Transcript File - Fitzgerald Pharmacy Technician Class

The Pharmacy
Technician 4E
Chapter 3
Drug Regulation and
Control
Chapter Outline
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Drug Regulation
New Drug Approval
Marketed Drugs
Behind-the-counter Medications
Sample Labels
Controlled Substances
DEA forms
Public Safety
Law and the Technician
Brief History of Statutory Pharmacy Law
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In the 19th century, drugs in the United States were
unregulated.
 Medicines did not require proof that they were either
safe or effective.
 Most agents contained a high content of alcohol.
 Some caused injury or death.
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To combat abuses in both formulation and labeling, in
1906 the U.S. Congress passed the first of a series of
landmark 20th century laws to regulate drugs.
Pure Food and Drug Act of 1906
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The purpose of the Pure Food & Drug Act was to
prohibit the interstate transportation or sale of
adulterated and misbranded food and drugs.
 Adulterated is impure by adding extraneous,
improper, or inferior ingredients.
 Misbranded to brand or label misleadingly or
fraudulently.
Did not require drugs to be labeled, but required that
drug labels not contain false information about the
drugs’ strength and purity.
Proved unenforceable and new legislation was
required.
Harrison Tax Act 1914
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Established that manufacturers, pharmacists,
importer, and physicians prescribing narcotics should
be Licensed and required to pay a tax.
The law enacted in response to growing opiates and
cocaine-containing medications.
Food, Drug, and Cosmetic (FDC) Act of
1938
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Sulfa poisoning caused the death of 107 people,
primarily children.
 Due to untested sulfanilamide concoction.
 In response to this event, FDC was introduced.
FDC is the most important piece of legislation in
pharmaceutical history.
Required only that drugs be SAFE for human
consumption before marketing.
Food, Drug, and Cosmetic (FDC) Act
of 1938
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Gave FDA the power to conduct inspections of
manufacturing plants to ensure compliance.
Act applied to interstate transactions, as well as to
intrastate transactions.
FDA required pharmaceutical manufacturers to file a
new drug application (NDA) with each new drug
before marketing.
Durham-Humphrey Amendment of
1951
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States that drug containers do not have to include “adequate
directions for use” as long as they include
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“Caution: Federal Law Prohibits Dispensing Without
Prescription.”
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Now, “Rx Only.”
Distinguished between
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Legend (prescription) drugs.
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Over-the-counter (OTC) (non-prescription) drugs.
Authorized
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Verbal prescriptions.
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Prescription refills.
Kefauver-Harris Amendment of 1962
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In 1962 a new sleeping pill containing the drug
THALIDOMIDE was found to cause severe birth
defects when used during pregnancy (Europe).
Extended the FDC Act of 1938 to require that
 Drugs not only be safe for humans but also be
EFFECTIVE.
Requires drug manufacturers to file
 An investigational new drug application (INDA) with
the FDA before initiating a clinical trial in humans.
 Once proven safe and effective, manufacturer may
submit an NDA seeking approval to market the
product.
Poison Prevention Packaging Act of
1970
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Passed to prevent accidental childhood poisonings
from prescription and nonprescription products.
Enforced by the Consumer Product Safety
Commission.
Requires most over-the-counter (OTC) and legend
drugs to be packaged in child-resistant containers.
 Cannot be opened by 80% of children under five.
 Can be opened by 90% of adults.
Older patients or people with a disability may request
a non-child-resistant container; other exceptions are
provided for by law.
Comprehensive Drug Abuse
Prevention and Control Act of 1970
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Commonly referred to as the Controlled Substances
Act (CSA).
Created to combat and control drug abuse and to
supersede previous federal drug abuse laws.
Created the Drug Enforcement Administration (DEA),
an arm of the Department of Justice.
 Charged with enforcement and prevention related
to the abuse of controlled substances like many
narcotic pain medications.
Comprehensive Drug Abuse Prevention
and Control Act of 1970
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Classified drugs with potential for abuse as controlled
substances.
Ranked controlled substances into five categories, or
schedules.
 Ranging from those with great potential for abuse
(Schedule I) to those with little potential (Schedule
V).
 Narcotics are highly regulated.
Comprehensive Drug Abuse
Prevention and Control Act of 1970
Schedule
I
II
III
IV
V
Medical Use
Examples
For research only – not
Heroin, LSD
approved for human use
