New Guidance from FDA: When to Submit a 510(k) for a Change to a Cleared Medical Device

Courtney A. Stevens, Esq. |Senior Attorney, Medmarc Loss Control

FDA’s newest guidance for medical device manufacturers, Deciding When to Submit a 510(k) for a Change to an Existing Device, issued August 8, addresses a question manufacturers commonly face,—when a 510(k) is necessary for a change to an already cleared device. Manufacturers’ failures to submit 510(k)s are frequently cited in warning letters as rendering a device adulterated. As such, it’s an issue medical device companies can’t be too careful in scrutinizing. Thankfully, this guidance does provide such much-needed clarity on exactly when a 510(k) is necessary, and when processing the change in accordance with Quality System (QS) requirements (e.g., documentation of changes and approvals in the master record, verification and revalidation, etc.) is sufficient.

The confusion over whether a 510(k) is necessary is largely due to the subjective, relative language in the regulations, requiring device-makers to submit a 510(k) when a change “could significantly affect the safety or effectiveness of the device.” (21 CFR 807.81 (a)(3)). The Agency tried to clarify its interpretation of that language in its first guidance document on this issue, published in 1997, but clearly, as evidenced by the frequency with which the manufacturers’ determination of “significant” changes differed from the Agency’s, greater clarity was needed still. (Once finalized, this draft guidance will supersede the 1997 Guidance on the subject.)

This guidance document improves upon its predecessor by providing a number of exacting flow chart-decision trees to guide manufacturers through the determination of a 510(k)s’ necessity with regard to different types of changes.

It begins by setting out the guidance principles to be first considered in determining the propriety of a 510(k), which I briefly summarize here:

  • Modifications made with intent to significantly affect safety or effectiveness of a device. This is the same language as is found in the regulations, and its meaning is fleshed out in the remainder of the document.
  • Could “significantly affect” evaluation and the role of testing. In order to determine significance of the effect, manufacturers must conduct risk-based assessments.
  • Unintended consequences of changes. One component deemed to make up a “significant effect” is if the change would result in unintended consequences or effects. The draft guidance provides sterilization as an example which may affect device materials, thereby affecting performance of the device.
  • Use of risk management. Here, the draft refers to ISO 147981: Medical devices – Application of risk management to medical devices, and instructs manufacturers to utilize an assessment combining the probability of occurrence of harm and the severity of that harm in determining “significant effect.”
  • Evaluating simultaneous changes. Even though changes may occur simultaneously, each change should be assessed individually and in combination.
  • Appropriate comparative device and cumulative effect of changes. In making the determination of a 510(k)’s propriety, manufacturers need to consider (1) how different a change makes the device from its initial or most recent iteration as described in their most recently cleared 510(k); and (2) the cumulative effect of all changes since the last 510(k) cleared for this device. That is, though previous changes did not require a 510(k) when made in isolation, does the cumulative effect of this change with those previously made nor warrant a 510(k), even if it, by itself, would not?
  • Documentation required. Even if a manufacturer determines a 510(k) is appropriate for a particular change, this does not alleviate them from compliance with all existing QS requirements, including all documentation, verification, and validation duties.
  • 510(k) submission for modified devices. When a 510(k) is submitted for a device with multiple modifications since its last cleared 510(k), the 510(k) should describe not only the most recent change that warranted the 510(k), but also all previous modifications even though they did not merit the submission of 510(k)s in and of themselves.
  • Substantial equivalence determination. Manufacturers need understand that submission of a 510(k) for a change pursuant to everything outlined in the regulation and this guidance document does not assure that a substantial equivalence determination will be provided.

 

With these considerations in mind, manufacturers may proceed to the different parts of the guidance instructing them on decision-making for different kinds of changes—labeling, control mechanisms, operating principles, etc. In each of these, manufactures will find the aforementioned decision trees to guide them through submission criteria.

An example of the flow charts included in this draft guidance:

8.16 - guidance flowchart

In addition to charts guiding decision making, the guidance also provides examples of documenting changes and written regulatory change assessments.

This should go a long way in facilitating manufacturers’ understanding of when 510(k)s for changes are necessary, and reduce the number of warning letters for companies’ failure to submit them, accordingly.

FDA Pushes Back the Date for Issuing Generic Drug Labeling Rule to April 2017

Jordan Lipp, Esq. | Partner, Davis Graham & Stubb

On Thursday, the FDA again pushed back the date it expected to issue its final rule on generic drug labeling.  The final rule is now expected in April 2017.  The highly controversial proposed rule, as discussed in more depth in earlier posts, would permit generic drug manufacturers to unilaterally change their labels under the changes-being-effected (“CBE”) process.  Besides likely creating a bureaucratic headache and allowing generic and brand-name labels to differ (potentially in violation of the Hatch-Waxman Act), the proposed rule would also threaten to undermine the generic drug preemption decisions by the U.S. Supreme Court.  The proposed rule has generated significant political heat for these reasons, and the date for the final rule has already been pushed back several times.  Although the FDA did not state a reason for pushing back the announcement of its final rule again, the new date of April 2017 is, of course, after the next election.  Whether the final rule will ever be issued, and what it may look like, are open questions.  In any event, the wait continues.

