California’s new electronic pedigree regulation will force every link in the pharmaceutical supply chain to rethink material handling.
Big pharma has a big material handling
problem. Make that several.
Criminals are infiltrating the nation’s
pharmaceutical supply chain
with knockoffs and diverting legitimate
drugs to the black market. Although
this is nothing new, the problem
has worsened in recent years. Drug counterfeiters
have become more sophisticated, and in the battle to protect
public health, the wrong side is winning.
FDA criminal investigations of drug counterfeiting
have increased six fold since 2000, and the U.S. pharmaceutical
industry loses approximately $2 billion to counterfeiting
every year, according to Ross Enterprise Inc., a
subsidiary of CDC Software.
New York-based Center for Medicine in the Public
Interest estimates sales of counterfeit drugs to reach $75
billion worldwide in 2010, an increase of more than 90%
from 2005. As much as 10% of the current global medicine
supply is counterfeit, according to the World Health
Organization.
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The long-term prognosis from the healthcare community
is dire, and laws designed to put a tight lid on counterfeiting
are getting tougher. The idea is to guard public
safety, reduce crime and protect profits of legitimate
pharmaceutical businesses.
Though the regulations are well intended and necessary,
problems inevitably arise when the ‘who’ and ‘what’
are spelled out, while the ‘how’ is missing. That’s happening
right now for companies that move pharmaceuticals
in California.
State of the Industry
One of the most daunting regulatory challenges for
any business involved in manufacturing or distributing
pharmaceuticals is the requirement to track and trace individual
drugs through pedigrees.
Drug pedigrees are not new, and they are not restricted
to California. In 1988, the FDA enacted the Prescription
Drug Marketing Act (PDMA), a key provision of which
was the requirement for pedigrees—statements of origin
that identify all prior sales of a specific drug and all transaction
dates as well as the parties involved in each transaction.
Under the PDMA, it’s the wholesaler’s responsibility
to generate and maintain each drug pedigree and produce
it, on demand, to an inspector or purchaser.
In recent years, though, regulations have become tougher,
with state legislatures adding complexity to the national
requirement. “More than 35 states have their own pedigree
laws or are currently working on them,” says Brian
Daleiden, director of product marketing at SupplyScape, a
software supplier to pharmaceutical companies.
“Florida, California, Texas and Indiana are just a few
examples,” adds David Crawford, project manager at
supply chain consulting firm Tompkins Associates. “More
states are expected to follow.”
California is taking the most aggressive approach by far
with its new electronic pedigree regulation, set to take effect
Jan. 1, 2009. The state will be the first in the nation
to require electronic pedigrees initiated by manufacturers
and verified and updated by every link in the pharmaceutical
supply chain—from point of origin (manufacturer)
to wholesale distributor to final dispenser (pharmacy). Because
of fears of forgery, paper pedigrees will no longer
be allowed in the Golden State.
Further complicating matters, the new regulation will require
item-level serialization for visibility all the way down
to a drug’s smallest saleable unit. This is an industry first.
Layers upon layers of inventory complexity will be added
to California’s pharmaceutical supply chain. “Changes
are expected to be substantive for all wholesalers, resellers
and redistributors of pharmaceuticals,” says Crawford.
Specifically, three main requirements of the new regulation—
item-level serialization, more detailed data collection
and electronic information management—will test
the limits of pharmaceutical handling.
Needles in Haystacks
Most drugs today are not serialized at the item, case or
pallet level, according to SupplyScape, and the software
firm estimates it will take a minimum of five to 10 years
for all drugs to be serialized at the item level.
Serialization introduces much more complexity into the
process of managing inventory. Manufacturers must assign
a unique number or identification code to each packaging
unit. A typical serialization system includes a code to
identify manufacturer, product type and specific item unit,
SupplyScape explains in a recent white paper addressing
the new requirements.
Although California puts the burden
of creating the pedigree on the
manufacturer, the new regulation
isn’t just a manufacturer issue. It will
undoubtedly have a domino effect
throughout the industry.
Material handling processes—from
picking to packing to shipping—will
have to be reconfigured. Specifically,
most experts agree that more process
steps will be required. Crawford estimates
the California regulation will result in a 10% overall increase in labor
throughout the industry.
A pharmaceutical distributor, for
example, will have to maintain tighter
control of inventory, and that may
require upgrading the WMS and rethinking
picking strategies. “If there
is any possibility that a given SKU/lot
combination with different unique
identifiers can enter a wholesaler’s
distribution facility, then there is a
regulatory requirement
for having processes and
procedures in place to keep
the products segregated—
physically as well as within
any WMS,” says Crawford.
“With serialization, you
can’t cross over lot numbers.
You have to find a way
to break down shipments
into lots and put them away
separately. You have to pick
the same item in the same
lot number, so you cannot
batch pick across lots. Pickto-
light technology can help
manage lot control, but you
can’t keep two lots in the
same location. There has to
be some way of segregating
lots.”