Dispensing severely restricted Morphine, oxycodone,
meperidine
Prescriptions can be refilled
up to 5 times in 6 months
Same as for Schedule III
Codeine with aspirin,
anabolic steroids
Benzodiazepines,
meprobamate
Some sold w/o a prescription; Liquid codeine
must be 18
combination preps.
Drug Listing Act of 1972
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Gives the FDA the authority to compile a list of currently
marketed drugs.
Each drug is assigned a unique and permanent product
code
 Known as a National Drug Code (NDC).
 Ten characters that identify manufacturer or
distributor, drug formulation, size and type of
packaging.
FDA requests, but does not require, that the NDC appear
on all drug labels.
1976 Medical Device Amendment
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The Medical Device Amendment requires pre-market
approval of safety and effectiveness of life sustaining
and life supporting medical devices.
Orphan Drug Act of 1983
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An orphan drug is intended for use in a few patients
with a rare disease or condition.
 Developing such a drug would be prohibitively
expensive, given the small market.
The Orphan Drug Act encourages the development of
orphan drugs by:
 Providing tax incentives.
 Granting manufacturers exclusive license.
Over 250 orphan drugs have been approved by the
FDA.
Drug Price Competition and
Patent-Term Restoration Act of 1984
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Also called Hatch-Waxman Act.
Allows substation of generic drugs with the same chemical
composition as brand name products.
Once the original patent expires, any manufacturer may
market a generic drug.
 Usually is less costly than the brand name.
A given drug typically has several names.
 Generic name is a common name given to a drug
regardless of brand name.
 One or more brand names under which the manufacturer
markets a drug.
Prescription Drug Marketing Act of 1987
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PROHIBITS
 Re-importation of a drug into the United States.
 United States seniors getting prescription medication from
Canada, Mexico, or other countries.
PROHIBITS
 Sale or trading of drug samples.
PROHIBITS
 Distribution of samples in response to prescription drug
samples being illegally diverted and distributed.
 To persons other than those licensed to prescribe them
except by mail or by common carrier.
Omnibus Budget Reconciliation Act of
1990 (OBRA-90)
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Requires states to establish standards for Drug Use Review
(DUR) by the pharmacist.
Requires pharmacists to offer counseling to Medicaid
patients.
Requires a manufacturers rebate to state Medicaid program
between the manufacturer’s best price for a drug (typically
the wholesale price) and the average billed price.
Health Insurance Portability and
Accountability Act (HIPAA) of 1996
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Defines the scope of health information that may or
may not be shared among health care providers
without patient consent.
Provided for broad and stringent regulation to respect
“Patient’s right to privacy.”
Affects the confidentiality of patient medical records.
 Placed safeguards to protect patient confidentiality.
 Requires healthcare facilities to provide information
to the patient on how they protect the patient’s
health information.
Health Insurance Portability and
Accountability Act (HIPAA) of 1996
In pharmacy, HIPAA requirements include:
 Restrictions on transmission of prescription data.
 Provision of a private area for counseling.
 A training program for employees about
confidentiality.
For pharmacy technicians, HIPAA means:
 Must not reveal any information on any patient
outside the pharmacy.
 Violations would be grounds for immediate
termination and legal action.
Food & Drug Administration
Modernization Act
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Authorizes fees to be added to a new drug application
(NDA) process to accelerate the review and approval
process for new drugs.
Updates the labeling on prescription medications .
 Products labeled “legend” are to be changed to read
“Only.”
 LEGEND is the term that has been used to indicate
whether a drug was available by prescription or
over-the-counter (OTC).
 New labeling requirements were implemented in
2004.
The FDA’s Center for Drug Evaluation &
Research
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Provides an Index to Drug-Specific Information with
patient, consumer and healthcare professional
information sheets, including FDA Alerts.
Works with drug manufacturers to develop risk
management programs for drugs with FDA.
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Alerts, such as the iPLEDGE program for Accutane.
Health care professionals, wholesalers, pharmacies and
patients must register in the iPLEDGE program to
prescribe , distribute, fill prescriptions, or use Accutane.
New Drug Approval
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All new drugs (domestic or imported) require FDA approval
before they can be marketed in the US.
Before approval, new drugs must be shown to be SAFE and
EFFECTIVE and its benefits OUTWEIGH its risks.
Drug manufacturers and not the FDA is responsible for proof.
The testing process currently takes about 8.5 years.
Discovery: 2-10 years.
Preclinical testing: laboratory and animal testing.
