Medical Devices; Exemptions From Premarket Notification: Class II Devices, 25910-25915 [2018-11879]
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25910
Federal Register / Vol. 83, No. 108 / Tuesday, June 5, 2018 / Rules and Regulations
number of small entities under the
criteria of the Regulatory Flexibility Act.
List of Subjects in 14 CFR Part 97
Air traffic control, Airports,
Incorporation by reference, Navigation
(air).
Issued in Washington, DC, on May 18,
2018.
John S. Duncan,
Executive Director, Flight Standards Service.
Adoption of the Amendment
Accordingly, pursuant to the
authority delegated to me, Title 14,
Code of Federal Regulations, part 97 (14
CFR part 97) is amended by
establishing, amending, suspending, or
removing Standard Instrument
Approach Procedures and/or Takeoff
Minimums and Obstacle Departure
Procedures effective at 0901 UTC on the
dates specified, as follows:
PART 97—STANDARD INSTRUMENT
APPROACH PROCEDURES
1. The authority citation for part 97
continues to read as follows:
■
Authority: 49 U.S.C. 106(f), 106(g), 40103,
40106, 40113, 40114, 40120, 44502, 44514,
44701, 44719, 44721–44722.
2. Part 97 is amended to read as
follows:
■
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Effective 21 June 2018
Fort Madison, IA, Fort Madison Muni, RNAV
(GPS) RWY 17, Amdt 1A
Big Rapids, MI, Roben-Hood, Takeoff
Minimums and Obstacle DP, Amdt 6A
Detroit, MI, Detroit Metropolitan Wayne
County, ILS OR LOC RWY 22L, ILS RWY
22L SA CAT I, Amdt 32A
Detroit, MI, Detroit Metropolitan Wayne
County, RNAV (RNP) W RWY 22R, OrigA
Detroit, MI, Detroit Metropolitan Wayne
County, RNAV (RNP) X RWY 3R, Orig-A
Detroit, MI, Detroit Metropolitan Wayne
County, RNAV (RNP) X RWY 21L, Orig-A
St Paul, MN, St Paul Downtown Holman Fld,
ILS OR LOC RWY 32, Amdt 6A
Omaha, NE, Eppley Airfield, RNAV (GPS) Y
RWY 18, Amdt 4A
Saranac Lake, NY, Adirondack Rgnl, Takeoff
Minimums and Obstacle DP, Amdt 8
Cleveland, OH, Cleveland-Hopkins Intl,
RNAV (GPS) Y RWY 6L, Amdt 2A
Ottawa, OH, Putnam County, VOR RWY 27,
Amdt 2C
Effective 19 July 2018
Manley Hot Springs, AK, Manley Hot
Springs, RNAV (GPS) RWY 18, Orig
Manley Hot Springs, AK, Manley Hot
Springs, RNAV (GPS) RWY 36, Orig
Manley Hot Springs, AK, Manley Hot
Springs, Takeoff Minimums and Obstacle
DP, Orig
Fayetteville/Springdale/Rogers, AR,
Northwest Arkansas Rgnl, ILS OR LOC
RWY 34, Amdt 4
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Auburn, CA, Auburn Muni, RNAV (GPS)
RWY 7, Orig-B
Long Beach, CA, Long Beach/Daugherty
Field/, ILS OR LOC RWY 30, Amdt 34
Long Beach, CA, Long Beach/Daugherty
Field/, RNAV (RNP) RWY 26R, Amdt 1A
Long Beach, CA, Long Beach/Daugherty
Field/, Takeoff Minimums and Obstacle
DP, Amdt 6A
Long Beach, CA, Long Beach/Daugherty
Field/, VOR OR TACAN RWY 30, Amdt 9
Oakland, CA, Metropolitan Oakland Intl,
RNAV (RNP) Z RWY 12, Amdt 2
Palm Springs, CA, Jacqueline Cochran Rgnl,
RNAV (GPS) RWY 30, Amdt 1
Palm Springs, CA, Jacqueline Cochran Rgnl,
VOR RWY 30, Amdt 2
Palm Springs, CA, Jacqueline Cochran Rgnl,
VOR–A, Amdt 1
Panama City, FL, Northwest Florida Beaches
Intl, ILS OR LOC RWY 16, ILS RWY 16 SA
CAT I, ILS RWY 16 SA CAT II, Amdt 3
Douglas, GA, Douglas Muni, ILS OR LOC
RWY 4, Amdt 2C
Kahului, HI, Kahului, ILS OR LOC RWY 2,
Amdt 25A
Springfield, IL, Abraham Lincoln Capital,
VOR RWY 4, Orig-C
Sterling/Rockfalls, IL, Whiteside Co Arpt-Jos
H Bittorf Fld, ILS OR LOC RWY 25, Amdt
11
Sterling/Rockfalls, IL, Whiteside Co Arpt-Jos
H Bittorf Fld, LOC BC RWY 7, Amdt 6
Sterling/Rockfalls, IL, Whiteside Co Arpt-Jos
H Bittorf Fld, NDB RWY 7, Amdt 6,
CANCELED
Sterling/Rockfalls, IL, Whiteside Co Arpt-Jos
H Bittorf Fld, RNAV (GPS) RWY 7, Amdt
1
Sterling/Rockfalls, IL, Whiteside Co Arpt-Jos
H Bittorf Fld, RNAV (GPS) RWY 25, Amdt
1
Howell, MI, Livingston County Spencer J
Hardy, RNAV (GPS) RWY 31, Amdt 1B
Howell, MI, Livingston County Spencer J
Hardy, VOR RWY 31, Amdt 11A,
CANCELED
Menominee, MI, Menominee Rgnl, ILS OR
LOC RWY 3, Amdt 3
Menominee, MI, Menominee Rgnl, RNAV
(GPS) RWY 3, Orig-A
Menominee, MI, Menominee Rgnl, RNAV
(GPS) RWY 21, Orig-C
Menominee, MI, Menominee Rgnl, RNAV
(GPS) RWY 32, Amdt 1C
Menominee, MI, Menominee Rgnl, Takeoff
Minimums and Obstacle DP, Amdt 3A
Menominee, MI, Menominee Rgnl, VOR–A,
Amdt 3C
Cabool, MO, Cabool Memorial, RNAV (GPS)
RWY 21, Orig-B
Cabool, MO, Cabool Memorial, VOR/DME
RWY 21, Amdt 2A, CANCELED
Ithaca, NY, Ithaca Tompkins Rgnl, ILS OR
LOC RWY 32, Amdt 7
Ithaca, NY, Ithaca Tompkins Rgnl, RNAV
(GPS) RWY 32, Orig-B
Ithaca, NY, Ithaca Tompkins Rgnl, VOR RWY
14, Amdt 14A, CANCELED
Ogdensburg, NY, Ogdensburg Intl, RNAV
(GPS) RWY 9, Amdt 1
Watertown, NY, Watertown Intl, Takeoff
Minimums and Obstacle DP, Amdt 3
Tiffin, OH, Seneca County, NDB RWY 24,
Amdt 7D
Tiffin, OH, Seneca County, RNAV (GPS)
RWY 6, Orig-B
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Tiffin, OH, Seneca County, RNAV (GPS)
RWY 24, Amdt 1C
Tiffin, OH, Seneca County, VOR RWY 6,
Amdt 9B
Anderson, SC, Anderson Rgnl, RNAV (GPS)
RWY 23, Amdt 2
Weslaco, TX, Mid Valley, RNAV (GPS) RWY
14, Orig-A
Weslaco, TX, Mid Valley, VOR–A, Orig-B
Eastsound, WA, Orcas Island, RNAV (GPS)
RWY 16, Amdt 2
Port Angeles, WA, William R Fairchild Intl,
ILS OR LOC RWY 8, Amdt 3A
Port Angeles, WA, William R Fairchild Intl,
RNAV (GPS) RWY 8, Amdt 1A
Port Angeles, WA, William R Fairchild Intl,
RNAV (GPS) RWY 26, Amdt 1B
Port Angeles, WA, William R Fairchild Intl,
Takeoff Minimums and Obstacle DP, Amdt
3A
Port Angeles, WA, William R Fairchild Intl,
WATTR SEVEN, Graphic DP
New Holstein, WI, New Holstein Muni,
RNAV (GPS) RWY 14, Orig-B
[FR Doc. 2018–11836 Filed 6–4–18; 8:45 am]
BILLING CODE 4910–13–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
21 CFR Parts 862, 866, 876, 880, and
884
[Docket No. FDA–2017–N–1129]
Medical Devices; Exemptions From
Premarket Notification: Class II
Devices
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Final order.
