21st Century Cures

The 21st Century Cures Act (P.L. 114-255) is landmark, bipartisan legislation that was signed into law on Dec. 13, 2016, and touches virtually all aspects of biomedical research, medical product development and the regulatory approval process. Read what FasterCures has said about 21st Century Cures over the years.

FasterCures worked closely with Congress, federal agencies and the advocacy community throughout the legislation’s journey to the president’s desk. In February 2017, we debuted the 21st Century Cures Tracker to track the implementation of the 100+ sections in Division A, which include the key provisions relevant to biomedical research and innovation. (Other divisions of the law pertain to mental health and Medicare; since those are not areas of focus for FasterCures, we will not be actively tracking them here.) Learn more about how to use the tracker with our FAQs page.

A few examples of the issues we will be tracking include the impact of changes to the National Institutes of Health’s administrative requirements for grantees, how the Food and Drug Administration implements new changes designed to enhance patient engagement and how the Department of Health and Human Services is using its new authorities to promote health information technology interoperability.

Many external factors will affect the progress of these initiatives, including policies related to hiring freezes and uncertain funding levels. This tracker is not meant to be a pass/fail report card, but rather a snapshot in time that can help explain impact and identify where progress is needed.

Please keep coming back, as we will be updating the information regularly. Use the button below to send us feedback on the value of the information we are presenting, and the usability of this new resource.

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FasterCures' 21st Century Cures Act Tracker (P.L. 114-255)

Status Section Tracked Deadlines and Requirements Update Date of Update Tags
fa fa-2x fa-long-arrow-right Sec. 1002. FDA innovation projects. Annual appropriation of funds into the FDA Innovation Account (FY17-25)
6/11/2017 - Requires submission of a work plan for the FDA Innovation Fund

7/7/2017: FDA Commissioner Scott Gottlieb, M.D. announced that the agency had submitted its final work plan to Congress.
5/9/2017: The FDA Science Board held a meeting to review the proposal.
5/5/2017: The FDA released its plan outlining proposed uses of innovation funds.

20170707 07/07/2017 FDA, Funding, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 2041. Task force on research specific to pregnant women and lactating women. 3/13/2017 (90 days): requires establishment of a "Task Force on Research Specific to Pregnant Women and Lactating Women;" 18 months after establishment of task force (by 6/13/18 ) -- requires Task Force submission of a report to Congress.

12/13/2018: requires HHS to update regulations and guidance, as appropriate, regarding the inclusion of pregnant women and lactating women in clinical research.

April 18, 2017, the Federal Register published a meeting notice for the Task Force which will be August 21 & 22, 2017 and a second meeting will be November 6-7, 2017 

March 21, 2017, the NIH formally announced the establishment of the task force within the Eunice Kennedy Shriver National Institute of Child Health and Human Development. NICHD has reported to us that it is now in the process of compiling the slate of nominees to serve on the taskforce for the Secretary’s consideration.

January 18, 2017, The Secretary of HHS delegated authority to the NIH to establish this task force.

20170418 04/18/2017 CDC, FDA, Guidances, NIH, Regulatory Affairs, Reports, Research
fa fa-2x fa-long-arrow-right Sec. 2063. Accessing, sharing, and using health data for research purposes. 12/13/2017: requires HHS issuance of guidance clarifying that remote access of health data by researchers (under appropriate circumstances) is not forbidden by regulation.
12/13/2017: requires HHS issuance of guidance clarifying requirements for the authorized disclosure of protected health information for research.
12/13/2017: requires HHS establishment of a "Working Group on Protected Health Information for Research" to study and, within 1 year of establishment, report on whether the uses and disclosures of protected health information for research purposes should be modified.
12/13/2017: requires submission of a report to the HHS Secretary
FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 CDC, Data Sharing, FDA, Guidances, HHS, NIH, Regulatory Affairs, Reports, Research
fa fa-2x fa-long-arrow-right Sec. 3001. Patient experience data. Requires FDA to include a statement regarding any patient experience data that was used at the time a drug is approved. FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, Patient Engagement, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3002. Patient-focused drug development guidance. 6/11/2017 (180 days): instructs FDA to develop a plan to issue draft and final versions of guidance documents regarding the collection of patient experience data, and the use of such data in drug development.
6/13/2018: requires FDA to issue a draft version of at least one such guidance identified in plan and within 18 months from close of public comment period, issue a final/ revised guidance.
12/13/2021: requires FDA to issued patient experience guidance documents

9/8/2017: CDER announced a public workshop entitled “CDER Rare Diseases Public Workshop: Strategies, Tools, and Best Practices for Effective Advocacy in Rare Diseases Drug Development.” This public workshop builds upon previous CDER patient advocacy public workshops and is primarily for the rare disease community to help them effectively understand what FDA needs to enhance drug development. 

