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Drug and Device Manufacturer Communications With Payors, Formulary Committees, and Similar Entities – Questions and Answers: Guidance for Industry and Review Staff

FinalCenter for Biologics Evaluation and Research Center for Devices and Radiological Health Center for Drug Evaluation and Research Office of the Commissioner06/13/2018

Description

This guidance provides answers to common questions regarding firms’ communication of health care economic information (HCEI) regarding their prescription drugs and medical devices to payors, formulary committees, or other similar entities with knowledge and expertise in the area of health care economic analysis (collectively referred to as payors).  This guidance also addresses common questions relating to dissemination to payors of information about medical products that are not yet approved or cleared for any use and dissemination to payors of information about unapproved uses of approved/cleared medical products.

Scope & Applicability

Product Classes

4
Prescription Drugs

Human prescription drugs including biological products

unapproved products

medical products that have not yet received FDA approval, clearance, or licensure

Medical Devices

Medical devices intended for human use; Approved or cleared medical devices

Approved Prescription Drugs

Products for which HCEI may be communicated under section 502(a).

Stakeholders

4
Payors

Entities with knowledge and expertise in health care economic analysis; Sophisticated audience including public and private sector entities responsible for financing health care costs.; Entities such as formulary committees that receive HCEI for coverage decisions.; Entities such as formulary committees receiving HCEI; entities such as formulary committees that receive health care economic information

firms

drug and device manufacturers communicating with payors

Formulary Committees

Entities carrying out responsibilities for selection of drugs for coverage

Manufacturer

Entity responsible for submitting NDINs

Regulatory Context

Attributes

3
Approved Indication

HCEI must relate to the disease or condition for which the drug is indicated.

Intended Use

Evidence of a new intended use based on communications

Generalizability

Applicability of HCEI from one health care setting to another.

Identified Hazards

Hazards

1
Financial/Affiliation Biases

Potential biases from funding or drafting underlying research.

Related CFR Sections (6)

Related Warning Letters (2)

  • False & Misleading Claims/Misbranded

    Aytu Biopharma

    2025-09-16
  • New Drug/Labeling/Misbranded

    CytoDyn, Inc.

    2022-02-22

See Also (8)

Drug and Device Manufacturer Communications With Payors, Formulary Committees, and Similar Entities – Questions and Answers: Guidance for Industry and Review Staff | Guideline Explorer | BioRegHub