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Please note: as of October 1, 2002, FDA charges fees for review of Premarket Notification 510(k)s and Premarket Approvals Review ProcessOverview The review of a premarket approval application (PMA) is a four-step review process consisting of:
Filing a PMA (21 CFR. 814.42) During the administrative and limited scientific review, FDA determines whether a PMA is suitable for filing by reviewing the PMA submission for information required by the FD&C Act, the PMA regulations (21 CFR 814), and Refuse to File policy. FDA has developed a Checklist for Filing Decision for PMAs. The filing of an application means that FDA has made a threshold determination that the application is sufficiently complete to begin an in-depth review. Within 45 days after a PMA is received by FDA, the agency will notify the applicant whether the application has been filed. The letter will include the PMA reference number and the date FDA filed the PMA. Expedited review status, if appropriate, may be communicated at this time. The date of filing is the date that a PMA accepted for filing was received by the agency. The 180-day period for review of a PMA starts on the date of filing. FDA will refuse to file the application for substantive review if a PMA application does not meet a minimum threshold of acceptability. If the information or data are presented unclearly or incompletely or are not capable of withstanding rigorous scientific review, FDA may consider the PMA incomplete and not file it. If FDA refuses to file a PMA, FDA will notify the applicant of the reasons for the refusal. This notice will identify the deficiencies in the application that prevent filing and will include the PMA reference number. FDA will advise the manufacturer of what information must be provided, or steps to be taken, to make the application fileable. If FDA refuses to file the PMA, the applicant may:
Should the applicant decide to request a meeting concerning a refuse-to-file decision, the applicant must choose either: 1) an informal conference at which the decision not to file the application will be reviewed; or 2) a meeting with the ODE division to discuss the specific deficiencies and the measures necessary to correct these deficiencies. Please be advised that FDA will not typically grant requests for an informal conference and a meeting with the reviewing ODE division regarding this decision due to resource limitations. Applicants should either request an informal conference or schedule a meeting with the reviewing ODE division to discuss the preparation of an appropriate response. FDA may refuse to file a PMA if FDA determines that any of the following applies:
In-depth review (21 CFR 814.44) FDA will begin substantive review of the PMA after it is accepted
for filing (§814.42). During the review process, FDA will notify the PMA
applicant via major/minor deficiency letters of any information needed
by FDA to complete the review of the application. The applicant may request
to meet with FDA within 100 days of the filing of the PMA to discuss the
review status of the application. The procedure for "Day-100 Meetings"
can be found in the guidance document "Guidance on PMA Interactive
Procedures for Day-100 Meetings and Subsequent Deficiencies - for Use
by CDRH and Industry; Final" If the applicant on their own initiative or at FDA`s request submits a PMA amendment (§814.37) which contains significant new data from a previously unreported study, significant updated data from a previously reported study, detailed new analyses of previously submitted data, or significant required information previously omitted, the review period may be extended up to 180 days. Panel Review (21 CFR 814.44) FDA may refer the PMA to an outside panel of experts (advisory committee). In general, all PMAs for the first-of-a-kind device are taken before the appropriate advisory panel for review and recommendation. However, as soon as FDA believes that (1) the pertinent issues in determining the safety and effectiveness for the type of medical device are understood and (2) FDA has developed the ability to address those issues, future PMAs for devices of that type are not be taken before an advisory panel unless a particular application presents an issue that can best be addressed through panel review. The PMA, or relevant portions, may be forwarded to each member of the appropriate FDA advisory committee for review. During the review process, FDA may communicate with the applicant [§814.37(b)] or with the advisory committee to respond to questions that may be raised by committee members or to provide additional information to the panel. FDA will maintain a record of all communications with the applicant and with the advisory committee. If the PMA is referred to an advisory committee, the committee must hold a public meeting to review the PMA in accordance with 21 CFR 14. The advisory committee must submit a final report to FDA that includes the committee's recommendation and the basis for such recommendation on the PMA. The advisory committee report and recommendation may be in the form of a meeting transcript signed by the chairperson of the committee. The following documents provide guidance for panel review. Panel Review of Premarket Approval Applications 5/3/91 (P91-2) Criteria for Panel Review of PMA Supplements 1/30/86 (P86-3) FDA takes into consideration the transcript of the meeting, the panel`s recommendation(s), and other information in reaching a final decision on the PMA. FDA informs the applicant whether FDA agrees with the panel`s recommendation or disagrees and what additional information is needed from the applicant (approvable/not approvable decision). If the application is approvable, the applicant must agree to the "Conditions of Approval." Notification of Approval (§814.44) Within 180 days of the date of filing of the PMA (§814.40), FDA will complete its review of the PMA and of the advisory committee`s report and recommendation and issue one of the following:
Approval Order After FDA reviews the committee`s final report, the FDA will issue an order to the applicant that the PMA is approved if none of the reasons in §814.45 (Denial of approval for a PMA) for denying approval of the application applies. FDA will approve an application on the basis of draft final labeling. Approval will be based on the condition that the applicant submits to FDA a copy of the final printed labeling before marketing. FDA will notify the public of the approval. The announcement of the decision and the availability of a summary of the safety and effectiveness data (SSED) on which the decision is based will be published on the Internet at http://www.fda.gov/cdrh/pmapage.html. The summary will include information about any adverse effects of the device on health. The announcement also provides the applicant and other interested persons an opportunity for administrative review of the FDA approval under section 515(d)(3) of the FD&C Act. On a quarterly basis, FDA will publish a list of approvals announced during that quarter in the Federal Register. When a notice of approval is published, data and information in the PMA file will be available for public disclosure in accordance with §814.9. Approvable Letter FDA will send the applicant an approvable letter if the application substantially meets the requirements of the FD&C Act, and FDA believes that it can approve the application if specific additional information is submitted or specific conditions are agreed to by the applicant. The approvable letter will describe the information that FDA requires to be provided by the applicant or the conditions that the applicant is required to meet to obtain approval. FDA may require, for example, as a condition of approval:
The applicant may have to agree to a postapproval study, restrictions on prescription use, or restrictions on the training of individuals who may use the device before approval. The applicant may also be notified of required postmarket surveillance and/or tracking requirements. In response to an approvable letter, the applicant may:
Not approvable letter FDA will send the applicant a not approvable letter if FDA believes that the application may not be approved for one or more of the reasons given in §814.45(a) or if FDA is unable to reach an approvable decision due to a lack of significant information in the application. The not approvable letter will describe the deficiencies in the application, including each applicable ground for denial under section 515(d)(2)(A)-(E) of the FD&C Act. When practical, FDA will identify what is necessary to make the PMA approvable. In response to a not approvable letter, the applicant may:
FDA will consider a PMA to have been withdrawn voluntarily if:
Service of orders (21 CFR 814.17) Any FDA orders, such as approval or denial, will generally be faxed and then sent to the PMA applicant or its designated agent by mail. A PMA applicant or its designated agent may arrange to pick up the FDA order at 9200 Corporate Blvd., Rockville, Maryland 20850 by contacting the PMA Staff at 301-594-2186. Standard Conditions of Approval The "Conditions of Approval" are the standard postapproval conditions imposed by FDA. These are applicable to all original PMAs and PMA supplements. As a condition of approval the sponsor agrees to abide by advertising and final printed labeling requirements and to submit adverse event reports, annual reports, and PMA supplements for certain changes. Additional specific conditions may be required for implanted devices. Applicants should carefully read the conditions of approval enclosed with the FDA approval letter. The "Conditions of Approval" is available on the Internet.http://www.fda.gov/cdrh/devadvice/pma/conditions.html PMA Amendments 814.37 An applicant may amend a pending PMA or PMA supplement to revise existing information or to provide additional information. FDA may request the applicant to amend a PMA or PMA supplement with any information regarding the device that is necessary for FDA or the appropriate advisory committee to complete the review of the PMA or PMA supplement. A PMA amendment submitted to FDA shall include the PMA or PMA supplement number assigned to the orignial submission and , if submitted on the applicants's own initiative, the reason for submitting the amendment. FDA may extend the time required for its review of the PMA or PMA supplement: If the applicant on its own itnitiatve or at FDA's request submits a major PMA amendment (e.g., an amendment that contains significant new data from a previously unreported study, significant updated data from a previously reported study, detailed new analyses of previously submitted data, or significant required information previously omitted), the review period may be entended up to 180 days. If an applicant declines to submit a major amendment requested by FDA, the review period may be extended for the number of days that elapse between the date of such request and the date that FDA receives the written response declining to submit the requested amendment. Resubmitted PMAs 814.37 Applicants may voluntarily withdraw their PMA or PMA supplement. If FDA requests an applicant to submit a PMA amendment, and a written response to FDA`s request is not received within 180 days, FDA will consider the pending PMA or PMA supplement to be withdrawn voluntarily by the applicant (abandoned). An applicant may resubmit a PMA or PMA supplement that was withdrawn, that FDA has refused to accept for filing, or that FDA has denied approval. A resubmitted PMA or PMA supplement must comply with the requirements of §814.20 or §814.39 and must include the PMA number assigned to the original submission as well as the applicant`s reason for resubmission. Steps in the PMA Application Process