The Food and Drug
Administration (FDA or the Agency) is
publishing an order to exempt a list of
class II devices from premarket
notification (510(k)) requirements,
subject to certain limitations. This
exemption from 510(k), subject to
certain limitations, is immediately in
effect for the listed class II devices. This
exemption will decrease regulatory
burdens on the medical device industry
and will eliminate private costs and
expenditures required to comply with
certain Federal regulations. FDA is also
amending the codified language for the
listed class II devices to reflect this final
determination. FDA is publishing this
order in accordance with the section of
the Federal Food, Drug, and Cosmetic
Act (FD&C Act) permitting the
exemption of a device from the
requirement to submit a 510(k).
DATES: This order is effective June 5,
2018.
FOR FURTHER INFORMATION CONTACT:
Scott McFarland, Center for Devices and
SUMMARY:
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Radiological Health (CDRH), Food and
Drug Administration, 10903 New
Hampshire Ave, Bldg. 66, Rm. 4676,
Silver Spring, MD 20993–0002, 301–
796–6217.
SUPPLEMENTARY INFORMATION:
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I. Statutory Background
Section 510(k) of the FD&C Act (21
U.S.C. 360(k)) and the implementing
regulations, 21 CFR part 807, subpart E,
require persons who intend to market a
new device to submit and obtain
clearance of a premarket notification
(510(k)) containing information that
allows FDA to determine whether the
new device is ‘‘substantially equivalent’’
within the meaning of section 513(i) of
the FD&C Act (21 U.S.C. 360c(i)) to a
legally marketed device that does not
require premarket approval.
On December 13, 2016, the 21st
Century Cures Act (Cures Act) (Pub. L.
114–255) was signed into law. Section
3054 of the Cures Act amended section
510(m) of the FD&C Act. As amended,
section 510(m)(2) provides that, 1
calendar day after the date of
publication of the final list under
section 510(1)(B), FDA may exempt a
class II device from the requirement to
submit a report under section 510(k) of
the FD&C Act, upon its own initiative or
a petition of an interested person, if
FDA determines that a 510(k) is not
necessary to provide reasonable
assurance of the safety and effectiveness
of the device. This section requires FDA
to publish in the Federal Register a
notice of intent to exempt a device, or
of the petition, and provide a 60calendar-day comment period. Within
120 days of publication of such notice,
FDA shall publish an order in the
Federal Register that sets forth its final
determination regarding the exemption
of the device that was the subject of the
notice.
II. Criteria for Exemption
There are a number of factors FDA
may consider to determine whether a
510(k) is necessary to provide
reasonable assurance of the safety and
effectiveness of a class II device. These
factors are discussed in the January 21,
1998, Federal Register notice (63 FR
3142) and subsequently in the guidance
the Agency issued on February 19, 1998,
entitled ‘‘Procedures for Class II Device
Exemptions from Premarket
Notification, Guidance for Industry and
CDRH Staff’’ (‘‘Class II 510(k)
Exemption Guidance’’). That guidance
can be obtained through the internet at
https://www.fda.gov/downloads/
MedicalDevices/
DeviceRegulationandGuidance/
GuidanceDocuments/UCM080199.pdf
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or by sending an email request to CDRHGuidance@fda.hhs.gov to receive a copy
of the document. Please use the
document number 159 to identify the
guidance you are requesting.
Accordingly, FDA generally considers
the following factors to determine
whether premarket notification is
necessary for class II devices: (1) The
device does not have a significant
history of false or misleading claims or
of risks associated with inherent
characteristics of the device; (2)
characteristics of the device necessary
for its safe and effective performance are
well established; (3) changes in the
device that could affect safety and
effectiveness will either (a) be readily
detectable by users by visual
examination or other means such as
routine testing, before causing harm, or
(b) not materially increase the risk of
injury, incorrect diagnosis, or ineffective
treatment; and (4) any changes to the
device would not be likely to result in
a change in the device’s classification.
FDA may also consider that, even when
exempting devices, these devices would
still be subject to the limitations on
exemptions.
III. Comments on the Proposed
Exemption and FDA Response
In the Federal Register of November
7, 2017 (82 FR 51633), FDA published
a notice (‘‘November 2017 notice’’)
announcing its intent to exempt, upon
its own initiative, certain class II
devices listed in table 1 from 510(k)
requirements, subject to certain
limitations, and provided opportunity
for interested persons to submit
comments by January 8, 2018. After
reviewing comments received, FDA is
now providing its final determination
on exempting the certain class II devices
listed in table 1 from 510(k)
requirements, subject to certain
limitations as identified in this order.
FDA is also amending the codified
language for the classification
regulations for the certain class II
devices listed in table 1 to reflect this
final determination. Persons with
pending 510(k) submissions for devices
that are now exempt from 510(k),
subject to the limitations, should
withdraw their submissions.
In response to the November 2017
notice announcing FDA’s intent to
exempt those device types from 510(k)
requirements, FDA received a
submission from one commenter—a
professional organization—opposing an
exemption from 510(k) for the genetic
health risk assessment test device type.
To make it easier to identify
comments and our responses, the word
‘‘Comment’’ appears in parentheses
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25911
before the comment’s description, and
the word ‘‘Response’’ in parentheses
precedes the response. Specific issues
raised by the comment and the Agency’s
response follows.
(Comment) The commenter
recommended FDA not exempt onetime FDA reviewed genetic health risk
assessment system devices from the
510(k) requirement because there would
be insufficient oversight to ensure the
analytical and clinical validity of these
tests, consumers would be misled
regarding which tests FDA has affirmed
are scientifically valid, and concerns
that, if one-time FDA reviewed genetic
health risk assessment system devices
were exempted, consumers would not
be assured of being adequately informed
about test quality. The commenter
believed it is not possible to assess the
analytical and clinical validity of all
genetic health risks a company might
offer by conducting a one-time review of
its ‘assessment system’, as proposed by
FDA. Such oversight, it is argued, will
only allow FDA to assess the analytical
and clinical validity, and ‘mitigate the
risks of false negatives and positives’,
for tests initially proposed by the
company during this one-time review.
The commenter believed that it does not
appear that there will be assessment of
the analytical or clinical validity of
subsequent tests offered, nor any
assessment of the risks to the consumer
of an incorrect result. This commenter
believed that FDA’s proposal to exempt
one-time FDA reviewed genetic health
risk assessment system devices will not
prevent scientifically invalid tests from
being marketed to the public and lacks
a comprehensive assessment. Further,
the commenter argued that, after
undergoing the one-time FDA review for
genetic health risk assessment tests,
companies would be able to market
subsequent tests to the public as part of
the same system and declare that the
tests meet FDA’s standards. Such tests
would not be held to any specific
standards of analytical or clinical
validity. The public would likely
assume (and purveyors would likely
advertise) that FDA had reviewed and
approved such tests as valid even
though they had not been reviewed by
the Agency. The commenter also argued
that there is a vast range of quality (i.e.,
scientific merit) of direct-to-consumer
(DTC) genetic health risk assessment
tests on the market. The commenter
argued that the market’s current mixing
of entertainment tests, which make
claims unsubstantiated by the scientific
literature, with those tests which have a
clinical utility, are clinically valid, and
can be supported by current scientific
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literature, is particularly confusing for
the average consumer.