Phase I: 20-80 healthy volunteers.
Phase II: 100-300 patient volunteers.
Phase III: 1,000-5,000 patients volunteers.
FDA review/approval Approved by FDA: 17 years.
Post-marketing testing Five year extension on patent
(Hatch-Waxman Act of 1984).
New Drug Approval Process
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Placebo
 Inactive substance: not real medicine administrated
 Gives the impression that they’re receiving the real
medicine.
 Used to compare against patients with the test drugs
Investigational New Drug Application (INDA)
 An application submitted to FDA by the manufacturer
before initiating a clinical trial in humans.
New Drug Application (NDA)
 Once proven safe and effective, manufacturer may
submit an NDA seeking approval to market the product.
Testing Phases
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Begins in the laboratory for chemical analysis.
Animal testing (preclinical testing)
 Use animals and treat them as humanly as possible.
 Test using different species.
 Only a fraction of the drugs tested on animals reach clinical
trials stage.
Clinical trials with humans
 INFORMED CONSENT is required for each patient before
enrolling into clinical trials.
 Requires for the patient to be told all the risks and other
treatment options in a language they understand.
 Patients should also be free to leave the trial at any time.
Clinical Trial Testing
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Phase I
 20-100 patients.
 Several months.
 The main purpose is to study SAFETY.
 Only about 25% of drugs tested in phase 1
successfully reach the market.
Phase II
 Up to several hundred patients.
 Several months to two years.
 The main purpose is short-term SAFETY AND
EFFECTIVENESS.
Clinical Trial Testing Cont.
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Phase III
 Several hundred to several thousands patients.
 1-4 years.
 The main purpose is safety, dosage, and
effectiveness.
Phase IV
 Begs after the drug is approved.
 Life time of the drug.
 The main purpose is for safety.
Clinical Trials
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Special “Treatment Status”
 Permission given to administer drugs in patients outside
the clinical trials for relief to a critically ill patient without a
better proven drug.
 E.g. AZT for AIDS in early 1990’s.
Controlled Trial
 Group of patients (with similar condition or disease) who
are given a placebo (or no drug) and used to compare the
effect of the test drug.
 Groups are placed on controlled or treatment arm
randomly.
Blind Trial
 The patient or the doctor who is treating the patient does
not know which arm of the study a particular patient is on.
Marketed Drugs
Patent is a right given to a manufacturer to exclusively
market a new product for a specific period of time
under a brand name.
 A patent is good for 17 years.
Hatch-Waxman Act of 1984
 Extends patient up to 5 years to compensate for lost
time in research before going to market.
 While the drug is under patent, a generic drug will
NOT be marketed by other companies.
Marketed Drugs
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Medical devices and biological products such as
insulin and vaccines must also meet FDA testing and
approval requirements.
The Center for Devices and Radiological Health
(CDRH) is responsible for devices.
The Center for Biologics Evaluation and Research
(CBER) is responsible for biological products made
from living organisms.
Marketed Drugs
Generic drugs are Pharmaceutically Equivalent is
identical to the brand-name product listed in the
orange book (FDA’s Approved Drugs Products
publication) in terms of
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Active ingredient.
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Dosage form.
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Route of administration and strength.
Therapeutically equivalent is the body uses of the drug
is the same.
Look Alike and Sound Alike Drugs
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Federal laws require containers NOT to look like
another drug, however some drugs look alike and
sound alike.
Safe ways to check the correct drug being dispensed
is to check the NDC number on the container against
the NDC number on the prescription label.
Over-the-Counter (OTC) Drugs
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OTC drugs have to be approved by the FDA .
Can be used upon the judgment of the consumer without a
prescription from a physician.
There are over 100,000 OTC drugs in 80 therapeutic categories.
The manufacturer has to follow a format called drug monograph
to be able to market with proper label including:
• Active ingredient
• Direction for use
• Amount of content
• Warnings
• Expiration date
Sample OTC
Label
Behind-The-Counter OTC Medications
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Medications sold without a prescription, but with
RESTRICTION on their sales.
Kept behind the pharmacy counter.
Limitation: 3.6 grams per day and 7.5 gram per
month.
E.g. Pseudoephedrine and Ephedrine containing
products.
Combat Methamphetamine Epidemic
Act
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Requires that cold and allergy medicine containing these
ingredients be kept behind the counter.
Set daily and monthly amount restrictions.
A sales record (written or electronic) must be kept for a
period of 2 years.
The record should contain:
 Drug name
 Quantity
