Digital Signatures

Digital signatures are commonly mis-understood, but they play an important role in securing the pharmaceutical supply chain. The Florida pedigree regulations allow the use of digital signatures on electronic pedigrees so that they can be “self-authenticated”. That is, so the pedigree can be authenticated on receipt without employing methods that require some kind of communication with each upstream owner of the drug—like phone calls, faxes, emails, etc.

Digital signatures employed in pedigrees can self-authenticate without any kind of communication. This can be a huge timesaver because it can fully automate the detection of improper supply chain behavior. Large volumes of “clean” pedigrees can be processed without human review or intervention with only those that have a problem being presented to a user for manual review and handling.

It’s not necessary to understand the technical details, but understanding some of the non-technical characteristics of digital signature technology is important for those in the pharmaceutical supply chain. Florida encoded the use of FIPS (Federal Information Processing Standards) digital signature standards directly into their regulations. California seems poised to do something similar.

I want to explain digital signatures without getting too technical. That’s hard to do, but here’s a common misconception that is easy to dispel. The term “digital signature” does not mean something that looks like this:

This is a scanned image of a hand written signature (compliments of a spam/scam email I received this morning). You could call this a “digitized signature”, but it is far from a “digital signature”. The digitized signature may mean something to people when the image is displayed so they can see it, but it means nothing to a computer. Nothing more than a photograph. It’s just a bunch of bits.

A true digital signature is one that a computer can make sense out of. The “sense” it can make is to determine whether the signature is valid or not. For that to work, the digital signature has to be composed of data. Here is an example of a long-form demo digital signature in XML format like those found inside DPMS pedigrees. It includes the core signature as well as the signer’s public key for use in decoding the signature, and a certificate that is digitally signed by a certificate authority who is willing to attest to the signer’s identity.

It looks pretty technical, doesn’t it? It is, but don’t get bogged down in the details. The point is, with this type of data, a computer can verify that a known trusted authority (the certificate authority) is positively willing to attest to the identity of the signer and that the public key included is positively from the signer. The computer can then use the public key to verify that the information being signed (not visible in this example) has not been modified since the signer applied the digital signature. All of this can be determined without the computer needing to go elsewhere for additional information.

Probably the most important thing a digital signature provides is the quality of “non-repudiation”. That is, because the certificate authority has pre-identified the signer in a way that can include the review of legal records, and as long as the signer has kept their private key secret, the signer cannot later claim that they did not sign a set of digital information that bears their digital signature. They cannot disclaim it. The signer is tightly bound to the signed data.

That’s a lot more than your bank can tell from the handwritten signature on your checks. Digital signatures are better in almost all respects.

The FDA, other federal government agencies and most U.S. state governments have embraced the use of digital signatures in digital legal documents. In pedigrees, digital signatures provide strong evidence that the information signed can or cannot be trusted. That’s why they are an obvious choice by regulators who want to move beyond paper pedigrees.

In summary, digital signatures provide the following benefits when used in electronic documents:

  • Positive identification of the signer
  • Non-repudiation of the information that is signed
  • Positive confirmation that the signed information has, or has not been modified since being signed
  • Signature validation can be performed without needing to communicate with external entities

The use of digital signatures in DPMS pedigrees is the feature that turns, what would otherwise be just a blob of data, into a standalone legal document that can be easily validated without needing to acquire any other information. It’s what allows DPMS pedigrees to be used as evidence in court for prosecution of counterfeiters, diverters and thieves.

For a more technical description of digital signatures and the PKI (Public Key Infrastructure) technology behind it, start with the definition in Wikipedia.

Now that I have covered digital signatures in general I can move on to discuss their use in specific pedigree approaches. Stay tuned.

The Legitimate and Illegitimate Supply Chains

There are a number of important misunderstandings out there related to exactly how illegitimate pharmaceuticals get into the hands of unsuspecting consumers and patients. We need to understand all there is to know about the subject, especially those who are responsible for protecting the public against criminal activity and those who are contemplating new laws aimed at elevating the integrity of the supply chain. In this post, I want to define and differentiate the legitimate and the illegitimate pharmaceutical supply chains.

Extracting the meanings we are looking for, Wiktionary defines the adjective “legitimate” as:

  1. Accordant with law or with established legal forms and requirements; lawful
  2. Conforming to known principles, or accepted rules; valid
  3. (obsolete) Authorized; real, genuine

and the adjective “illegitimate” as:

  1. Illegal; against the law

I don’t think there is any surprise here since these words are in fairly common use, but let’s apply these adjectives to the pharmaceutical supply chain. We could deduce:

The Legitimate Pharmaceutical Supply Chain: The chain of pharmaceutical supply that conforms to known and established legal forms, principles and requirements; the lawful supply chain; the valid supply chain; the real, the authorized, the genuine supply chain.