(Response) We agree that the concerns
raised above are important. These
concerns were considered during our
review and development of the initial
classification regulation for genetic
health risk assessment system devices
and in our consideration of whether to
exempt one-time FDA reviewed genetic
health risk assessment system devices
from the 510(k) requirement. We believe
these concerns have been addressed and
accounted for in our determination that
the 510(k) requirement is not necessary
to provide a reasonable assurance of
safety and effectiveness for these
devices. We outline our rationale below.
Consumer understanding of genetic
risk is clearly an important issue that
was considered extensively by FDA in
the context of genetic health risk
assessment system devices. This issue
was balanced with the increasing desire
from the public to learn more about
one’s own genetic makeup and how it
affects genetic risk for health conditions.
To ensure that the tests and test reports
are presented to the lay consumer in a
manner that is understandable, we
employed several requirements.
Consumer understanding of the tests
and associated test reports is assured by
user comprehension study
requirements, specific labeling
requirements for these over-the-counter
(OTC) tests, and general requirements
for devices. The special labeling
requirements for these devices under
§ 866.5950(b) (21 CFR 866.5950(b))
include providing information on the
manufacturer’s website about frequently
asked questions, available professional
guidelines, and how to obtain access to
a genetic counselor.
A. User Comprehension Study
A user comprehension study is
required under § 866.5950(b)(3)(iii)(M).
The required user comprehension study
must assess comprehension of the test
process and results by potential users of
the test with pre- and post-test user
comprehension studies. This study must
be conducted on a statistically sufficient
sample size of non-trained individuals
who represent the demographics of the
United States as well as a diverse range
of age and educational levels. The study
must include directly evaluating a
representative sample of the material
being presented to the user during use
of the test. The test that is given to the
participants must be informed by a
physician and/or genetic counselor that
identifies the appropriate general and
variant-specific concepts contained
within the material being tested in the
user comprehension study to ensure
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that all relevant concepts are
incorporated in the study as well as
having included the definition of the
target condition being tested and related
symptoms, explain the intended use and
limitations of the test, explain the
relevant ethnicities in regard to the
variant tested, explain genetic health
risks and relevance to the user’s
ethnicity, and assess participants’
ability to understand the following
comprehension concepts: The test’s
limitations, purpose, appropriate action,
test results, and other factors that may
have an impact on the test results. The
outcome of this study has to meet
rigorous standards, including meeting
predefined primary endpoint criteria,
including a minimum of a 90 percent or
greater overall comprehension rate (i.e.,
selection of the correct answer) for each
comprehension concept. In addition, the
testing must follow a format where users
have limited time to complete the
studies (such as an onsite survey format
and a one-time visit with a cap on the
maximum amount of time that a
participant has to complete the tests).
From our experience with user
comprehension studies, the Agency
believes that meeting or exceeding these
user comprehension study requirements
ensures that the materials presented to
the user are adequate for OTC use. The
information the test provider must
provide on its website includes a
summary table of comprehension rates
regarding comprehension concepts (e.g.,
purpose of test, test results, test
limitations, ethnicity relevance for the
test results, etc.) for each study report.
B. Frequently Asked Questions
The manufacturer’s website must
have a frequently asked questions
section in the summary and technical
information sections under
§ 866.5950(b)(3)(ii)(C)(3) and
(b)(3)(iii)(L)(3). For the frequently asked
questions sections, information must be
included that is specific for each
variant/disease pair that is reported and
scientifically valid and supported by
corresponding publications. Further
information must be included that
explains the health condition/disease
being tested, the purpose of the test, the
information the test will and will not
provide, the relevance of race and
ethnicity on the test results, information
about the population to which the
variants in the test is most applicable,
the meaning of the result(s), other risks
factors that contribute to disease,
appropriate followup procedures, how
the results of the test may affect the
user’s family, including children, and
links to resources that provide
additional information.
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C. Resources
Likely the test labeling information
provided by the test manufacturer will
not be the sole source of information
that the consumer is seeking or even
requires. For this reason, there are
requirements under
§ 866.5950(b)(3)(ii)(C)(2) and
(b)(3)(iii)(L)(2) that the manufacturer of
the test provide a pre-purchase page in
the summary and technical information
sections that includes information
regarding professional guidelines for
testing specific genes and variants.
Similar information must be provided in
the frequently asked questions section
found in the summary and technical
information sections on the
manufacturer’s website, under
§ 866.5950(b)(3)(ii)(C)(3) and
(b)(3)(iii)(L)(3). These frequently asked
questions sections must include a
statement about the current professional
guidelines for testing these specific
gene(s) and variant(s) and, if guidelines
do not exist for certain genes or variants
being tested for, then this information
must be provided as well. Further, to
facilitate more personalized support,
under § 866.5950(b)(1)(i)(E), test
manufacturers are required to provide
information in the § 809.10 (21 CFR
809.10) compliant labeling and any prepurchase page and test report generated
regarding how a user obtains access to
a genetic counselor, board-certified
clinical molecular geneticist, or
equivalent healthcare professional
regarding the results of a user’s test.
D. Genetic Health Risk Assessment
System Tests
The tests that fall under the genetic
health risk assessment system regulation
are identified in the regulation in
§ 866.5950(a) as a qualitative in vitro
molecular diagnostic system used for
detecting variants in genomic
deoxyribonucleic acid (DNA) isolated
from human specimens that will
provide information to users about their
genetic risk of developing a disease to
inform lifestyle choices and/or
conversations with a healthcare
professional. This assessment system is
for OTC use. This device does not
determine the person’s overall risk of
developing a disease.
The limitations that are most
important for lay users to know about
the intended use of these tests that fall
under this device type are conveyed via
the limiting statements required, under
§ 866.5950(b)(1)(i), to be provided on
the § 809.10 compliant labeling and any
pre-purchase page and test report
generated. One of these limiting
statements must explain that this test is
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not intended to diagnose a disease, tell
you anything about your current state of
health, or be used to make medical
decisions, including whether or not you
should take a medication or how much
of a medication you should take. The
limitations that are most important for
healthcare professionals to know about
the intended use of tests that fall under
this device type are, under
§ 866.5950(b)(1)(ii), required to be
provided in the § 809.10 labeling and
any test report generated. These
limitations include that the test is
intended to provide users with their
genetic information to inform lifestyle
decisions and conversations with their
doctor or other healthcare professional
and that any diagnostic or treatment
decisions should be based on testing
and/or other information that a
healthcare professional determines to be
appropriate for a patient.
E. Rigorous Validation Requirements
FDA believes the analytical validation
requirements are sufficiently detailed in
the special controls under
§ 866.5950(b)(3)(iii)(J) that test providers
will have no difficulty in appropriately
following these requirements. A high
accuracy requirement is necessary for
tests that are provided under this
regulation and accuracy point estimates
for all variants is required to be 99
percent or higher under
§ 866.5950(b)(3)(iii)(J)(1)(vii) or else they
cannot be claimed or reported. Once
FDA has reviewed one test that
demonstrates this level of accuracy,
then the test provider has demonstrated
an ability to meet the accuracy
requirements for additional similar tests
offered.
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F. Four Important Limitations on the
Scope of the Classification Regulation
FDA agrees that there are four
important express limitations to the
types of tests that can be offered under
this classification regulation even when
these special controls are met. Tests
cannot be offered under this
classification regulation that are
indicated for prenatal testing;
predisposition for cancer where the
result of the test may lead to
prophylactic screening, confirmatory
procedures, or treatments that may
incur morbidity or mortality to the
patient; assessing the presence of
genetic variants that impact the
metabolism, exposure, response, risk of
adverse events, dosing, or mechanisms
of prescription or OTC medications; or
assessing the presence of deterministic
autosomal dominant variants.
