Navigating the FDA and CMS Policy Alignment

Two of the most important pillars supporting the healthcare sector are the Food and Drug Administration (FDA) of the United States and the Centers for Medicare & Medicaid Services (CMS). The FDA is in charge of ensuring that medical devices are both safe and effective. The coverage and benefits that are provided to CMS’s beneficiaries are decided by CMS. Because of the different legislative authorities held by these two agencies, the regulatory environment that medical device manufacturers must operate in is quite complicated.

One such program run by the FDA is called the Breakthrough Devices Program, or BDP for short. Its purpose is to encourage innovation by bestowing Breakthrough designations early on in the process of device development in order to speed up the approval process for market release. This strategy is flexible enough to accommodate a higher degree of ambiguity regarding the benefits and risks involved, provided sufficient postmarket evidence is gathered.

The BDP’s Impact on Healthcare Costs and Innovation

The healthcare sector has been profoundly affected as a result of the BDP’s initiatives. Since the year 2020, devices that have been given the Breakthrough designation have, in effect, automatically qualified to receive supplementary Medicare reimbursement. This change came about as a result of CMS’s decision to relax a long-standing requirement that medical devices demonstrate “substantial clinical improvement” for the people they serve (the beneficiaries).

However, the BDP’s strategy has not been without of difficulties throughout its history. The BDP might make it possible for the FDA to grant approval based on evidence that isn’t quite as stringent, including single-arm trials that focus on surrogate end goals and only have short-term follow-up. Because of this strategy, several medical devices have been granted approval based on evidence that may not be typical of Medicare recipients as a whole.

There is a significant opportunity for the BDP to serve as a catalyst for innovation in the healthcare sector. On the other hand, this raises a number of issues in terms of ensuring that the highest quality evidence is provided to guide clinical care. In order to maintain this equilibrium, the FDA and CMS will need to continue to collaborate on the improvement of their respective rules and procedures.