, Approval Order, , SSED, Final Draft Labeling Early Collaboration Applicants are encouraged to contact FDA to obtain further guidance prior to the submission of a PMA application. This will be especially beneficial to new applicants who have not previously had contact with FDA and for applicants proposing to study new technologies or new uses for existing technologies. Early interaction with FDA should help to increase the applicant's understanding of FDA requirements, regulations, and guidance documents, and will allow FDA personnel to familiarize themselves with the new technologies. Increased interaction between FDA and applicants should help to speed the regulatory process and minimize delays in the development of useful devices intended for human use. The applicant may request a "PrePMA determination" meeting with FDA. This meeting held early in device development will provide the applicant with the agency`s determination of the type of valid scientific evidence that will be necessary to determine if the device is effective for its intended use. Additional information on early collaborations meetings can be found in "Early Collaboration Meetings under the FDA Modernization Act (FDAMA)" http://www.fda.gov/cdrh/ode/guidance/310.pdf Once the applicant understands the review process through FDA regulations and guidance documents, the applicant is encouraged to contact the review divisions within the Office of Device Evaluation to discuss device-specific requirements. The PMA staff may be contacted for general questions relating to the PMA laws, regulations, policies, and administrative issues on (301) 594-2186. FDA Action On a PMA Denial of approval of a PMA (§814.45) FDA may deny approval of a PMA if the applicant fails to follow the requirements of the PMA regulation or if FDA determines that any of the grounds for denying approval of a PMA specified in section 515(d)(2)(A)-(E) of the FD&C Act applies. In addition, FDA may deny approval of a PMA for any of the following reasons:
FDA will issue any order denying approval of a PMA in accordance with §814.17. The order will inform the applicant of the deficiencies in the PMA, including each applicable ground for denial under section 515(d)(2) of the FD&C Act and the regulations under Part 814, and, where practical, will identify measures required to place the PMA in approvable form. The order will include a notice of an opportunity to request review under section 515(d)(3) of the FD&C Act. FDA will use the criteria specified in §860.7 (Determination of Safety and Effectiveness) in deciding whether to approve or deny approval of a PMA. FDA may use information other than that submitted by the applicant in making such determination. FDA will publish a Federal Register notice of an order denying approval of the PMA. The notice will be placed on the Internet (http://www.fda.gov/cdrh) and will state that a detailed summary of information concerning the safety and effectiveness of the device, including information about any adverse effects on health, is available on the Internet and has been placed on public display. FDA will publish in the Federal Register after each quarter a list of the denials announced in that quarter. When a notice of denial of approval is made publicly available, data and information in the PMA file will be available for public disclosure in accordance with §814.9. FDA will issue an order denying approval of a PMA after an approvable or not approvable letter has been sent and the applicant has:
Withdrawal of approval of a PMA (21 CFR 814.46) FDA may issue an order withdrawing approval of a PMA if FDA determines from any information available that:
FDA may seek advice on scientific matters from any appropriate FDA advisory committee in deciding whether to withdraw approval of a PMA. FDA may also use information other than that submitted by the applicant in deciding whether to withdraw approval of a PMA. Before issuing an order to withdraw approval of a PMA, FDA will issue the holder of the approved application a notice of opportunity for an informal hearing under 21 CFR 16. If the applicant does not request a hearing or, if after the 21 CFR 16 hearing is held, FDA decides to proceed with the withdrawal, FDA will issue an order withdrawing approval of the application. The order (§814.17) will state each ground for withdrawing approval and will include a notice of an opportunity for administrative review under section 515(e)(2) of the FD&C Act. FDA will publish a Federal Register notice of an order withdrawing approval of a PMA. The notice will state that a detailed summary of information concerning the safety and effectiveness of the device, including information about any adverse effects on health, has been placed on public display and that copies are available upon request. When a notice of withdrawal of approval is published, data and information in the PMA file will be available for public disclosure under §814.9. Temporary Suspension of Premarket Approval (§814.47) If, after providing the sponsor with an opportunity for a regulatory informal hearing regarding the proposed withdrawal of PMA approval, and FDA determines there is a reasonable probability that continued distribution of a PMA-approved device would cause serious adverse health consequences or death, FDA shall by order temporarily suspend the PMA. In cases where there is sufficient grounds, FDA will proceed expeditiously to withdraw the PMA approval. Section 515 of the Federal Food, Drug, and Cosmetic Act PMA Refuse to File Procedures (P94-1) PMA Filing Decision (P90-2) Checklist for Filing Decision for PMA Clinical Utility and Premarket Approval (P91-1) Panel Review of Premarket Approval Applications 5/3/91 (P91-2) Criteria for Panel Review of PMA Supplements 1/30/86 (P86-3) Panel Review of PMAs for "Me Too" Devices 7/25/86 (P86-6) Updated 6/11/2003
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