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G. False or Misleading Claims
It is a prohibited act for devices to
have labeling that is false or misleading
in any particular manner, and thus FDA
would deem such device to be
misbranded under section 502(a) of the
FD&C Act (21 U.S.C. 352(a)). This
prohibition would include prohibiting
the manufacturer of a genetic health risk
assessment test device from falsely or
misleadingly representing a test as
having been part of an original FDA
cleared device when it was added
subsequently to FDA clearance. This
prohibition would also include falsely
or misleadingly representing the
analytical or clinical validity of one of
its tests. In addition, under section
502(c) of the FD&C Act, it is a
prohibited act and thus FDA would
deem a device to be misbranded if any
information required on the labeling of
a device by FDA by or under the FD&C
Act is not placed prominently thereon
with such conspicuousness and in such
terms, as to render it likely to be read
and understood by the ordinary
individual under customary conditions
of purchase and use. Thus, a genetic
health risk assessment test device for
which a manufacturer later modified the
formerly compliant labeling to make the
labeling such that the labeling was not
likely to be read and understood by the
ordinary individual under customary
conditions of purchase and use would
be a misbranded device.
H. Conclusion
In summary, all tests that are
marketed under this classification
regulation must meet the general
controls and the special controls that are
specified in the regulation. Ability of a
manufacturer to meet these special
controls is demonstrated during the onetime review. Even after the one-time
review, the general controls and special
controls must continue to be met,
including for all tests added or modified
after the one-time review of a
manufacturer’s device.
IV. Limitations on Exemptions
FDA has determined that 510(k) is not
necessary to assure the safety and
effectiveness of the class II devices
listed in table 1. This determination is
based, in part, on the Agency’s
knowledge of the device, including past
experience and relevant reports or
studies on device performance (as
appropriate), the applicability of general
and special controls, and the Agency’s
ability to limit an exemption.
A. General Limitations of Exemptions
FDA’s exemption from 510(k) for class
II devices listed in table 1 applies only
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25913
to those devices that have existing or
reasonably foreseeable characteristics of
commercially distributed devices within
that generic type, or, in the case of in
vitro diagnostic devices, for which a
misdiagnosis, as a result of using the
device, would not be associated with
high morbidity or mortality. A
manufacturer of a listed device is still
required to submit a 510(k) to FDA
before introducing a device or
delivering it for introduction into
commercial distribution when the
device meets any of the conditions
described in §§ 862.9 to 892.9 (21 CFR
862.9 to 21 CFR 892.9).
B. Partial Limitations of Exemptions
In addition to the general limitations,
FDA may also partially limit an
exemption from 510(k) requirements to
specific devices within a listed device
type when initial Agency assessment
determines that the factors laid out in
the Class II 510(k) Exemption Guidance
do not weigh in favor of exemption for
all devices in a particular group. In such
situations where a partial exemption
limitation has been identified, FDA has
determined that premarket notification
is necessary to provide a reasonable
assurance of safety and effectiveness for
these devices. In table 1, for example,
FDA is listing the exemption of the
genetic health risk assessment system,
but limits the exemption to such devices
that have received a first-time FDA
marketing authorization (e.g., 510(k)
clearance) for the genetic health risk
assessment system (a ‘‘one-time FDA
reviewed genetic health risk assessment
system’’). FDA has determined that a
one-time FDA review (e.g., premarket
notification) of a genetic health risk
assessment system is necessary to
provide reasonable assurance of the
safety and effectiveness of the device.
FDA has determined that a one-time
FDA review of a genetic health risk
assessment system is necessary to
mitigate the risk of false negatives and
false positives by ensuring that certain
information be submitted to FDA to
allow the Agency to assess the safety
and effectiveness of the devices as well
as to ensure the devices perform to
acceptable standards.
Exemption from the requirement of
510(k) does not exempt a device from
other applicable regulatory controls
under the FD&C Act, including the
applicable general and special controls.
This exemption from 510(k), subject to
the limitations described above, is
immediately in effect for the device
types identified in table 1. This
exemption will decrease regulatory
burdens on the medical device industry
and will eliminate private costs and
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25914
Federal Register / Vol. 83, No. 108 / Tuesday, June 5, 2018 / Rules and Regulations
expenditures required to comply with
Federal regulations.
V. List of Class II Devices
FDA is identifying the following list
of class II devices that will no longer
require premarket notification under
section 510(k) of the FD&C Act, subject
to the general limitations to the
exemptions found in §§ 862.9 to 892.9
and any partial exemption limitations
identified in table 1:
TABLE 1—CLASS II DEVICES
Product
code
21 CFR section
Device type
862.1840 .............
Total 25-hydroxyvitamin D Mass
Spectrometry Test System.
Genetic Health Risk Assessment
System.
PSL
Endoscope Disinfectant Basin .........
Purifier, Water, Ultraviolet, Medical
Vibrator for Therapeutic Use, Genital.
PUP
KMG
KXQ
866.5950 .............
876.1500 .............
880.6710 .............
884.5960 .............
PTA
Partial exemption limitation (if applicable)
Exemption is limited to a genetic health risk assessment system that has
received a first-time FDA marketing authorization (e.g., 510(k) clearance) for the genetic health risk assessment system (a ‘‘one-time FDA
reviewed genetic health risk assessment system’’).
FDA is revising the name of product
code PUP to further clarify the device
type that this product code is intended
to represent. The device type was
previously ‘‘Endoscope Maintenance
System.’’ To more accurately reflect the
devices which fall within this device
type (product code PUP), the device
type has been renamed ‘‘Endoscope
Disinfectant Basin.’’ Specifically, these
devices are described as ‘‘Wall-mounted
tube(s) for holding disinfectant solution
and endoscope insertion tubes and
accessories.’’ This description has not
changed since publication of the
November 2017 notice.
List of Subjects
VI. Analysis of Environmental Impact
PART 862—CLINICAL CHEMISTRY
AND CLINICAL TOXICOLOGY
DEVICES
The Agency has determined under 21
CFR 25.30(h) that this action is of a type
that does not individually or
cumulatively have a significant effect on
the human environment. Therefore,
neither an environmental assessment
nor an environmental impact statement
is required.
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VII. Paperwork Reduction Act of 1995
This final order refers to previously
approved collections of information
found in other FDA regulations and
guidance. These collections of
information are subject to review by the
Office of Management and Budget
(OMB) under the Paperwork Reduction
Act of 1995 (44 U.S.C. 3501–3520). The
collections of information in part 807,
subpart E, regarding premarket
notification submissions, have been
approved under OMB control number
0910–0120; and the collections of
information in 21 CFR parts 801 and
809, regarding labeling, have been
approved under OMB control number
0910–0485.
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4. In § 866.5950, revise paragraph (b)
introductory text to read as follows:
■
21 CFR Part 862
Medical devices.
21 CFR Part 866
Biologics, Laboratories, Medical
devices.
21 CFR Parts 876, 880, and 884
Medical devices.
Therefore, under the Federal Food,
Drug, and Cosmetic Act and under
authority delegated to the Commissioner
of Food and Drugs, 21 CFR parts 862,
866, 876, 880, and 884 are amended as
follows:
1. The authority citation for part 862
continues to read as follows:
■
Authority: 21 U.S.C. 351, 360, 360c, 360e,
360j, 360l, 371.
§ 866.5950
system.
Genetic health risk assessment
*
*
*
*
*
(b) Classification. Class II (special
controls). The genetic health risk
assessment system device, when it has
previously received a first-time FDA
marketing authorization (e.g., 510(k)
clearance) for the genetic health risk
assessment system (a ‘‘one-time FDA
reviewed genetic health risk assessment
system’’), is exempt from the premarket
notification procedures in part 807,
subpart E, of this chapter subject to the
limitations in § 866.9. The device must
comply with the following special
controls:
*
*
*
*
*
PART 876—GASTROENTEROLOGY–
UROLOGY DEVICES
■
2. In § 862.1840, revise paragraph (b)
introductory text to read as follows:
■
§ 862.1840 Total 25-hydroxyvitamin D
mass spectrometry test system.