 Name and address of purchaser
 Date and time of the sale
 Proof of ID
 Signature of the purchaser.
Exempt Narcotics
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Sold by a pharmacist without a prescription.
 E.g. Cough syrups that contain a small amount of
codeine.
Only pharmacists can approve their dispensing.
Purchasers have to:
 Be at least 18 years old.
 Provide identification
Document the sale in a bound record book (name
and address of the purchaser, drug name and
quantity, date, name or initial of the pharmacist.)
Emergency Contraceptives
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Plan B®
 Has a dual marketing status (both Rx and OTC).
 OTC >17 years old.
 Prescription < 17 years old.
Exception
 Pharmacists in some states have authority to
prescribe and dispense under protocol to patients
under 17 years old.
Manufacturing Label
brand & generic names NDC number Manufacturer’s name
& address
Dispensing
Storage
requirements
Lot Number
& Exp Date
Legend statement
controlled substances mark
PT 3:3
Product Labeling
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Package Inset – is prescription information which
comes with a document on the drug product.
Includes:
 Clinical pharmacology,
 Indications,
 Contraindications,
 Warnings,
 Adverse reaction, and
 Other related information.
Intended for health care professionals who
prescribe or dispense the product
Is contained in a reference book called Physician Desk
Reference (PDR).
National Drug Code (NDC
Number) NDC 01234-5678-90
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Identification number assigned by the manufacturer to
a drug product.
Has 3 sets of numbers.
 1st five digits - manufacturer.
 2nd four digits - medication strength and dosage
form.
 3rd two digits - package size.
Prescription Bottle
F
A
D
C
K
E
I
B
A: Rx number
B: Prescribing physician
C: Date
D: Patient Name
E: Drug Name, strength, dosage form
F: Pharmacy Name, Address,
and phone number
G: Quantity
H
J
H: Number of refills remaining
I: Manufacturer of the drug
J: Expiration date
K: Direction for use
Controlled Substances
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Drugs that have an abuse potential.
Enacted in 1970 by Controlled Substance Act (CSA) .
Five groups (or schedules) of such drugs and put a strict
guideline on their distribution.
Requires to register with the Drug Enforcement
Administration (DEA) of the Justice Department.
DEA Registration
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Each pharmacy registers.
 Pharmacy employees are not required to register.
 Registration varies from 1 to 3 years in length.
Laws vary from state to state.
 some state laws are more stringent than the
federal CSA.
 the most stringent of the laws will be followed
 If federal law is more stringent, it is followed.
 If state law is more stringent, it is followed.
Drug Enforcement Administration (DEA)
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Issues licenses
 To medical practitioners to write prescriptions for
scheduled drugs.
 To pharmacies to order scheduled drugs from
wholesalers.
 Distributors to distribute controlled substances.
Inspects medical facilities, including pharmacies.
Tracks narcotics from manufacturer to warehouse to
pharmacy.
DEA Regulations
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Manufacturers must label controlled drugs using the letter
“C.”
 e.g. C-II, C-III, etc.
Record keeping
 Schedule II – 7 years
 Others – 2 years
Storage
 Schedule II – should be kept separately in a locked, and
tamper-proof narcotic cabinet secured to the floor or wall.
 Schedule III-V can be stored on the shelf with other
prescription drugs.
Dispensing of Schedule II Drugs
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Prescriptions for Schedule II substances must be handsigned by the prescriber except in emergencies.
 To minimize fraudulent use.
 To maintain a record-tracking system.
An emergency supply of a Schedule II drug (72 hours
supply) can be provided to a patient without a written
prescription in most states.
DEA Form 222
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Used to order C-I and C-II.
Must be signed by a registered person.
Three copies:
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Copy 1: Blue copy is retained by the supplier.
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Copy 2: Green copy is sent to the DEA.
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Copy 3: Brown copy is kept for your records.
Must be kept in a separate file from other invoices.
Note that C-III - C-V does not require federal order
forms.
Form has its own unique serial number.
Form can be requested online.
DEA Form 222
PT 3:5
DEA Numbers
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Assigned to prescribers for controlled drugs.
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Two letters and seven digits .
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First letter is a code identifying the type of registrant.
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Second letter is the initial of the registrant's last name.
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Seventh digit is a “checksum" that is calculated.
DEA Numbers
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Example: AR4342793
 Add 1st +3rd +5th number = ___.
 Add 2nd+4th +6th number = ___ multiply by 2 =__.
 Then add ____+____=____.