 

FDA Settles with Amarin in Off-Label Promotion Free Speech Lawsuit

Jordan Lipp, Esq. | Partner, Davis Graham & Stubb

As discussed more in an earlier post, Amarin Pharma sued the FDA in May 2015 asserting that under the First Amendment’s free speech protections, it could engage in truthful and non-misleading speech promoting the off-label use of its drug, Vascepa, for the treatment of patients with persistently high triglyceride levels.  On August 7, 2015, a federal judge in New York granted Amarin’s preliminary injunction in the case, and held that under the First Amendment’s free speech protections, the FDA could not bring a misbranding action against Amarin for Amarin’s off-label promotion.  As the Court stated:  “Where the speech at issue consists of truthful and non-misleading speech promoting the off-label use of an FDA-approved drug, such speech . . . cannot be the act upon which an action for misbranding is based.”

Yesterday, Amarin and the FDA settled this lawsuit.  The settlement largely mirrors the Court’s preliminary injunction order – with the FDA agreeing “to be bound by the Court’s conclusions that Amarin may engage in truthful and non-misleading speech promoting the off-label use of Vascepa®,” and Amarin agreeing that it “bears the responsibility, going forward, of assuring that its communications to doctors regarding off-label use of Vascepa® remain truthful and non-misleading.”  The settlement also sets forth a preclearance procedure between Amarin and the FDA on other future off-label promotion of Vascepa.

This settlement cements Amarin’s victory on its preliminary injunction.  The course of this lawsuit has provided a roadmap for drug and device manufacturers looking to promote their products off-label – in terms of how to raise such promotional plans with the courts to obtain court approval and FDA agreement on such off-label promotion.

What Scalia’s Passing Means to Life Sciences Companies

Courtney A. Stevens | Senior Attorney, Loss Control | Medmarc Insurance Group

The recent passing of Justice Antonin Scalia, the Court’s longest-serving justice, means more than just political scuttlebutt over who will get to appoint his replacement. For life sciences companies, it means the loss of a real ally in matters of tort liability and a powerful force in intellectual property.

Preemption

Scalia authored the 8-1 majority opinion in Riegel v. Medtronic, 552 U.S. 312 (2008), a pivotal decision in preemption jurisprudence that held that the Medical Device Amendments to the Food, Drug and Cosmetic Act (FDCA) preempted state-law claims relating to the safety and effectiveness of pre-market approval (PMA) devices. This effectively shields makers of PMA devices from products liability claims.

In Wyeth v. Levine, 555 U.S. 555 (2009), which undermined preemption in holding that FDA approval of a medication does not preempt state law failure-to-warn claims, Scalia joined the dissent (authored by Justice Samuel Alito). The dissent argued that this holding was inconsistent with their previously-adopted “conflict preemption” analysis.

Continue reading “What Scalia’s Passing Means to Life Sciences Companies”

FDA Issues Draft Guidance: Postmarket Cybersecurity for Medical Devices

Jordan Lipp | Partner Davis Graham & Stubbs LLP

A little over a year after issuing final guidance on premarket submissions for management of cybersecurity in medical devices, discussed here, the FDA issued draft guidance on postmarket cybersecurity (available here).  The FDA’s stated purpose of this draft guidance, which it just issued, is to clarify “FDA’s postmarket recommendations and [to] emphasizes that manufacturers should monitor, identify and address cybersecurity vulnerabilities and exploits as part of their postmarket management of medical devices.”  As cybersecurity threats are continually evolving, the FDA explains that it is not possible to completely mitigate cybersecurity risks solely through premarket controls.  Recognizing that “medical device cybersecurity is a shared responsibility between stakeholders,” the draft guidance addresses both risk management and remediation of cybersecurity threats.  It also discusses the interplay of cybersecurity issues and medical device companies’ reporting requirements, setting forth several examples of what should or should not be reported. Continue reading “FDA Issues Draft Guidance: Postmarket Cybersecurity for Medical Devices”

Regulatory Roundup: FDA Reports and Guidances in August

Courtney A. Stevens, Esq. | Senior Attorney, Medmarc Loss Control

Recommendations for a National Medical Device Evaluation System

On August 20, the FDA released, for public comment, a report from the Medical Device Registry Task Force and the Medical Devices FDA logo.jpgEpidemiology Network. The report described the inadequacies in the existing framework for medical device evaluation, what a more effective system would look like, what devices would be particularly ripe for evaluation via such a system, and how the system could be implemented. The full report can be found here.

FDA Issued Several New Drug and Device Guidances

The Agency issued several new guidance documents in August, including the following. Continue reading “Regulatory Roundup: FDA Reports and Guidances in August”

FDA Reopens Comment Period on Generic Drug Labeling Proposed Rule

Jordan L. Lipp | Partner, Davis Graham & Stubbs LLP

Bowing to pressure from stakeholders and Congress, on Tuesday FDA announced that it would reopen the comment period (through April 27, 2015) for its proposed rule that would allow generic drug manufacturers to unilaterally change their labels.  And, FDA set a public meeting for March 27, 2015, in order to “provide a public forum for FDA to listen to comments on the proposed rule.”  As discussed in more depth in an earlier post, FDA’s highly controversial proposed rule would permit generic drug manufacturers to unilaterally change their labels under changes-being-effected (“CBE”) process, which not only would result in the potential for generic and brand-name labels to differ, but would also threaten to undermine recent generic drug preemption decisions by the U.S. Supreme Court. Continue reading “FDA Reopens Comment Period on Generic Drug Labeling Proposed Rule”