Authority: 21 U.S.C. 351, 360, 360c, 360e,
360j, 360l, 371.
*
■
*
*
*
*
(b) Classification. Class II (special
controls). The device is exempt from the
premarket notification procedures in
part 807, subpart E, of this chapter
subject to the limitations in § 862.9. The
device must comply with the following
special controls:
*
*
*
*
*
PART 866—IMMUNOLOGY AND
MICROBIOLOGY DEVICES
3. The authority citation for part 866
continues to read as follows:
■
Authority: 21 U.S.C. 351, 360, 360c, 360e,
360j, 360l, 371.
PO 00000
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5. The authority citation for part 876
continues to read as follows:
6. In § 876.1500, revise paragraph
(b)(1) to read as follows:
§ 876.1500
Endoscope and accessories.
*
*
*
*
*
(b) * * *
(1) Class II (performance standards).
The device, when intended as an
endoscope disinfectant basin, which
consists solely of a container that holds
disinfectant and endoscopes and
accessories, is exempt from the
premarket notification procedures in
part 807, subpart E, of this chapter
subject to the limitations in § 876.9.
*
*
*
*
*
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Federal Register / Vol. 83, No. 108 / Tuesday, June 5, 2018 / Rules and Regulations
PART 880—GENERAL HOSPITAL AND
PERSONAL USE DEVICES
7. The authority citation for part 880
continues to read as follows:
■
Authority: 21 U.S.C. 351, 360, 360c, 360e,
360j, 360l, 371.
8. In § 880.6710, revise paragraph (b)
to read as follows:
■
§ 880.6710
purifier.
Medical ultraviolet water
*
*
*
*
*
(b) Classification. Class II
(performance standards). The device is
exempt from the premarket notification
procedures in part 807, subpart E, of
this chapter subject to the limitations in
§ 880.9.
PART 884—OBSTETRICAL AND
GYNECOLOGICAL DEVICES
9. The authority citation for part 884
continues to read as follows:
■
Authority: 21 U.S.C. 351, 360, 360c, 360e,
360j, 360l, 371.
10 In § 884.5960, revise paragraph (b)
to read as follows:
■
§ 884.5960
use.
Genital vibrator for therapeutic
*
*
*
*
*
(b) Classification. Class II
(performance standards). The device is
exempt from the premarket notification
procedures in part 807, subpart E, of
this chapter subject to the limitations in
§ 884.9.
Dated: May 29, 2018.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2018–11879 Filed 6–1–18; 8:45 am]
BILLING CODE 4164–01–P
DEPARTMENT OF VETERANS
AFFAIRS
38 CFR Part 17
RIN 2900–AQ15
Case Management Services Grant
Program
Department of Veterans Affairs.
Interim final rule.
AGENCY:
ACTION:
The Department of Veterans
Affairs (VA) is amending its regulations
that govern programs benefitting
homeless veterans to implement a new
statutory requirement to establish a new
grant program that will provide case
management services to improve the
retention of housing by veterans who
were previously homeless and are
transitioning to permanent housing and
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SUMMARY:
VerDate Sep<11>2014
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to veterans who are at risk of becoming
homeless. The grant program
established by this interim final rule
will be an essential part of VA’s
attempts to eliminate homelessness
among the veteran population.
DATES: This final rule is effective June
5, 2018. Comments must be received on
or before August 6, 2018.
ADDRESSES: Written comments may be
submitted through https://
www.Regulations.gov; by mail or handdelivery to: Director, Regulation Policy
and Management (00REG), Department
of Veterans Affairs, 810 Vermont Ave.
NW, Room 1063B, Washington, DC
20420; or by fax to (202) 273–9026.
(This is not a toll-free telephone
number.) Comments should indicate
that they are submitted in response to
‘‘RIN 2900–AQ15—Case Management
Services Grant Program.’’ Copies of
comments received will be available for
public inspection in the Office of
Regulation Policy and Management,
Room 1063B, between the hours of 8
a.m. and 4:30 p.m., Monday through
Friday (except holidays). Please call
(202) 461–4902 for an appointment.
(This is not a toll-free telephone
number.) In addition, during the
comment period, comments may be
viewed online through the Federal
Docket Management System (FDMS) at
https://www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT:
Jeffery Quarles, Director, Grant and Per
Diem Program, (10NC1HM), VA
National Grant and Per Diem Program
Office, 10770 N 46th Street, Suite C–
200, Tampa, FL 33617, (877) 332–0334.
(This is a toll-free number.)
SUPPLEMENTARY INFORMATION: In an
effort to reduce homelessness in the
veteran population, Congress has
required VA to expand its benefits for
homeless veterans by establishing a new
grant program to provide funds to
organizations within communities that
will provide case management services
to improve the retention of housing by
veterans who were previously homeless
and are transitioning to permanent
housing and to veterans who are at risk
of becoming homeless. See Public Law
114–315, sec. 712 (Dec. 16, 2016)
(codified at 38 U.S.C. 2013). This
interim final rule adds this new case
management program to VA’s Homeless
Providers Grant and Per Diem Program
regulations by adding a new subpart G
to 38 CFR part 61 to accurately reflect
these changes in law. The new case
management program will mirror
existing homeless grant per diem
programs as much as possible for ease
of administrating and running the new
grant program.
PO 00000
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25915
61.90 Grant for Case Management
Services—Program
Paragraph (a) of § 61.90 states that
non-profit organizations and State,
local, and tribal governments are
eligible to apply for a grant to provide
case management services. (For
purposes of this program, the term
‘‘tribal government’’ means an entity
described in paragraph (2) of the
definition of public entity in 38 CFR
61.1.) To ensure that grant funding is
used to provide case management
services to as many veterans as possible,
this same paragraph provides that case
management services grant funds under
this program ‘‘may not be used for
veterans who are receiving case
management services from permanent
supportive housing programs (e.g.
Housing and Urban Development-VA
Supportive Housing) or rapid rehousing/homeless prevention programs
(e.g. Supportive Services for Veterans
Families (SSVF)).’’ Paragraph (b)
identifies examples of case management
services that grantees can provide using
these grant funds. Such services
include, but are not limited to, ‘‘Making
home visits by the case manager to
monitor housing stability; Providing or
coordinating educational activities
related to meal planning, tenant
responsibilities, the use of public
transportation, community resources,
financial management, and the
development of natural supports;
Making referrals to needed services,
such as mental health, substance use
disorder, medical, and employment
services; and Participating in case
conferencing with other service
providers who are working with the
veteran.’’ Paragraph (c) sets a 6-month
time limit for veterans to receive case
management services. However, VA
may approve a request to extend
services beyond the 6-month period if
an organization submits a request to VA
in writing and VA approves it before the
6-month time limit expires. Because in
most circumstances case management
services are provided to veterans after
they have been in receipt of benefits
under the Grant and Per Diem Program,
VA believes that 6 months would, in
most cases, be sufficient time for a
veteran to have the necessary tools in
place to retain permanent housing.
61.92 Grant for Case Management
Services—Application and Rating
Criteria
For ease of administration and
internal consistency between grant
programs benefiting homeless veterans,
VA will, to the extent applicable and
appropriate, adopt standards for the
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Agencies
[Federal Register Volume 83, Number 108 (Tuesday, June 5, 2018)]
[Rules and Regulations]
[Pages 25910-25915]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-11879]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
21 CFR Parts 862, 866, 876, 880, and 884
[Docket No. FDA-2017-N-1129]
Medical Devices; Exemptions From Premarket Notification: Class II
Devices
AGENCY: Food and Drug Administration, HHS.
ACTION: Final order.
-----------------------------------------------------------------------
SUMMARY: The Food and Drug Administration (FDA or the Agency) is
publishing an order to exempt a list of class II devices from premarket
notification (510(k)) requirements, subject to certain limitations.
