Skip to main content

Medical Devices: FDA Should Take Steps to Ensure That High-Risk Device Types Are Approved through the Most Stringent Premarket Review Process

GAO-09-190 Published: Jan 15, 2009. Publicly Released: Jan 15, 2009.
Jump To:
Skip to Highlights


The Food and Drug Administration (FDA) within the Department of Health and Human Services (HHS) is responsible for oversight of medical devices sold in the United States. Regulations place devices into three classes, with class III including those with the greatest risk to patients. Unless exempt by regulation, new devices must clear FDA premarket review via either the 510(k) premarket notification process, which determines if a new device is substantially equivalent to another legally marketed device, or the more stringent premarket approval (PMA) process, which requires the manufacturer to supply evidence providing reasonable assurance that the device is safe and effective. Class III devices must generally obtain an approved PMA, but until FDA issues regulations requiring submission of PMAs, certain types of class III devices may be cleared via the 510(k) process. The FDA Amendments Act of 2007 mandated that GAO study the 510(k) process. GAO examined which premarket review process--510(k) or PMA--FDA used to review selected types of device submissions in fiscal years 2003 through 2007. GAO reviewed FDA data and regulations, and interviewed FDA officials.


Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of Health and Human Services should direct the FDA Commissioner to expeditiously take steps to issue regulations for each class III device type currently allowed to enter the market through the 510(k) process. These steps should include issuing regulations to (1) reclassify each device type into class I or class II, or requiring it to remain in class III, and (2) for those device types remaining in class III, require approval for marketing through the PMA process.
Closed – Implemented
As of December 2019, FDA has implemented this recommendation. In 2009, the agency began a 5-step process to reclassify or to require premarket approvals (PMAs) for 26 class III device types. This process was modified by the Food and Drug Administration Safety and Innovation Act (FDASIA)-instead of issuing regulations as the final step, FDA issues an administrative order to reclassify or require PMAs for the device types. In 2014, the agency reported it had set a goal to have all remaining devices finalized by the second quarter of 2015; however the agency did not meet that goal. The agency completed the process for reclassifying or requiring a PMA for each class III device type permitted to enter the market through the 510(k) process in December 2019.

Full Report

Office of Public Affairs


Consumer protectionFederal regulationsInformation technologyInspectionMedical equipmentMedical review criteriaMedical suppliesPrivate sector practicesProduct evaluationProduct safetyPublic healthQuality assuranceRequirements definitionRisk assessmentRisk managementSafety regulationStandardsTotal quality managementCost estimatesMedical devices