In its first occasion to interpret § 353b of the Federal Food, Drug, and Cosmetic Act (FDCA), the US Court of Appeals for the Ninth Circuit relied on the "implied preemption doctrine" to affirm a district court's case dismissal for failure to state a claim under Fed. R. Civ. P. 12(b)(6). Nexus Pharmaceuticals, Inc. v. Central Admixture Pharmacy Services, Inc., Case No. 20-56227 (9th Cir. Sept. 13, 2022) (Kleinfeld, Nelson, VanDyke, JJ.)
Nexus developed and trademarked Emerphed, a US Food & Drug Administration (FDA) approved ready-to-use ephedrine sulfate in a vial. Central Admixture operates a network of compounding pharmacies and sells ephedrine sulfate in ready-to-use syringes without FDA approval, because compounding pharmacies do not need FDA approval. Compounding happens when ingredients in medicines are combined, mixed and altered for individual patients. Under 21 U.S.C. § 353b, drug compounding by "outsourcing facilities" is allowed without FDA approval, but the FDCA excludes compounded drugs that are "essentially a copy of one or more approved drugs."
The FDCA contains an exclusive enforcement provision prohibiting private enforcement, stating that proceedings to enforce or restrain violations of the FDCA, which includes the compounding statute, must be by and in the name of the United States. To avoid the FDCA's bar on private enforcement, Nexus alleged that Central Admixture violated the laws of several states in which it sells Emerphed, all of which prohibit the sale of drugs not approved by the FDA. Nexus argued that Central Admixture's ephedrine sulfate was "essentially a copy" of Emerphed and therefore was excluded from the outsourcing facilities exception. The district court disagreed and dismissed the state law claims under the implied preemption doctrine. The district court explained that all of Nexus's claims depended on the determination of whether Central Admixture's ephedrine sulphate was "essentially a copy" of Emerphed, and that the "plain text of the [FDCA] left that determination in the first instance to the FDA and its enforcement process." Nexus appealed.
The Ninth Circuit explained that the Supremacy Clause of the US Constitution is the "source of preemption doctrine, which invalidates state laws that are contrary to federal statutes," but noted that there is no clear sorting of case law and no rigid formula to determine when state law runs contrary to federal law. Therefore, the Court relied on several controlling cases regarding the statute governing FDA approval of medical devices, not drugs. Medical device cases are distinguishable because the medical device statute includes an express preemption clause prohibiting states from imposing any safety or effectiveness requirement different from or in addition to those imposed by federal law. In explaining these cases, the Court noted that the claims that were allowed to go forward did not rely on noncompliance with FDA requirements (as Nexus did), but rather on traditional tort law duties. The purported violation of a state law that substantively says "comply with the FDCA" is not a traditional common law tort. The Court also explained that these cases taught that despite a presumption against implied preemption, there is nevertheless a live doctrine of implied preemption.
The Ninth Circuit further explained that it has been "protective of the FDA's statutory monopoly on enforcement authority." FDA documents demonstrate the difficulties of interpreting and enforcing the "essentially a copy" provisions. Citing its 2013 decision in Perez v. Nidek Co., Ltd., the Court explained that to let Nexus proceed with this claim without FDA determination would "permit Nexus to assume enforcement power which the statute does not allow and require the finder of fact to make a decision that the FDA itself did not make."
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