This exemption from 510(k), subject to certain limitations, is
immediately in effect for the listed class II devices. This exemption
will decrease regulatory burdens on the medical device industry and
will eliminate private costs and expenditures required to comply with
certain Federal regulations. FDA is also amending the codified language
for the listed class II devices to reflect this final determination.
FDA is publishing this order in accordance with the section of the
Federal Food, Drug, and Cosmetic Act (FD&C Act) permitting the
exemption of a device from the requirement to submit a 510(k).
DATES: This order is effective June 5, 2018.
FOR FURTHER INFORMATION CONTACT: Scott McFarland, Center for Devices
and
[[Page 25911]]
Radiological Health (CDRH), Food and Drug Administration, 10903 New
Hampshire Ave, Bldg. 66, Rm. 4676, Silver Spring, MD 20993-0002, 301-
796-6217.
SUPPLEMENTARY INFORMATION:
I. Statutory Background
Section 510(k) of the FD&C Act (21 U.S.C. 360(k)) and the
implementing regulations, 21 CFR part 807, subpart E, require persons
who intend to market a new device to submit and obtain clearance of a
premarket notification (510(k)) containing information that allows FDA
to determine whether the new device is ``substantially equivalent''
within the meaning of section 513(i) of the FD&C Act (21 U.S.C.
360c(i)) to a legally marketed device that does not require premarket
approval.
On December 13, 2016, the 21st Century Cures Act (Cures Act) (Pub.
L. 114-255) was signed into law. Section 3054 of the Cures Act amended
section 510(m) of the FD&C Act. As amended, section 510(m)(2) provides
that, 1 calendar day after the date of publication of the final list
under section 510(1)(B), FDA may exempt a class II device from the
requirement to submit a report under section 510(k) of the FD&C Act,
upon its own initiative or a petition of an interested person, if FDA
determines that a 510(k) is not necessary to provide reasonable
assurance of the safety and effectiveness of the device. This section
requires FDA to publish in the Federal Register a notice of intent to
exempt a device, or of the petition, and provide a 60-calendar-day
comment period. Within 120 days of publication of such notice, FDA
shall publish an order in the Federal Register that sets forth its
final determination regarding the exemption of the device that was the
subject of the notice.
II. Criteria for Exemption
There are a number of factors FDA may consider to determine whether
a 510(k) is necessary to provide reasonable assurance of the safety and
effectiveness of a class II device. These factors are discussed in the
January 21, 1998, Federal Register notice (63 FR 3142) and subsequently
in the guidance the Agency issued on February 19, 1998, entitled
``Procedures for Class II Device Exemptions from Premarket
Notification, Guidance for Industry and CDRH Staff'' (``Class II 510(k)
Exemption Guidance''). That guidance can be obtained through the
internet at https://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM080199.pdf or by
sending an email request to [email protected] to receive a copy
of the document. Please use the document number 159 to identify the
guidance you are requesting.
Accordingly, FDA generally considers the following factors to
determine whether premarket notification is necessary for class II
devices: (1) The device does not have a significant history of false or
misleading claims or of risks associated with inherent characteristics
of the device; (2) characteristics of the device necessary for its safe
and effective performance are well established; (3) changes in the
device that could affect safety and effectiveness will either (a) be
readily detectable by users by visual examination or other means such
as routine testing, before causing harm, or (b) not materially increase
the risk of injury, incorrect diagnosis, or ineffective treatment; and
(4) any changes to the device would not be likely to result in a change
in the device's classification. FDA may also consider that, even when
exempting devices, these devices would still be subject to the
limitations on exemptions.
III. Comments on the Proposed Exemption and FDA Response
In the Federal Register of November 7, 2017 (82 FR 51633), FDA
published a notice (``November 2017 notice'') announcing its intent to
exempt, upon its own initiative, certain class II devices listed in
table 1 from 510(k) requirements, subject to certain limitations, and
provided opportunity for interested persons to submit comments by
January 8, 2018. After reviewing comments received, FDA is now
providing its final determination on exempting the certain class II
devices listed in table 1 from 510(k) requirements, subject to certain
limitations as identified in this order. FDA is also amending the
codified language for the classification regulations for the certain
class II devices listed in table 1 to reflect this final determination.
Persons with pending 510(k) submissions for devices that are now exempt
from 510(k), subject to the limitations, should withdraw their
submissions.
In response to the November 2017 notice announcing FDA's intent to
exempt those device types from 510(k) requirements, FDA received a
submission from one commenter--a professional organization--opposing an
exemption from 510(k) for the genetic health risk assessment test
device type.
To make it easier to identify comments and our responses, the word
``Comment'' appears in parentheses before the comment's description,
and the word ``Response'' in parentheses precedes the response.
Specific issues raised by the comment and the Agency's response
follows.
(Comment) The commenter recommended FDA not exempt one-time FDA
reviewed genetic health risk assessment system devices from the 510(k)
requirement because there would be insufficient oversight to ensure the
analytical and clinical validity of these tests, consumers would be
misled regarding which tests FDA has affirmed are scientifically valid,
and concerns that, if one-time FDA reviewed genetic health risk
assessment system devices were exempted, consumers would not be assured
of being adequately informed about test quality. The commenter believed
it is not possible to assess the analytical and clinical validity of
all genetic health risks a company might offer by conducting a one-time
review of its `assessment system', as proposed by FDA. Such oversight,
it is argued, will only allow FDA to assess the analytical and clinical
validity, and `mitigate the risks of false negatives and positives',
for tests initially proposed by the company during this one-time
review. The commenter believed that it does not appear that there will
be assessment of the analytical or clinical validity of subsequent
tests offered, nor any assessment of the risks to the consumer of an
incorrect result. This commenter believed that FDA's proposal to exempt
one-time FDA reviewed genetic health risk assessment system devices
will not prevent scientifically invalid tests from being marketed to
the public and lacks a comprehensive assessment. Further, the commenter
argued that, after undergoing the one-time FDA review for genetic
health risk assessment tests, companies would be able to market
subsequent tests to the public as part of the same system and declare
that the tests meet FDA's standards. Such tests would not be held to
any specific standards of analytical or clinical validity. The public
would likely assume (and purveyors would likely advertise) that FDA had
reviewed and approved such tests as valid even though they had not been
reviewed by the Agency. The commenter also argued that there is a vast
range of quality (i.e., scientific merit) of direct-to-consumer (DTC)
genetic health risk assessment tests on the market. The commenter
argued that the market's current mixing of entertainment tests, which
make claims unsubstantiated by the scientific literature, with those
tests which have a clinical utility, are clinically valid, and can be
supported by current scientific
[[Page 25912]]
literature, is particularly confusing for the average consumer.
(Response) We agree that the concerns raised above are important.
These concerns were considered during our review and development of the
initial classification regulation for genetic health risk assessment
system devices and in our consideration of whether to exempt one-time
FDA reviewed genetic health risk assessment system devices from the
510(k) requirement. We believe these concerns have been addressed and
accounted for in our determination that the 510(k) requirement is not
necessary to provide a reasonable assurance of safety and effectiveness
for these devices. We outline our rationale below.
Consumer understanding of genetic risk is clearly an important
issue that was considered extensively by FDA in the context of genetic
health risk assessment system devices. This issue was balanced with the
increasing desire from the public to learn more about one's own genetic
makeup and how it affects genetic risk for health conditions. To ensure
that the tests and test reports are presented to the lay consumer in a
manner that is understandable, we employed several requirements.
Consumer understanding of the tests and associated test reports is
assured by user comprehension study requirements, specific labeling
requirements for these over-the-counter (OTC) tests, and general
requirements for devices. The special labeling requirements for these
devices under Sec. 866.5950(b) (21 CFR 866.5950(b)) include providing
information on the manufacturer's website about frequently asked
questions, available professional guidelines, and how to obtain access
to a genetic counselor.
A. User Comprehension Study
A user comprehension study is required under Sec.
