federal misbranding provisions. 3 Drug manufacturers and their products, however, are subject to rigorous federal oversight.

By the 1990s, the FDA had become aware that many establishments with retail pharmacy licenses were purchasing large quantities of bulk drug substances; combining those substances into specific drug products before ever receiving any valid prescriptions; and then marketing those drug products to practitioners and patients. The FDA suspected that establishments engaged in this large-scale speculative “compounding” were doing so to circumvent those new drug, adulteration, and misbranding provisions of the Food, Drug, and Cosmetic Act (Act) 4 that regulate the manufacture of drugs.

To combat this perceived problem, the FDA issued CPG 7132.16, in an effort to establish the following “policy”:

POLICY
FDA recognizes that a licensed pharmacist may compound drugs extemporaneously after receipt of a valid prescription for an individual patient....
Pharmacies that do not otherwise engage in practices that extend beyond the limits set forth in this CPG may prepare drugs in very limited quantities before receiving a valid prescription, provided they can document a history of receiving valid prescriptions that have been generated solely within an established professional practitioner-patient-pharmacy relationship and provided further that they maintain the prescription on file for all such products dispensed at the pharmacy as required by state law. If a pharmacy compounds finished drugs from bulk active ingredient materials considered to be unapproved new drug substances, as defined in 21 CFR 310.3(g), such activity must be covered by an FDA-sanctioned investigational new drug appli *594 cation (IND) that is in effect in accordance with 21 U.S.C. Section 355(i) and 21 CFR 312.
Pharmacies may not, without losing their status as retail entities, compound, provide, and dispense drags to third parties for resale to individual patients.
FDA will generally continue to defer to state and local officials (sic) regulation of the day-to-day practice of retail pharmacy and related activities....
FDA may, in the exercise of its enforcement discretion, initiate federal enforcement actions against entities and responsible persons when the scope and nature of a pharmacy’s activity raises the kind of concerns normally associated with a manufacturer and that results in significant violations of the new drag, adulteration, or misbranding provisions of the Act.

This CPG goes on to identify nine factors that the FDA “will consider” in determining whether to initiate an enforcement action, but explains that the “list of factors is not intended to be exhaustive and other factors may be appropriate for consideration in a particular ease.”

The FDA issued CPG 7132.16 without complying with APA notice-and-comment procedures, 5 as the agency considered CPG 7132.16to be for internal guidance. The FDA explains that CPG 7132.16 was intended to be used within the agency, primarily by FDA district offices, as an aid in identifying those pharmacies that manufacture drugs under the guise of traditional compounding. 6

P2C2, an organization comprising individuals and entities engaged in the practice of pharmacy, interprets CPG 7132.16 differently. Soon after CPG 7132.16 issued, the FDA notified some of the organization’s members that their activities were more consistent with drag manufacturing than with traditional compounding, and that they and their products were thus subject to the regulations applicable to drug manufacturers. On behalf of those and other members, P2C2 filed suit in federal district court, claiming that CPG 7132.16is invalid because it is a substantive rule issued in violation of the APA’s notice- and-comment requirement. The FDA responded that P2C2 lacked standing and that its claim was not ripe, but the district court disagreed. Both parties then filed cross motions for summary judgment, which the trial court denied, finding that there remained genuine issues of material fact. Following a two-day bench trial, the district court made extensive findings of fact and conclusions of law, and ruled that CPG 7132.16 is either an “interpretative rale” or “policy statement,” but it is not a “substantive rale.” Consequently, held the district court, the FDA was exempt from complying with the APA’s notice-and-comment requirements, and CPG 7132.16was validly promulgated.

P2C2 timely appealed, contending that the district court erred in concluding that CPG 7132.16was not a substantive rale. The FDA responded that the district court had correctly held that CPG 7132.16 was not a substantive rale, and reurged its ripeness and standing arguments. 7

II

ANALYSIS

A. STANDARD OF REVIEW

We review for clear error the district court’s findings of fact. We consider de novo the court’s conclusions of law, 8 which include the court’s ruling that CPG 7132.16 is not a “substantive rale.” 9

*595 B. The PROPER Characterization of CPG 7132.16

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Cite This Page — Counsel Stack

Bluebook (online)
56 F.3d 592, 1995 WL 360384, Counsel Stack Legal Research, https://law.counselstack.com/opinion/professionals-and-patients-for-customized-care-v-shalala-ca5-1995.