The total should be a number whose last digit is the
same as the last digit of the DEA number.
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AR4342793
 (4+4+7=15 3+2+9=14 14x2=28 then 15+28=43).
Drug Enforcement Administration (DEA)

Branch of the U.S. Justice Department responsible for
regulating sale and use of drugs with abuse potential.
 Responsible for enforcing laws regarding both legal
and illegal addictive substances.
 Directs most of its efforts toward illegal drug
trafficking.
 Supervises legal use of narcotics and other
controlled substances.
Controlled Substance Prescriptions
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The DEA number must appear on the form and the
patient’s full name and full street address must be
entered.
NO REFILL is allowed on Schedule II prescriptions.
When filling the prescription, the pharmacist draws a
line across the prescription indicating it has been
filled.
Federal Laws
A prescription for a controlled substance must meet
the following requirements.
 Patient’s full name and address.
 Practitioner’s name, address, and DEA#.
 Drug name, strength, dosage form, quantity,
directions, and refills.
 Must be written in ink or typewritten and signed by
prescriber.
 Controlled substance must be dated on the date of
issuance.
Federal Laws
Schedule III, IV, and V Prescriptions
 May be verbal, written, or faxed and may be refilled
if authorized by the prescriber.
 Schedule III and IV may be refilled up to 5 times
within 6 months.
 Schedule V may be refilled as directed by the
prescriber.
 Schedule II requires a written prescription by the
prescriber that is signed and is not refilled.
Food and Drug Administration (FDA)
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Primary responsibility and authority is to enforce the
law and create regulations to assist in providing the
public with safe drug products.
Requires all manufacturers to file applications for
investigation studies and approval of new drugs.
Oversees the recall of dangerous products.
Has no legal authority over the practice of pharmacy
in each state (is a responsibility of the BOARD OF
PHARMACY).
Public Safety
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FDA approval process is quite thorough, but it is
impossible to fully prove that a drug is safe for use.
The FDA has several options if it determines that a
marketed drug presents a risk of illness, injury, or gross
consumer deceptions.
Requests healthcare professionals and the public to
report any adverse effects of drugs once they are
marketed.
FDA seizes the drug, stops distribution, or may issue a
recall of the drug.
MedWatch
 Allows
any healthcare professional to report a
serious adverse event that is suspected of being
associated with the use of an FDA-regulated product.
 Includes product problem, or medication error.
 A voluntary program.
 Designed to detect side effects not identified from
research studies.
 Manufacturers must file a report if an adverse drug
reaction is reported.
 Reports can be made.

Phone 1-800-FDA-0178, by mail, or online.
Public Safety
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Adverse Effect
 Unintended side effect of a medication that is
negative or in some way injurious to a patient’s
health.
Injection
 Court order preventing a specific action.
 E.g. the distribution of potentially dangerous
drugs.
Recalls
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Removal of a drug from the market based on report .

Can be prescription or over-the-counter from the market.

Can be from the public or healthcare professionals

Adverse drug effect can be reported to the Manufacturer
or to the FDA.
Steps
1.
FDA will contact the manufacturer.
2.
Manufactures contact wholesalers, retailers, and all
consumer levels.
3.
Personal phone calls are made or letters are sent to
customers.
4.
Recalls are listed publicly.
5.
Listed in the weekly FDA enforcement report.
Types of Recalls
Class I:
Serious adverse effects or death.
Class II:
Cause temporary but reversible effects.
Class III:
Not likely to cause adverse effects.
Vaccine Adverse Event Reporting System
(VAERS)
 Vaccine
Adverse Event Reporting Systems (VAERS)
 MedWatch does not monitor vaccines.
 Performed by VAERS.
 Post-marketing surveillance system operated by
the FDA and the Centers for Disease Control
(CDC).
 Report
 (1-800-822-7967), online, or submitted by mail on
a downloaded form.
Law and the Technician

Federal laws provide foundation for the state
laws which governs pharmacy practice.
State Laws
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Responsible for licensing of all prescribers and
dispensers.
Each state enacts laws governing the manufacturer,
distribution, prescription, and dispensing of
prescription drugs.
Pharmacists must comply with both federal
regulations and regulations in the state(s) in which
they practice.
Such regulations may reside in different departments
of the state, such as the board of pharmacy, the
department of health, or consumer affairs.
State Boards of Pharmacy
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
Composed of leaders from the pharmacy community
and the public.
Activities vary from state to state .
 Can suspend or revoke pharmacy/pharmacist license
or registration.
 Provide regulations regarding the practice of
pharmacy.
State Boards of Pharmacy &Legal
Duties of Pharmacy Personnel

No statutory federal definition of the role of the pharmacy
technician exists.
 No uniform definition of role and duties of pharmacy
technicians from state to state.
 Roles and duties of pharmacy technicians are changing.

