After 23 years, de novo classification review finally has an implementing regulation!
The other major review processes have had their regulations in place for many decades. The Medical Device Amendments of 1976 created the initial premarket application (PMA) review and 510(k) substantial equivalence review processes. Only a year later, in 1977, FDA promulgated regulations governing 510(k) reviews (21 C.F.R. Part 807, Subpart E). In 1986, FDA followed up with the PMA regulations (21 C.F.R. Part 814).
In 1997, the de novo classification process was added to the Federal Food, Drug, and Cosmetic Act (FDCA) by the Food and Drug Administration Modernization Act of 1997. The de novo process was later amended by the Food and Drug Administration Safety and Innovation Act and the 21st Century Cures Act. Yet, all this time, this process lacked implementing regulations governing the process and the criteria for approval. The regulatory uncertainty has ill‑befitted a very important pathway to market for novel medical devices.
The rule became final on October 5, 2021 via publication in the Federal Register. The new rule will be codified in 21 C.F.R. Part 860. It was published approximately three years after the December 7, 2018 release of the proposed rule (see blog post on the proposed rule here). The de novo rule is structurally similar to the 510(k) regulations (21 C.F.R. Part 807, Subpart E) and the PMA regulations (21 C.F.R. Part 814), and consistent with existing guidance documents on de novo request content and review:
- De Novo Classification Process (Evaluation of Automatic Class III Designation)
- FDA and Industry Actions on De Novo Classification Requests: Effect on FDA Review Clock and Goals
- Acceptance Review for De Novo Classification Requests
As discussed in detail in our post on the proposed rule, there are certain features of the de novo regulations that will increase the burden on de novo requesters, and may exceed FDA’s statutory authority.
The final rule is largely unchanged from the proposed rule. Perhaps the most controversial provision in the de novo rule is the inspectional authority FDA grants itself: “[the Agency] may inspect relevant facilities to help determine” (1) that both nonclinical and clinical data were collected in a manner that ensures the data accurately represents device benefits and risks, and (2) that implementation of the Quality System Regulation (QSR), along with general and special controls, provide adequate assurance of safety and effectiveness.
In our post on the proposed rule, we pointed out that with certain 510(k)s and generally all PMAs, the FDCA affirmatively grants pre‑approval inspection authority. Specifically, for 510(k)s, QSR inspections are prohibited unless FDA finds that “there is a substantial likelihood that the failure to comply with such regulations will potentially present a serious risk to human health.” FDCA § 513(f)(5). In the PMA context, the statute permits FDA to withhold approval if manufacturing facilities do not conform to QSR requirements. Id. § 515(d)(2)(C). In contrast, the FDCA is silent regarding pre-classification inspections for de novo requests. Some commenters, including AdvaMed, noted this apparent lack of inspectional statutory authority when it comes to de novo classification.
In the preamble, FDA insists that the inspectional authority claimed in the final rule is narrowly drawn and will not be much used. FDA says inspections may be necessary if a device has “critical and/or novel manufacturing processes that may impact the safety and effectiveness of the device.” 86 Fed. Reg. 54,826, 54,832 (Oct. 5, 2021). FDA clarifies that, unlike pre-approval inspections conducted during a PMA review, the purpose of an inspection of a manufacturing facility for a de novo review is “not for the purpose of reviewing for compliance with the QSR.” Id. Rather, it is to “determine whether the proposed special controls are sufficient to reasonably assure safety and effectiveness or if additional controls are needed under section 513(f)(2)” of the FDCA. Id. FDA forecasts that the circumstances where an inspection is necessary “should arise with a small percentage of De Novo requests.” Id.
As to nonclinical and clinical testing facilities, FDA asserts authority to inspect comes from section 513(a)(1)(C), which defines Class III devices and subjects them to premarket approval under section 515. FDA states that such inspections are necessary in order to “ensure the data accurately represents the risks and benefits of the device.” Id.
It remains to be seen whether FDA will be successful in justifying the new inspectional authority. As discussed in our blog post on the proposed rule, the statutory provision that authorizes classification proceedings (FDCA § 513) does not authorize manufacturing inspections, except for a limited exception in the 510(k) context. Since a de novo review is at bottom the promulgation of a new classification regulation under authority of § 513, it seems a stretch to say that it authorizes FDA to undertake inspections in connection with such classification proceedings. As to the testing facility inspections, without more explanation than was provided in the preamble, it is not clear how section 513(a)(1)(C) provides authority.
On the timing of de novo reviews, both the proposed and final rule state that FDA will grant or deny a de novo classification request within 120 days after receipt, with the exception of a pause in FDA’s review clock for up to 180 days while a requester responds to deficiencies identified by FDA. The 120-day deadline is already in the statute, so FDA had no choice but to adopt this deadline in the final rule.
Of course, despite the statutory deadline, pursuant to the MDUFA IV commitment letter, FDA currently has a goal to review 70% of de novo requests received in FY 2022 within 150 days. The final rule theoretically shaves the current review timeline down by 30 days, and it applies to all de novo requests (not just 70% of requests).
It will be interesting to see if and how FDA will be able to meet the new, shorter timeline. It is possible that this shortened timeline will motivate FDA to be selective in its decisions to conduct pre‑classification inspections. Alternatively, perhaps FDA will simply fail to meet the timeline or will continue to make to agreements with Congress that override both the statutory and regulatory timeline.
The final rule requires, among other things, that the requestor submit a copy of representative advertisements for the device. FDA disagreed with a comment that advertisements are outside the scope of a Class I and Class II device review, stating that “such information is necessary to determine the device’s intended use and its safety and effectiveness for the purposes of classification.” 86 Fed. Reg. at 54,839. FDA does not have authority over the advertising of Class I and II devices (which was given to the Federal Trade Commission), so the Agency justifies this request based on its authority to consider intended use when determining safety and effectiveness. 21 C.F.R. § 860.7(b)(2).
The final rule becomes operative on January 3, 2022. As FDA begins to implement these provisions, we will be particularly interested in seeing how frequently FDA chooses to conduct pre‑classification inspections and whether they keep such inspections within the narrow scope described in the preamble.