6/9/2017: FDA released the “Plan for Issuance of Patient‐Focused Drug Development Guidance” in accordance with this provision.

20170908 09/08/2017 FDA, Guidances, Patient Engagement, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3004. Report on patient experience drug development. Requires FDA to periodically issue a report on FDA's use of patient experience data in regulatory decision-making, in particular with respect to the review of patient experience data and information on patient-focused drug development tools as part of approved applications. FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, Patient Engagement, Regulatory Affairs, Reports
fa fa-2x fa-long-arrow-right Sec. 3011. Qualification of drug development tools. 12/13/2018: instructs FDA to convene a public meeting to solicit input on a new qualification process for biomarkers and other drug development tools.
12/13/2018: requires FDA to publish taxonomy on drug development tools for public comment. 1 year after close of comment period taxonomy must be finanlized.
12/13/2019: directs FDA to issue draft guidance on this qualification process.
12/13/2021: directs FDA to release a report which describes the use of, and success of, this new qualification process.
FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, Guidances, Medical Product Development, Regulatory Affairs, Reports
fa fa-2x fa-binoculars Sec. 3012. Targeted drugs for rare diseases. Permits FDA to allow the sponsor of a drug or biologic application for a genetically targeted drug or variant protein targeted drug to rely on data for the same or similar technology from previously approved applications developed by the same sponsor. FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, Rare Disease, Regulatory Affairs
fa fa-2x fa-binoculars Sec. 3013. Reauthorization of program to encourage treatments for rare pediatric diseases. Reauthorizes the pediatric rare disease priority review voucher program until 2020. FasterCures will periodically update based on the implementation and use of the voucher program. 20161213 12/13/2016 FDA, Medical Product Development, Rare Disease, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3014. GAO study of priority review voucher programs. 12/31/2020: requires GAO to issue report evaluating the three Priority Review Voucher (PRV) programs: Neglected Tropical Disease, Rare Pediatric Disease, and Medical Countermeasure. FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, GAO, Medical Countermeasures, Medical Product Development, Rare Disease, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3021. Novel clinical trial designs. 6/13/2018: directs FDA to host a public meeting to discuss the incorporation of complex adaptive and other novel trial designs into clinical protocols and new drug applications.

12/13/2019: requires FDA to issue draft guidance addressing the use of complex adaptive and other novel trial design in the development of new drugs or biologicals; within 1 year after the public comment period closes, FDA finalization of such guidance.
FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 Clinical Trials, FDA, Guidances, Medical Product Development, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3035. Report on regenerative advanced therapies. 3/1/2017 (and every year thereafter): requires HHS to submit a report to Congress on the number and type of applications for regenerative advanced therapies.
FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, Regenerative Medicine, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3036. Standards for regenerative medicine and regenerative advanced therapies. 12/13/2017: instructs HHS to review regulations and guidance relevant to regenerative advanced therapies; and, through a public process, update such regulations and guidance as the Secretary determines appropriate.
FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, Guidances, Regenerative Medicine, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3038. Combination product innovation. Contains a number of elements designed to improve the regulation and review of combination products, including issuing guidance by 12/13/2020 that describes the process for managing pre-submission interactions, best practices for ensuring that feedback represents FDA's best advice, and information on meetings between the sponsor and FDA. FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, Guidances, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3044. Susceptibility test interpretive criteria for microorganisms; antimicrobial susceptibility testing devices. 12/13/2017: instructs FDA to establish and regularly maintain a website that lists appropriate interpretive criteria standards for antimicrobial drug susceptibility assays.
12/13/2018: requires FDA to submit a report to Congress on implementation of this provision.


FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, Infectious Disease, Regulatory Affairs, Reports
fa fa-2x fa-long-arrow-right Sec. 3051. Breakthrough devices. 12/13/2017: requires FDA to issue guidance on the implementation of the medical device review pathway established by this provision.
1/1/2019: requires FDA to issue a report to Congress on the new medical device review pathway and opportunities for improvement.
FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, Medical Devices, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3052. Humanitarian device exemption. 6/13/2018: requires FDA to issue a guidance document define "probable benefit" in the context of the humanitarian device exemption.

On June 7, 2017 FDA rule notice in the Federal Register: section 3052 of the 21st Century Cures Act amended section 520(m) of the FD&C Act to allow for HDE approval for devices that, among other things, treat or diagnose a disease or condition that affects “not more than 8,000” individuals in the United States; this threshold had been “fewer than 4,000” individuals in the United States (amending 21 U.S.C. 360j(m), passim). This final rule amends part 814 (21 CFR part 814) in several places to accurately reflect the threshold recently enacted into law.

20170607 06/07/2017 FDA, Guidances, Medical Devices, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3053. Recognition of standards. Instructs FDA to review and update its guidance on submission and evaluation of independent standards for medical device review.
FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, Guidances, Medical Devices, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3055. Classification panels. Requires FDA to provide an annual opportunity for stakeholders to provide recommendations for individuals with appropriate expertise to fill voting member positions on medical device classification panels

6/23/2017: FDA is requesting nominations for voting members to serve on the Device Good Manufacturing Practice Advisory Committee and device panels of the Medical Devices Advisory Committee in the Center for Devices and Radiological Health.

20170623 06/23/2017 FDA, Medical Devices, Regulatory Affairs
fa fa-2x fa-check Sec. 3056. Institutional review board flexibility. Removes the requirement that a sponsor of medical device trial use a local institutional review board. In effect upon enactment.

On June 7, 2017 FDA rule notice in the Federal Register: “section 3056 of the 21st Century Cures Act amended section 520 of the FD&C Act to remove the requirement for institutional review committees, i.e., IRBs, for devices to be “local”, (amending 21 U.S.C. 360j, passim). This final rule amends 21 CFR 814.124(a), “IRB approval”, to remove the term “local” and related language in order to accurately reflect the requirements recently enacted into law.”

20170607 06/07/2017 FDA, Medical Devices, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3057. CLIA waiver improvements. 12/13/2017: instructs CMS to issue draft guidance on CLIA waiver improvements, and issuance of final guidance within one year after comment period closes.

Additional information on the Clinical Laboratory Improvement Amendments (CLIA) can be found on the CMS website.

20161213 12/13/2016 CMS, FDA, Guidances, Medical Devices, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3058. Least burdensome device review. 6/13/2018: requires FDA to conduct an audit on training and use of least burdensome requirements during review of medical devices.
FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, Medical Devices, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3059. Cleaning instructions and validation data requirement. 6/11/2017: requires HHS to identify and publish of a list of reusable medical devices that require additional instruction on, and validation of, proper cleaning and disinfection procedures.

On June 9, 2017 FDA published such a list in the Federal Register. This list becomes effective on August 8, 201

20170609 06/09/2017 FDA, Medical Devices, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3060. Clarifying medical software regulation. 12/13/2018 (and every two years thereafter): requires HHS issuance of a report on the current state of health-related software and the regulation of those products.

12/30/2016: FDA communicated its interpretation of this policy through final guidance titled "Medical Device Accessories--Describing Accessories and Classification Pathway for New Accessory Types"

20161213 12/13/2016 FDA, Health IT, Regulatory Affairs, Reports
fa fa-2x fa-long-arrow-right Sec. 3054. Certain class I and class II devices. 3/13/2017 (and every 5 years thereafter), instructs FDA to publish in the Federal Register a notice that contains Class II devices exempt from reporting requirements due to low risk; followed by 60 day public comment period. Final list published 7/11/2017.
4/12/2017 (and every 5 years thereafter): instructs FDA to provide a list of Class I devices exempt from reporting requirements due to low risk.

April 13, 2017, FDA issued a notice in the Federal Register identifying a list of class I devices that are now exempt from premarket notification requirements, subjects to certain eliminations. FDA's action will decrease regulatory burdens on the medical device industry and will eliminate private costs and expenditures required to comply with certain Federal regulation.