In addition to creating
and maintaining a
more complex inventory
system, California manufacturers
responsible for
generating e-pedigrees
may also have to rethink
packaging strategies.
“If a case has 100 syringes,”
Crawford explains,
“those 100 syringes have
to be serialized. If it will be
for sale individually, each
syringe has to be packaged
separately. The state wants
information available at the
lowest level possible. It’s
like a social security number
for every sellable unit
out there,” he adds.
Production lines may have to be
converted from bulk to unit-of-use
packaging. “Since each package has to
have a unique identifier, bottles may
have to be packaged separately,” says
Daleiden. “Manufacturers have to decide
where in the line is the best time
to package and tag the items,” he adds.
“Should they stock the items then identify
them later before shipping?”
Jack Walsh, director of sales and
brand protection solutions at Videojet
Technologies, says manufacturers
will need to have more control over
product in process. How they achieve
that is up to them.
“A company may need a custom
conveyor in some instances for complete
control of items on the packaging
line,” says Walsh. “Another may
create a multi-lane system that batches
product for cases or split product
in line and automatically
batch it for operators in
packaging. There isn’t a
material handling product
that is going to fit an infinite
number of solutions,”
he adds.
To cope with the additional
complexity, some
companies are using a
“phase-in” approach by
maintaining distinct inventory
earmarked for California,
says Daleiden. Of
course, this strategy isn’t
without its problems. They
have to decide whether
they are going to require
serialized product upfront
or find a way to segregate
the California inventory
from the rest as it comes in.
Other companies are starting
slow by tracking and
tracing only “high-risk”
drugs until they can get up
to speed.
Information
Overload
Because California will
require manufacturers to
develop and print a unique
identifier on each saleable
unit of drug product, more
data must be collected and
managed, both inside the
four walls and across company
lines.
Selecting and implementing
track-and-trace procedures for collecting, verifying,
updating and storing new data
for the e-pedigree mandate will be
challenging for most companies.
Not only does data have to be collected,
it must also be ‘read’ and verified
by other links in the chain. The
California law requires pharmacies
and wholesalers to verify the authenticity
and status of serial numbers
generated by manufacturers.
“This means affirmatively verifying,
before any distribution of a prescription
drug occurs, that each transaction
listed on the pedigree has actually occurred,”
Crawford explains. “At the
time of physical receiving,” he continues,
“a process must be in place to confirm
that the physical product being
received has a matching pedigree.”
Though California does not mandate
any specific track-and-trace technology,
RFID appears to be the most
promising, and the FDA has openly
recommended it. The reasons for the
FDA endorsement are clear: Shipment
information can be built into an RFID
tag and captured electronically by an
RFID scanner. And, RFID allows for
efficient item-level data capture because
it doesn’t require line of sight; an
RFID scanner can ‘read’ an entire case
at once and collect data for every bottle
in that case.
Still, RFID isn’t problem free.
“While RFID holds tremendous potential
as an anti-counterfeiting tool,
technology immaturity, high costs, a
fuzzy return-on-investment picture
and requisite infrastructure and
business operational changes have
slowed the pace of deployment,”
says SupplyScape in its white paper.
“Both linear and 2D barcodes can
provide serialized, item-level information,”
SupplyScape contends, “but
they must be read one at a time, take
longer to read and require a direct
line of sight.” Building an RFID infrastructure
is a major undertaking, both
financially and operationally, SupplyScape
adds, while “barcodes are
significantly less expensive.”
“Because of uncertainty about how fast their trade networks can build
their RFID infrastructure, companies
are looking at barcodes and even dual
tagging,” Daleiden adds. That’s not
to say generating e-pedigrees with
barcodes will be any easier. “Tagging
and scanning alone require significant
infrastructure investments,” says
Daleiden. “Manufacturers will have
to label all the individual products,
then scan them on the outbound
side so that they know which drugs
went out.”
Walsh agrees. “Compliance will
require a combination of coding and
labeling, marking, data capture and
database management tools and software—
the whole kit and caboodle.”
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Further Study… For more information about the complex
material handling challenges that come
with e-pedigree requirements, contact the
following sources:
- Associated Pharmacies Inc., Scottsboro,
Ala., www.apirx.com
- Mikoh Corp., McLean, Va., www.mikoh.com
- Cardinal Health, Dublin, Ohio, www.cardinal.com
- Ross Enterprise Inc., Atlanta, www.rossinc.com
- SupplyScape, Woburn, Mass., www.supplyscape.com
- Tompkins Associates, Raleigh, N.C., www.tompkinsinc.com
- Videojet Technologies, Wood Dale,
Ill., www.videojet.com
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Speaking in Tongues
California defines an e-pedigree
as an ever-growing chain of custody
detailing a drug’s path through the
supply chain, so each company involved
in the manufacture or distribution
of the drug has to view and
add to the pedigree. Under the California
scenario, the seller identifies
the drug and the full chain of custody
then certifies the pedigree and
transmits it in advance to the trading
partner receiving the drug, which
then authenticates the pedigree.