866.5950(b)(3)(iii)(M). The required user comprehension study must
assess comprehension of the test process and results by potential users
of the test with pre- and post-test user comprehension studies. This
study must be conducted on a statistically sufficient sample size of
non-trained individuals who represent the demographics of the United
States as well as a diverse range of age and educational levels. The
study must include directly evaluating a representative sample of the
material being presented to the user during use of the test. The test
that is given to the participants must be informed by a physician and/
or genetic counselor that identifies the appropriate general and
variant-specific concepts contained within the material being tested in
the user comprehension study to ensure that all relevant concepts are
incorporated in the study as well as having included the definition of
the target condition being tested and related symptoms, explain the
intended use and limitations of the test, explain the relevant
ethnicities in regard to the variant tested, explain genetic health
risks and relevance to the user's ethnicity, and assess participants'
ability to understand the following comprehension concepts: The test's
limitations, purpose, appropriate action, test results, and other
factors that may have an impact on the test results. The outcome of
this study has to meet rigorous standards, including meeting predefined
primary endpoint criteria, including a minimum of a 90 percent or
greater overall comprehension rate (i.e., selection of the correct
answer) for each comprehension concept. In addition, the testing must
follow a format where users have limited time to complete the studies
(such as an onsite survey format and a one-time visit with a cap on the
maximum amount of time that a participant has to complete the tests).
From our experience with user comprehension studies, the Agency
believes that meeting or exceeding these user comprehension study
requirements ensures that the materials presented to the user are
adequate for OTC use. The information the test provider must provide on
its website includes a summary table of comprehension rates regarding
comprehension concepts (e.g., purpose of test, test results, test
limitations, ethnicity relevance for the test results, etc.) for each
study report.
B. Frequently Asked Questions
The manufacturer's website must have a frequently asked questions
section in the summary and technical information sections under Sec.
866.5950(b)(3)(ii)(C)(3) and (b)(3)(iii)(L)(3). For the frequently
asked questions sections, information must be included that is specific
for each variant/disease pair that is reported and scientifically valid
and supported by corresponding publications. Further information must
be included that explains the health condition/disease being tested,
the purpose of the test, the information the test will and will not
provide, the relevance of race and ethnicity on the test results,
information about the population to which the variants in the test is
most applicable, the meaning of the result(s), other risks factors that
contribute to disease, appropriate followup procedures, how the results
of the test may affect the user's family, including children, and links
to resources that provide additional information.
C. Resources
Likely the test labeling information provided by the test
manufacturer will not be the sole source of information that the
consumer is seeking or even requires. For this reason, there are
requirements under Sec. 866.5950(b)(3)(ii)(C)(2) and (b)(3)(iii)(L)(2)
that the manufacturer of the test provide a pre-purchase page in the
summary and technical information sections that includes information
regarding professional guidelines for testing specific genes and
variants. Similar information must be provided in the frequently asked
questions section found in the summary and technical information
sections on the manufacturer's website, under Sec.
866.5950(b)(3)(ii)(C)(3) and (b)(3)(iii)(L)(3). These frequently asked
questions sections must include a statement about the current
professional guidelines for testing these specific gene(s) and
variant(s) and, if guidelines do not exist for certain genes or
variants being tested for, then this information must be provided as
well. Further, to facilitate more personalized support, under Sec.
866.5950(b)(1)(i)(E), test manufacturers are required to provide
information in the Sec. 809.10 (21 CFR 809.10) compliant labeling and
any pre-purchase page and test report generated regarding how a user
obtains access to a genetic counselor, board-certified clinical
molecular geneticist, or equivalent healthcare professional regarding
the results of a user's test.
D. Genetic Health Risk Assessment System Tests
The tests that fall under the genetic health risk assessment system
regulation are identified in the regulation in Sec. 866.5950(a) as a
qualitative in vitro molecular diagnostic system used for detecting
variants in genomic deoxyribonucleic acid (DNA) isolated from human
specimens that will provide information to users about their genetic
risk of developing a disease to inform lifestyle choices and/or
conversations with a healthcare professional. This assessment system is
for OTC use. This device does not determine the person's overall risk
of developing a disease.
The limitations that are most important for lay users to know about
the intended use of these tests that fall under this device type are
conveyed via the limiting statements required, under Sec.
866.5950(b)(1)(i), to be provided on the Sec. 809.10 compliant
labeling and any pre-purchase page and test report generated. One of
these limiting statements must explain that this test is
[[Page 25913]]
not intended to diagnose a disease, tell you anything about your
current state of health, or be used to make medical decisions,
including whether or not you should take a medication or how much of a
medication you should take. The limitations that are most important for
healthcare professionals to know about the intended use of tests that
fall under this device type are, under Sec. 866.5950(b)(1)(ii),
required to be provided in the Sec. 809.10 labeling and any test
report generated. These limitations include that the test is intended
to provide users with their genetic information to inform lifestyle
decisions and conversations with their doctor or other healthcare
professional and that any diagnostic or treatment decisions should be
based on testing and/or other information that a healthcare
professional determines to be appropriate for a patient.
E. Rigorous Validation Requirements
FDA believes the analytical validation requirements are
sufficiently detailed in the special controls under Sec.
866.5950(b)(3)(iii)(J) that test providers will have no difficulty in
appropriately following these requirements. A high accuracy requirement
is necessary for tests that are provided under this regulation and
accuracy point estimates for all variants is required to be 99 percent
or higher under Sec. 866.5950(b)(3)(iii)(J)(1)(vii) or else they
cannot be claimed or reported. Once FDA has reviewed one test that
demonstrates this level of accuracy, then the test provider has
demonstrated an ability to meet the accuracy requirements for
additional similar tests offered.
F. Four Important Limitations on the Scope of the Classification
Regulation
FDA agrees that there are four important express limitations to the
types of tests that can be offered under this classification regulation
even when these special controls are met. Tests cannot be offered under
this classification regulation that are indicated for prenatal testing;
predisposition for cancer where the result of the test may lead to
prophylactic screening, confirmatory procedures, or treatments that may
incur morbidity or mortality to the patient; assessing the presence of
genetic variants that impact the metabolism, exposure, response, risk
of adverse events, dosing, or mechanisms of prescription or OTC
medications; or assessing the presence of deterministic autosomal
dominant variants.
G. False or Misleading Claims
It is a prohibited act for devices to have labeling that is false
or misleading in any particular manner, and thus FDA would deem such
device to be misbranded under section 502(a) of the FD&C Act (21 U.S.C.
352(a)). This prohibition would include prohibiting the manufacturer of
a genetic health risk assessment test device from falsely or
misleadingly representing a test as having been part of an original FDA
cleared device when it was added subsequently to FDA clearance. This
prohibition would also include falsely or misleadingly representing the
analytical or clinical validity of one of its tests. In addition, under
section 502(c) of the FD&C Act, it is a prohibited act and thus FDA
would deem a device to be misbranded if any information required on the
labeling of a device by FDA by or under the FD&C Act is not placed
prominently thereon with such conspicuousness and in such terms, as to
render it likely to be read and understood by the ordinary individual
under customary conditions of purchase and use. Thus, a genetic health
risk assessment test device for which a manufacturer later modified the
formerly compliant labeling to make the labeling such that the labeling
was not likely to be read and understood by the ordinary individual
under customary conditions of purchase and use would be a misbranded
device.
H. Conclusion
In summary, all tests that are marketed under this classification
regulation must meet the general controls and the special controls that
are specified in the regulation. Ability of a manufacturer to meet
these special controls is demonstrated during the one-time review. Even
after the one-time review, the general controls and special controls
must continue to be met, including for all tests added or modified
after the one-time review of a manufacturer's device.
IV. Limitations on Exemptions
FDA has determined that 510(k) is not necessary to assure the
safety and effectiveness of the class II devices listed in table 1.
This determination is based, in part, on the Agency's knowledge of the
device, including past experience and relevant reports or studies on
device performance (as appropriate), the applicability of general and
special controls, and the Agency's ability to limit an exemption.