March 14, 2017, FDA issued a notice in the Federal Register identifying more than 1,000 medical class II devices it is proposing to exempt or partially exempt from the premarket review process. A 60-day comment period is now open, after which FDA may narrow or expand this list.

20170413 04/13/2017 FDA, Medical Devices, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3073. Establishment of Food and Drug Administration Intercenter Institutes. 12/13/2017: requires FDA establishment of at least one Intercenter Institute.

On January 19, 2017, Commissioner Califf announced the formation of the Oncology Center of Excellence and named Richard Pazdur as its director.  The FDA allocated $3.6 million of existing agency funds to establish the OCE. However, a drafting error in sec. 1001(b)(3)(A) may prevent FDA from receiving an additional $75 million to fund the OCE. (Read more here and here).

20170119 01/19/2017 FDA, Regulatory Affairs
fa fa-2x fa-check Sec. 3088. Clarifying Food and Drug Administration emergency use authorization. Clarifies Food and Drug Administration emergency use authorization.

Complete. For more information on FDA's Medical Countermeasures work relating to 21st Century Cures.

20161213 12/13/2016 FDA, Medical Countermeasures, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3022. Real world evidence. 12/13/2018: requires FDA to develop and begin to implement, a framework to evaluate the use of real world evidence to help support the approval a new indication for a for a previously approved drug, or to support post-approval study requirements.

12/13/2021: requires FDA to issue draft guidance based on implementation and use of RWE framework which describes circumstances where RWE may be relied upon and appropriate standards and methodologies for collection and analysis of RWE; by 18 months after the above comment period closes finalization of guidance.

7/31/2017: FDA announced  a public workshop, "A Framework for Regulatory Use of Real-World Evidence” convened by the the Duke-Robert J. Margolis, MD, Center for Health Policy at Duke University and supported by a cooperative agreement with FDA. The purpose of the public workshop is to bring the stakeholder community together to discuss a variety of topics related to the use of real-world data (RWD) and real-world evidence (RWE) in drug development and regulatory decision making.

20161213 12/13/2016 FDA, Guidances, Medical Product Development, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3086. Encouraging treatments for agents that present a national security threat. Establishes a Priority Review Voucher program at FDA to incentivize the development of medical countermeasures; sunsets 10/1/2023.

4/28/2017: For more information on FDA Priority Voucher Programs please review this RAPS article entitled "Regulatory Explainer: Everything You Need to Know About FDA’s Priority Review Vouchers." As noted in the articled, to date no product has been awarded a priority review voucher under the medical counter measures program. For more information on FDA's Medical Countermeasures work relating to 21st Century Cures.

FasterCures will periodically assess this item as appropriate. For more information on FDA's Medical Countermeasures work relating to 21st Century Cures.

00170428 04/28/0017 FDA, Medical Countermeasures, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 3042. Limited population pathway. Creates a new pathway for FDA to approve antibacterial and antifungal drugs based for limited populations, using a benefit-risk profile specific to that population.
6/13/2018: requires FDA to issue draft guidance describing this pathway and related processes.
At least every 2 years, FDA must report to Congress on the applications and approvals under this program.
12/31/2021: requires GAO issuance of a report on this program.
FasterCures will periodically assess this item as appropriate. 20161213 12/13/2016 FDA, GAO, Infectious Disease, Regulatory Affairs, Reports
fa fa-2x fa-binoculars Sec. 4004. Information blocking. HHS is directed, through rule-making, to determine activities that do not constitute information blocking, and therefore are not subject to penalties established by this section. (No date provided in law.)

FasterCures will periodically assess this item as appropriate.

20161213 12/13/2016 Health IT, HHS, Interoperability, ONC, Regulatory Affairs
fa fa-2x fa-long-arrow-right Sec. 4002. Transparent reporting on usability, security, and functionality. 12/13/2017: requires ONC promulgation of a rule updating the health IT certification program to include new requirements for interoperability.
12/13/2017: requires HHS awarding of grants, contracts, or agreements to independent entities on a competitive basis to support the convening of stakeholders as described in subsection (a)(2), collect the information required to be reported in accordance with the criteria established as described subsection (a)(3), and develop and implement a process in accordance with paragraph (5) and report such information to the Secretary.

FasterCures will periodically assess this item as appropriate.

20161213 12/13/2016 Health IT, Interoperability, ONC, Regulatory Affairs

 

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