When the shipment arrives, the pedigree
is matched to the product and
signed, verifying its accuracy.
Data standards will be necessary
to ensure every link can receive, interpret
and process the same information.
The GS1 EPCglobal drug
pedigree messaging standard has
been recognized as one approach to
developing serial numbers, but that’s
only a starting point.
Authentication, according to SupplyScape,
“leverages the product serial number information stored on
an RFID tag or barcode on a drug’s
packaging so that it can be used by
wholesalers and pharmacies to verify
the product integrity of the drug
package.”
“It’s one thing to serialize your product,” Daleiden says, “but if your
downstream trading partners aren’t
checking that information, you’re not
really getting any benefit. You can’t
do this in a silo.
“Once the product is tagged by the
manufacturer, the wholesaler needs
to receive the product, scan it, pick
it and ship it to pharmacy chains,”
explains Daleiden. “Dispensation
points (pharmacies) need to receive
the product, as well. There are more
than 60,000 pharmacy dispensation
points in the U.S. and 11,000 in California
alone,” he adds. “A lot of companies
are going to have to have the
ability to scan an RFID tag.”
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Case Study #1 Is RFID the Answer?
The FDA is a staunch supporter of RFID technology
for tracking and tracing drugs in the pharmaceutical
supply chain. The federal agency even created its
own “RFID Workgroup,” charged with monitoring adoption of
RFID in the pharmaceutical industry. And, in a report issued
February 2004, entitled “Combating Counterfeit Drugs,” the
FDA recommended that RFID technology be in “widespread
use throughout the pharmaceutical industry by 2007.”
Now that we’re nearing the end of that year, how has RFID
fared?
Cardinal Health, one of the “Big Three” pharmaceutical
wholesalers in the U.S. next to AmeriSource-Bergen and
McKesson, says industry standards and technology issues
still need to be addressed by the healthcare industry before
RFID can be adopted industry wide. According to the
company, the industry must agree on a single RFID protocol
and technology to avoid “significant process and cost
inefficiencies.”
Under California’s requirement, “serialized, item-level
pedigrees will be the responsibility of the entire supply
chain, starting with the manufacturer and ending with the
pharmacy,” says Julie Kuhn, project director at Cardinal
Health. “Furthermore, each company within the supply chain
is responsible for ‘updating’ the item-level pedigree upon
each change of ownership. No one throughout the chain
can purchase a drug without a pedigree,” she adds. “While
this has the potential to secure the nation’s supply chain,
it also has the potential for massive red tape and onerous
implementation.”
Cardinal Health also has concerns about RFID read rates
at all packaging levels and suggests the industry accept
barcode technology in addition to RFID. Finally, unit-level
“inference” should be accepted when unit-level read rates
are not possible.
Cardinal Health speaks from experience. From February
2006 through the fall of that year, the giant wholesaler
tested ultra-high frequency (UHF) RFID tags to determine if
they could be applied, encoded and read at normal product
speeds during packaging and distribution.
The company placed RFID tags on the labels of brandname,
solid-dose prescription drugs then encoded the
electronic product code (EPC) at the unit, case and pallet
levels during the packaging process. The products were
shipped from its headquarters facility in Dublin, Ohio, to its
distribution center in Findlay, Ohio, where the data was read
and authenticated as products were handled “under typical
operating conditions,” according to the company. From the
Findlay DC, the tagged product was sent to a pharmacy to
test read rates and data flow using the same technology as
the DC.
Results from the pilot suggested that RFID tags could
be inlaid into existing FDA-approved pharmaceutical label
stock and applied and encoded on packaging lines at normal
operational speeds. Cardinal Health also reported that
the RFID tag application and encoding required “minimal
adjustments” to its labeling and packaging lines.
However, there were difficulties when it came to reading
item-level data. Reliable unit-level read rates “in excess of
96%” were recorded when individual cases were scanned
one at a time and when mixed with other products in tote
containers ready for delivery to a pharmacy. On the other
hand, unit-level read rates were not reliable within a full
pallet load.
Individual bottles were picked and placed in tote
containers with other products that did not have RFID tags.
While unit-level read rates from the totes were reliable
during the quality-control phase, additional unit-level
read rates were not reliable at the shipping dock of the
distribution center or at the receiving doors at the pharmacy.
Cardinal Health concluded that, while using UHF RFID
technology at the unit, case and pallet levels is feasible for
track and trace, several challenges remain before it can be
adopted industry wide.
