Ian Windmill, PhD
WASHINGTON, D.C. — Members of the American Academy of Audiology (AAA) and International Hearing Society (IHS) learned yesterday afternoon that the Over-The-Counter Hearing Aid Act legislation has now been attached to the Medical Device User Fee and Modernization Act (MDUFA). According to AAA President Ian Windmill, the MDUFA bill is considered “must-pass” and is scheduled to be voted on today in the assigned Senate committee.
Under the MDUFA, first passed in 2002, the FDA was given authority to collect user fees from medical device sponsors for review activities. The MDUFA was updated and reauthorized in 2007 and 2012, and the next update to the bill will be in place from October 1, 2017 through September 30, 2022.
Because the current OTC hearing aid legislation has sponsors from both political parties, and now that it has been attached to a must-pass bill, the likelihood of passage has increased significantly.
OTC Hearing Aid Legislation: Likely to Pass in 2017
Scott Beall, AuD
IHS Past-President, Scott Beall, AuD, has stated his belief that the legislation is likely to pass between now and the end of the year. Posting on the AAA member forum, he encouraged his colleagues to help further shape the language of the bill, specifically getting section 711 “modified or removed”.
The full current draft text of section 711 is shown below for reference:
(a) IN GENERAL.-Section 520 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360j), as amended by section 707, is further amended by adding at the end the following:
(q) REGULATION OF OVER-THE-COUNTER HEARING AIDS.-
(1) DEFINITION.-In this subsection, the term over-the-counter hearing aid’ means a device that-
(A) uses the same fundamental scientific technology as air conduction hearing aids (as defined in section 874.3300 of title 21, Code of Federal Regulations) (or any successor regulation) or wireless air conduction hearing aids (as defined in section 874.3305 of title 21, Code of Federal Regulations) (or any successor regulation);
(B) is intended to be used by adults over the age of 18 to compensate for perceived mild to moderate hearing impairment;
C) through tools, tests, or software, allows the user to control the over-the-counter hearing aid and customize it to the user’s hearing needs;
(D) may-
(i) use wireless technology; or
(ii) include tests for self-assessment of hearing loss; and
(E) is available over-the-counter, without the supervision, prescription, or other order, involvement, or intervention of a licensed person, to consumers through in-person transactions, by mail, or online.
(2) REGULATION.-An over-the-counter hearing aid shall be subject to the regulations promulgated in accordance with section 710(b) of the FDA Reauthorization Act of 2017 and shall be exempt from sections 801.420 and 801.421 of title 21, Code of Federal Regulations (or any successor regulations).
(b) REGULATIONS TO ESTABLISH CATEGORY.-
(1) IN GENERAL.-The Secretary of Health and Human Services (referred to in this section as the Secretary”), not later than 3 years after the date of enactment of this Act, shall promulgate proposed regulations to establish a category of over-the-counter hearing aids, as defined in subsection (q) of section 520 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360j) as amended by subsection (a), and, not later than 180 days after the date on which the public comment period on the proposed regulations closes, shall issue such final regulations.
(2) REQUIREMENTS.-In promulgating the regulations under paragraph (1), the Secretary shall-
(A) include requirements that provide reasonable assurances of the safety and efficacy of over-the-counter hearing aids;
(B) include requirements that establish or adopt output limits appropriate for over-the-counter hearing aids;
(C) include requirements for appropriate labeling of the over-the-counter hearing aid, including how consumers may report adverse events, any conditions or contraindications, and any advisements to consult promptly with a licensed physician; and
(D) describe the requirements under which the sale of over-the-counter hearing aids is permitted, without the supervision, prescription, or other order, involvement, or intervention of a licensed person, to consumers through in-person transactions, by mail, or online.
(3) PREMARKET NOTIFICATION.-The Secretary shall make findings under section 510(m) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360(m)) to determine whether over-the-counter hearing aids (as defined in section 520(q) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360j), as amended by subsection (a)) require a report under section 510(k) to provide reasonable assurance of safety and effectiveness.
(4) EFFECT ON STATE LAW.-No State or local government shall establish or continue in effect any law, regulation, or order specifically applicable to hearing products that would restrict or interfere with the servicing, marketing, sale, dispensing, use, customer support, or distribution of over-the-counter hearing aids (as defined in section 520(q) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360j), as amended by subsection (a)) through in-person transactions, by mail, or online, that is different from, in addition to, or otherwise not identical to, the regulations promulgated under this subsection, including any State or local requirement for the supervision, prescription, or other order, involvement, or intervention of a licensed person for consumers to access over-the-counter hearing aids.