Requirements for pharmacy technicians vary by state.
 Some states require licensure or registration with the
board.
 Some states require passing national certification exams.
 Technicians duties in all states must be carried out under
the direct supervision of a licensed pharmacist.
Law and the Technician
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Legal liability means you can be prosecuted for misconduct or
negligence.
Misconduct means a wrongful, improper, or unlawful conduct
motivated by premeditated or intentional purpose.
Negligence is the most common form of misconduct.
 Refers to failure to do something that should or must be
done.
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Incorrect labeling, failure to maintain patient confidentiality.
Failure to recognize expired drugs.
Calculation errors.
Dispensing wrong medication.
Incorrect handling of controlled substance.
Inaccurate record keeping.
Compliance is doing what is required.
American Society of Health-System
Pharmacists (ASHP)
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One of the various professional bodies and
associations which set and maintain pharmacy
standards.
Over 30,000 members primarily practice in hospitals.
Serves as an accrediting organization for pharmacy
residency and pharmacy technician training
programs.
Drug and Professional Standards
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United States Pharmacopeia (USP)
 Independent scientific not-for-profit organization.
 Sets quality standards for prescription drugs, OTC
drugs, and dietary supplements.
United States Pharmacopeia
 Official publication of USP.
 Develops authoritative, unbiased information on
drug use.
JCAHO





Joint Commission on Accreditation of Health Care
Organizations.
Independent non-profit organization.
Establishes standards and monitors compliance
Monitors over 20,000 health care programs.
Covers hospital, health care networks, HMOs, and
nursing homes.
National Association of Boards of
Pharmacy (NABP)



The NABP represents all 50 state boards of pharmacy.
 Assists in developing, implementing, and enforcing
uniform standards.
 Develops licensing exams for pharmacists.
Coordinates reciprocation of pharmacist licenses from
one state to another.
Meets regularly to discuss national trends and issues
in pharmacy law.
National Association of Boards of
Pharmacy (NABP)




Verifies the licensure of online pharmacies.
 Internet VIPPS® program (Verified Internet Pharmacy Practice
Sites).
NO regulatory authority, unlike the FDA or DEA.
Coordinates issuance of “NCPDP Provider ID.”
 Assigned a unique number to pharmacies in the United States and
territories of the United States.
 Identifies your pharmacy to health plan claims processors and
third party contractors.
Developed the Model State Pharmacy Practice Act (MSPPA).
Others


Basic criminal and civil laws apply to pharmacy
technicians.
Crimes like theft, discrimination, sexual harassment,
fraud, etc. are punishable just as they would be
outside of your job.
Terms to Remember
1.
2.
3.
4.
5.
6.
7.
8.
9.
Adverse effect
Combat methamphetamine
epidemic act (CMEA)
Compliance
Controlled substance mark
Controlled substances
Dual marketing
Exempt narcotics
Injunction
Legend drug
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Liability
NDC (national drug code)
Negligence
Pediatric
Pharmaceutical equivalent
Placebo
Product labeling
Protocol
Recall
Therapeutic equivalent
Terms to Remember
20. Pure Food and Drug Act of 1906
21. Food, Drug, and Cosmetic (FDC) Act of 1938
22. Durham-Humphrey Amendment of 1951
23. Kefauver-Harris Amendment of 1962
24. Comprehensive Drug Abuse Prevention and Control Act of 1970
25. Poison Prevention Packaging Act of 1970
26. Drug Listing Act of 1972
27. Orphan Drug Act of 1983
28. Drug Price Competition and Patent-Term Restoration Act of 1984
29. Prescription Drug Marketing Act of 1987
30. Omnibus Budget Reconciliation Act of 1990 (OBRA-90)
31. Health Insurance Portability and Accountability Act (HIPAA) of
1996
32. Medicare Prescription Drug, Improvement, and Modernization
Act of 2003