Just months after the pilot results were announced,
Cardinal Health said it would integrate RFID into the
operations of its Sacramento, Calif., distribution center
by the fall of 2007 to prepare for California’s e-pedigree
regulation.
“When manufacturers provide us with products containing
item-level RFID tags, we’ll be able to ‘read’ the RFID tag
when it enters our facility, and then, we’ll ‘read’ it again
as it leaves our facility,” explains Kuhn. “We do not do any
modification to the RFID tag. These are passive tags that
are strictly a unique identifier,” she continues. “We use
that unique identifier as a ‘key’ to pull or push required
information for pedigrees to the pedigree application. The
electronic signature that is utilized is the secured electronic
transaction. So, we receive, read and pass the RFID tag
through our DC, but we maintain and send the pedigree
information electronically, not on the RFID tag.”
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Case Study #2 Similar Challenges
in Florida
Clint King, vice president and general manager at
Associated Pharmacies Inc. (API), a buying cooperative
for more than 1,000 independent pharmacies in 40 states,
doesn’t have to deal with item-level tracking—yet. Though
API doesn’t distribute drugs to California, a significant
portion of its members are located in Florida, a state that
requires pedigrees from distributors that do not buy direct
from manufacturers.
To create a Florida pedigree, API has to label incoming
product with both lot number and date of receipt. When
Florida first enacted the law, API wasn’t lot tracking, says
King. He felt case-level serialization was the only realistic
way to generate pedigrees without creating new storage
locations.
“We don’t have enough locations for every lot number
of each day,” says King. “If lot number ABC comes in on
Monday, and lot number ABC comes in on Tuesday, we have
to be able to tell which day the product came in. And, that
requires different locations unless you serialize cases.”
If item serialization is mandated in Florida, as it will
be in California, King will have to rework his inventory
strategy again. Although the Florida regulation doesn’t
require pedigrees to be electronic, King said receiving paper
pedigrees from wholesalers and sending paper pedigrees to pharmacies every day “would be an administrative
nightmare.” So, he chose the electronic route.
API hit a wall, though, when the pharmacies it shipped
to didn’t have the ability to decode and view API’s epedigrees.
As a result, API considered an online solution
from SupplyScape, a company that provides e-pedigree data
management, authentication and digital certificate services.
With the SupplyScape e-pedigree application, pharmacies
simply go to an Internet browser to access a Web portal
where they retrieve e-pedigrees for any drugs they purchase
from API.
Because SupplyScape’s e-pedigree data management
software is hosted over the Internet, API was able to
integrate it into its operations fairly quickly. The data is
housed on SupplyScape’s servers, so API didn’t need to add
data storage at its facility. API was also able to integrate the
software with its WMS and process live pedigrees within 90
days, according to King.
At receiving, API scans one-dimensional barcodes
and builds a file on its WMS, which is connected to the
SupplyScape application. The data file includes serial
number, lot number, day received and PO number.
At the outbound shipping dock, “we scan the serial
number again, and that builds another file for SupplyScape
that indicates to whom the product was sent,” King explains.
Though regulatory compliance was the main goal, API
experienced additional benefits as a result of case-level
serialization and the e-pedigree application. The company
now knows where the physical drug is located for any
pedigree in its system. Physical product can be matched to
pedigrees, making returns easier to handle.
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E-Pedigrees, RFID
Not Enough?
According to a recent survey
conducted by Mikoh Corp., RFID
and e-pedigrees don’t sufficiently ensure
pharmaceutical integrity.
Mikoh polled “several thousand”
manufacturing and distribution managers
in the pharmaceutical industry, and
67% reported they have experienced
pharmaceutical tampering in the past.
Fully 95% identified RFID as an “ideal
solution” to protect product integrity
during manufacturing and distribution.
However, “an overwhelming 76% of
respondents stated that RFID tags must
be physically secure to safeguard against
shrinkage, diversion and counterfeiting.”
Mikoh concluded that “simple RFID is not
enough to ensure pharmaceutical product
integrity.”
“While RFID is a promising solution,
a hole must be addressed: physical
security,” says Andrew Strauch, vice
president of product marketing and management. Strauch says conventional
RFID tags can be easily moved from one
item to another without affecting RFID
functionality. He adds that it would be
easy for a criminal to remove the RFID
tags, steal the drug and leave the tags in
the empty carton. “Track-and-trace and
e-pedigree systems detect the tag and
infer the presence of the product. As a
result, RFID can actually disguise theft and
counterfeiting,” he says.
To address this issue, Mikoh developed
a line of RFID tags and labels called
Smart&Secure that automatically become
disabled if tampered with or moved.
“The tag is a pressure-sensitive
label incorporating a chip and antenna
manufactured from destructible,
conductive ink,” according to the
company. “Its tamper layer causes
antenna damage when the tag is
compromised or removed.” Result: The
RFID tag is disabled, and a tamper alert
is automatically sent to an RFID reader.
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