The Illegitimate Pharmaceutical Supply Chain: The illegal supply chain

Again, no surprises here.

We need one more definition: supply chain.

Wikipedia defines “Supply Chain” as:

“A supply chain is the system of organizations, people, technology, activities, information and resources involved in moving a product or service from supplier to customer. …”

For pharmaceuticals, the supply chain begins with the manufacturer and ends with the consumer, or patient. (For logistical purposes we often talk of our supply chain beginning with the drug manufacturer and ending with the pharmacy, but in actual fact, it ends when the product is irreversibly consumed by the patient.)

We have a single legitimate pharmaceutical supply chain in the United States–filled with complexity, but singular nonetheless. I’ve heard people make the claim that “their [pharma] supply chain is secure”, as if there were many pharma supply chains and it is no concern of theirs if anyone else’s supply chain might not be secure. For security purposes we should treat the U.S. supply chain as a single entity. Martin Luther King famously once wrote, “Injustice anywhere is a threat to justice everywhere”. Similarly, in the pharma supply chain, it could be said that insecurity anywhere is a threat to security everywhere.

Likewise, I believe we have only one significant illegitimate supply chain: the internet. That’s a topic all on its own.

Both the legitimate and the illegitimate supply chains end with the consumer/patient. Interestingly, illegitimate drugs (counterfeit, stolen, diverted, up-labeled, adulterated) can reach the consumer/patient from both the legitimate and the illegitimate supply chains.

Here is perhaps the first surprise in this essay. If we have already separated the legitimate and the illegitimate pharma supply chains, how is it possible for illegitimate drugs to make it into the legitimate supply chain? Wouldn’t they only exist in the illegitimate supply chain?

The answer to the second question is “No”. I selected the adjectives “legitimate” and “illegitimate” for supply chains and for the drugs that pass in them. Just because the adjective is the same doesn’t mean that the subjects are bound to each other.

The answer to the first question is less intuitive. How do illegitimate drugs make it to consumers/patients through the legitimate supply chain? The answer is well documented in Katherine Eban’s book, “Dangerous Doses” already discussed in an earlier post. Look at the case of Timothy Fagan. His parents did not order his Epogen from a website. They bought it (in New York in 2002, prior to the crackdown on criminals in Florida…don’t miss my comments on how much has changed since then) from their favorite national chain pharmacy, a very solid participant in the legitimate pharma supply chain. But the Epogen was “counterfeit” (actually up-labeled and spoiled due to storage at improper temperatures) and Timothy nearly lost his life as the result.

In her book, Eban follows the path of the Epogen from manufacturer to Fagan. It’s a very interesting case. A legitimate drug started out in the legitimate supply chain and it was transformed into an illegitimate drug on its way to the consumer/patient. Did it exit the legitimate supply chain, get transformed by criminals and then get reintroduced, or was the transformation executed by criminals who had infiltrated the legitimate supply chain? The answer depends on whether all of the owners were properly licensed to buy and sell that type of pharmaceutical. If they were, then the drug did not exit the legitimate supply chain. Yes, one or more of the supply chain participants were criminal enterprises, but because they were licensed, they were a legitimate part of the legitimate pharma supply chain at the time.

The point is, individual or groups of criminals can infiltrate the legitimate supply chain at any point (even in big-name companies…read the book!). Once they do, illegitimate drugs can be introduced into the supply chain…easily.

The Florida Pedigree Law

Important Notice To Readers of This Essay On November 27, 2013, President Barack Obama signed the Drug Quality and Security Act of 2013 into law. That act has many provisions, but one is to pre-empt all existing and future state serialization and pedigree laws like those that previously existed in California and Florida. Some or all of the information contained in this essay is about some aspect of one or more of those state laws and so that information is now obsolete. It is left here only for historical purposes for those wishing to understand those old laws and the industry’s response to them.What is the fundamental goal of today’s drug pedigree laws? Certainly it has something to do with making it harder for criminals to introduce illegitimate drugs (counterfeit, stolen, diverted, up-labeled, improperly stored, adulterated) into our legitimate drug supply chain. But exactly how they are to accomplish that is sometimes hard to see. Like most of our laws, pedigree laws seem to suffer from design-by-committee and then they are contorted beyond comprehension by lobbyists. If a lobbyist can’t prevent new regulations from being enacted in the first place, the next best thing seems to be to ensure that the law that is passed is so twisted that it doesn’t entirely make sense.