A. General Limitations of Exemptions
FDA's exemption from 510(k) for class II devices listed in table 1
applies only to those devices that have existing or reasonably
foreseeable characteristics of commercially distributed devices within
that generic type, or, in the case of in vitro diagnostic devices, for
which a misdiagnosis, as a result of using the device, would not be
associated with high morbidity or mortality. A manufacturer of a listed
device is still required to submit a 510(k) to FDA before introducing a
device or delivering it for introduction into commercial distribution
when the device meets any of the conditions described in Sec. Sec.
862.9 to 892.9 (21 CFR 862.9 to 21 CFR 892.9).
B. Partial Limitations of Exemptions
In addition to the general limitations, FDA may also partially
limit an exemption from 510(k) requirements to specific devices within
a listed device type when initial Agency assessment determines that the
factors laid out in the Class II 510(k) Exemption Guidance do not weigh
in favor of exemption for all devices in a particular group. In such
situations where a partial exemption limitation has been identified,
FDA has determined that premarket notification is necessary to provide
a reasonable assurance of safety and effectiveness for these devices.
In table 1, for example, FDA is listing the exemption of the genetic
health risk assessment system, but limits the exemption to such devices
that have received a first-time FDA marketing authorization (e.g.,
510(k) clearance) for the genetic health risk assessment system (a
``one-time FDA reviewed genetic health risk assessment system''). FDA
has determined that a one-time FDA review (e.g., premarket
notification) of a genetic health risk assessment system is necessary
to provide reasonable assurance of the safety and effectiveness of the
device. FDA has determined that a one-time FDA review of a genetic
health risk assessment system is necessary to mitigate the risk of
false negatives and false positives by ensuring that certain
information be submitted to FDA to allow the Agency to assess the
safety and effectiveness of the devices as well as to ensure the
devices perform to acceptable standards.
Exemption from the requirement of 510(k) does not exempt a device
from other applicable regulatory controls under the FD&C Act, including
the applicable general and special controls. This exemption from
510(k), subject to the limitations described above, is immediately in
effect for the device types identified in table 1. This exemption will
decrease regulatory burdens on the medical device industry and will
eliminate private costs and
[[Page 25914]]
expenditures required to comply with Federal regulations.
V. List of Class II Devices
FDA is identifying the following list of class II devices that will
no longer require premarket notification under section 510(k) of the
FD&C Act, subject to the general limitations to the exemptions found in
Sec. Sec. 862.9 to 892.9 and any partial exemption limitations
identified in table 1:
Table 1--Class II Devices
----------------------------------------------------------------------------------------------------------------
Partial exemption
21 CFR section Device type Product code limitation (if applicable)
----------------------------------------------------------------------------------------------------------------
862.1840............................ Total 25-hydroxyvitamin PSL ...........................
D Mass Spectrometry
Test System.
866.5950............................ Genetic Health Risk PTA Exemption is limited to a
Assessment System. genetic health risk
assessment system that has
received a first-time FDA
marketing authorization
(e.g., 510(k) clearance)
for the genetic health
risk assessment system (a
``one-time FDA reviewed
genetic health risk
assessment system'').
876.1500............................ Endoscope Disinfectant PUP ...........................
Basin.
880.6710............................ Purifier, Water, KMG ...........................
Ultraviolet, Medical.
884.5960............................ Vibrator for KXQ ...........................
Therapeutic Use,
Genital.
----------------------------------------------------------------------------------------------------------------
FDA is revising the name of product code PUP to further clarify the
device type that this product code is intended to represent. The device
type was previously ``Endoscope Maintenance System.'' To more
accurately reflect the devices which fall within this device type
(product code PUP), the device type has been renamed ``Endoscope
Disinfectant Basin.'' Specifically, these devices are described as
``Wall-mounted tube(s) for holding disinfectant solution and endoscope
insertion tubes and accessories.'' This description has not changed
since publication of the November 2017 notice.
VI. Analysis of Environmental Impact
The Agency has determined under 21 CFR 25.30(h) that this action is
of a type that does not individually or cumulatively have a significant
effect on the human environment. Therefore, neither an environmental
assessment nor an environmental impact statement is required.
VII. Paperwork Reduction Act of 1995
This final order refers to previously approved collections of
information found in other FDA regulations and guidance. These
collections of information are subject to review by the Office of
Management and Budget (OMB) under the Paperwork Reduction Act of 1995
(44 U.S.C. 3501-3520). The collections of information in part 807,
subpart E, regarding premarket notification submissions, have been
approved under OMB control number 0910-0120; and the collections of
information in 21 CFR parts 801 and 809, regarding labeling, have been
approved under OMB control number 0910-0485.
List of Subjects
21 CFR Part 862
Medical devices.
21 CFR Part 866
Biologics, Laboratories, Medical devices.
21 CFR Parts 876, 880, and 884
Medical devices.
Therefore, under the Federal Food, Drug, and Cosmetic Act and under
authority delegated to the Commissioner of Food and Drugs, 21 CFR parts
862, 866, 876, 880, and 884 are amended as follows:
PART 862--CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES
0
1. The authority citation for part 862 continues to read as follows:
Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.
0
2. In Sec. 862.1840, revise paragraph (b) introductory text to read as
follows:
Sec. 862.1840 Total 25-hydroxyvitamin D mass spectrometry test
system.
* * * * *
(b) Classification. Class II (special controls). The device is
exempt from the premarket notification procedures in part 807, subpart
E, of this chapter subject to the limitations in Sec. 862.9. The
device must comply with the following special controls:
* * * * *
PART 866--IMMUNOLOGY AND MICROBIOLOGY DEVICES
0
3. The authority citation for part 866 continues to read as follows:
Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.
0
4. In Sec. 866.5950, revise paragraph (b) introductory text to read as
follows:
Sec. 866.5950 Genetic health risk assessment system.
* * * * *
(b) Classification. Class II (special controls). The genetic health
risk assessment system device, when it has previously received a first-
time FDA marketing authorization (e.g., 510(k) clearance) for the
genetic health risk assessment system (a ``one-time FDA reviewed
genetic health risk assessment system''), is exempt from the premarket
notification procedures in part 807, subpart E, of this chapter subject
to the limitations in Sec. 866.9. The device must comply with the
following special controls:
* * * * *
PART 876--GASTROENTEROLOGY-UROLOGY DEVICES
0
5. The authority citation for part 876 continues to read as follows:
Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.
0
6. In Sec. 876.1500, revise paragraph (b)(1) to read as follows:
Sec. 876.1500 Endoscope and accessories.
* * * * *
(b) * * *
(1) Class II (performance standards). The device, when intended as
an endoscope disinfectant basin, which consists solely of a container
that holds disinfectant and endoscopes and accessories, is exempt from
the premarket notification procedures in part 807, subpart E, of this
chapter subject to the limitations in Sec. 876.9.
* * * * *
[[Page 25915]]
PART 880--GENERAL HOSPITAL AND PERSONAL USE DEVICES
0
7. The authority citation for part 880 continues to read as follows:
Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.
0
8. In Sec. 880.6710, revise paragraph (b) to read as follows:
Sec. 880.6710 Medical ultraviolet water purifier.
* * * * *
(b) Classification. Class II (performance standards). The device is
exempt from the premarket notification procedures in part 807, subpart
E, of this chapter subject to the limitations in Sec. 880.9.
PART 884--OBSTETRICAL AND GYNECOLOGICAL DEVICES
0
9. The authority citation for part 884 continues to read as follows:
Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.
0
10 In Sec. 884.5960, revise paragraph (b) to read as follows:
Sec. 884.5960 Genital vibrator for therapeutic use.
* * * * *
(b) Classification. Class II (performance standards). The device is
exempt from the premarket notification procedures in part 807, subpart
E, of this chapter subject to the limitations in Sec. 884.9.
Dated: May 29, 2018.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2018-11879 Filed 6-1-18; 8:45 am]
BILLING CODE 4164-01-P