The Florida pedigree law is a case in point. Well intentioned, but apparently designed by people who were not entirely familiar with the massive number of drug packages that pass through distribution centers and on to pharmacies in our modern pharmaceutical supply chain. This law centered around a paper document for every transaction. The proposed law went through many modifications on its way to being enacted, and even then, the legislature continued to modify it as multiple lobbies convinced state senators and representatives of their particular dislike for various requirements. The law that eventually went into effect on July 1, 2006 had a number of strange provisions.

  1. It’s paper-based
    The final law had been modified to allow an electronic representation of a pedigree, but it remained essentially a paper pedigree. Though you could store it and transmit it electronically—they required very secure FIPS standards (Federal Information Processing Standards) for the electronic version—when an inspector wanted to inspect it, the very secure electronic document had to be printed out and presented on paper. A secure electronic pedigree that is printed out onto paper loses all of its security and can be faked very easily.
  2. Pharmacies could return within 7 days without updating the pedigree
    Shortly before the law went into effect, the legislature and governor passed a modification that allows pharmacies to purchase drugs from a wholesaler and then return them to the wholesaler without providing an updated pedigree, as long as both transactions are completed within 7 days. This allows drugs to be re-introduced into the supply chain with pedigrees that legally do not reflect all of the transactions that have occurred, thus hiding potentially important transactions.
  3. Primary wholesaler invoice statement
    Also shortly before the law went into effect a provision was inserted that allowed primary wholesalers to create a “pedigree” by simply printing on their customer’s invoices a statement that asserts that the drugs on the transaction were purchased directly from the manufacturer. Any wholesaler who cannot purchase directly from the manufacturer must purchase their drugs from one of the primary wholesalers. Those drugs must come with a fully documented pedigree that the primary wholesaler created (not the kind with the simple invoice statement). A fully documented pedigree is much harder and much more expensive to generate and maintain.
  4. No manufacturer requirements
    In Florida, the manufacturer of each drug is not involved in the creation and maintenance of drug pedigrees. The first wholesaler to purchase the drugs from the manufacturer must start the pedigree to reflect that purchase. They must then update the pedigree to reflect the sale of the drug to their customer. All of this is necessary whenever the drugs are sold to another wholesaler. If they are sold directly to a pharmacy, the simple invoice statement “pedigree” is sufficient, as described above.
  5. No serialization
    The Florida law requires careful tracing of every package of drugs from first purchase from a manufacturer until distributed to a pharmacy, but without the benefit of a serial number attached to each unit. This is hard to do without costing a lot of time and money because each shipment of a given drug has a different history. It must be traced separately from all other shipments of that same drug. Without serialization, the processes necessary to do it must be performed carefully and exactly. Any mis-step can cause a break in the trace which results in drugs that cannot be sold in the state.
  6. Allows information to be redacted
    Finally, a bizarre late addition allows certain information to be redacted (removed) from a pedigree document if the information is considered sensitive. But when pedigrees are held electronically using the required FIPS standards, any modification will cause the pedigree to be broken. That is, it will appear as though someone has tampered with it—the very condition that would lead a buyer to fear that the drugs may be counterfeit or otherwise illegitimate. The provision that allows redaction is in total conflict with the provision that requires use of FIPS standards.

So with the addition of these strange provisions, what is the Florida pedigree law really accomplishing? I don’t think it is having the effect that was hoped by the original creators. As far as I can tell by reading the original version, it appears that the goal was to force each buyer of drugs to actively verify that the supply chain history shown on each drug pedigree was accurate.

In this way, the responsibility for detection of criminal activity was distributed to all participants in the supply chain, rather than remaining solely with the few inspectors from the Florida Department of Health. This is the one piece of genius in the otherwise flawed law.

Considering the original proposed law and the six strange provisions listed above, a summary of the primary failures of the Florida Pedigree Law would have to include the following:

  • It’s paper-based
  • It doesn’t involve the manufacturer
  • It doesn’t rely on package serial numbers
  • It is full of holes designed to accommodate special interests

I’m afraid this pedigree law is so flawed that it has simply resulted in higher costs with little or no additional protection from criminals; nearly the worst possible outcome. Why have pharma supply chain crimes apparently decreased in Florida since the law was enacted? In my opinion, it’s entirely because the same law greatly increased wholesaler licensing requirements and the penalties for crimes.

With the development of the Florida law as backdrop, California stepped up with the intention of creating a better pedigree law. Were they successful where Florida failed? I’ll discuss their attempt soon.

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