(e) NEW GUIDANCE ISSUED.-Not later than the date on which final regulations are issued under subsection (b), the Secretary shall update and finalize the draft guidance of the Department of Health and Human Services entitled, ”Regulatory Requirements for Hearing Aid Devices and Personal Sound Amplification Products”, issued on November 7, 2013. Such updated and finalized guidance shall clarify which products, on the basis of claims or other marketing, advertising, or labeling material, meet the definition of a device in section 201 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321) and which products meet the definition of a personal sound amplification product, as set forth in such guidance.
(d) STUDY.-Not later than 3 years after the date of enactment of this Act, the Comptroller General of the United States shall submit to Congress a report evaluating consumer experience with hearing health care, hearing screening in the primary care setting, and consumer adoption, usage, and outcomes related to hearing technology. The Comptroller General shall update such report not later than 2 years after the final regulations described in subsection (b) are issued, and shall evaluate how implementation of such regulations has impacted hearing health care, including recommendations for improving consumer access to appropriate hearing health care.
OTC Bill Committee Vote
It has come to our attention that the anticipated vote today in the Senate HELP committee on the MDUFA bill, with attached OTC hearing aid legislation, has been postponed in light of the Senate Democratic Caucus holding an emergency meeting to discuss the sudden and unexpected dismissal of FBI Director James Comey.
Post-Publication Update: 5/11/17
The Senate HELP committee held a hearing today at 9:30am, which included discussion of the MDUFA bill. During this morning’s hearing, committee Chairman Sen. Lamar Alexander (R-TN) urged his colleagues to keep the MDUFA bill as bi-partisan as possible and avoid “controversial amendments” that could slow down the process to get the legislation through the Senate and House and onto the President’s desk by July.
Senate HELP Committee Chairman, Lamar Alexander (R-TN)
The Senate HELP committee later passed the FDA bill with almost unanimous support, by a vote of 21-2. A full recording of the hearing can be watched here.
After delaying the mark up by one day, the Senate Health Education Labor and Pensions (HELP) Committee met on Thursday, May 11 to consider legislation (S. 934) that would reauthorize the US Food and Drug Administration (FDA) drug and device user fees. Before voting, the Senate HELP Committee unanimously adopted the
manager’s amendment released on May 8. The manager’s amendment included a number of added provisions, including one that directs the FDA to develop a category of over-the-counter hearing aids. The Senate HELP Committee then voted to approve the device user fee package. This legislation, including the OTC hearing aid provision, will now move to the full Senate for consideration. The current authorization for the user fees expires on September 30 so we anticipate the Senate to act quickly on this legislation.
—American Academy of Audiology, May 11, 2017
Post-Publication Update: 6/8/17
On June 7, the House Energy and Commerce (E&C) Committee held a markup on the FDA Reauthorization Act of 2017. During the markup, changes were made to the OTC hearing aid provision which included the addition of language that strengthens labeling requirements to ensure consumers understand that OTC devices are only intended for adults over the age of 18. Additionally, the amended language also directs HHS to analyze and report adverse events related to OTC hearing aid devices to Congress no later than two years after the regulations are finalized.
According to a AAA news release, Rep. David McKinley also submitted an amendment with language that would have OTC devices include access to a test performed by a licensed hearing care professional. The amendment, however, was later withdrawn.
The House E&C Committee unanimously voted the legislation out of the committee and the bill will now go to the full House of Representatives for final consideration.
Its ironical that they will allow OTC hearing aids for mild to moderate hearing losses. Programming such aids needs more expertise and professionalism compared to aids for severe to profound hearing losses.
Seems like AAA and IHS never thought about this. Such a shame !
What are you saying. A little evidence to your statement would help, otherwise you sound like another nit picker interested in the status quo ripoff situation that currently presents itself.i
Brian are you interested in an article I wrote about” Are PSAPS and OTC hearing aids the next target for product liability/negligence lawsuits?”
A very promising development. As a four decade consumer of hearing aids, I have become increasingly disappointed that audiologists have not put the patients’ needs above their own. During the past few years, it seems that many hearing aid professionals are more concerned about preserving the ‘status quo’ sales model.
The US hard of hearing population has not been served by the existing high price/low volume sales channel. Things need to change as most Americans with hearing loss do not have hearing aids. We can do much better for our fellow citizens.
There is plenty of room in the market for audiologists to service those Americans who are willing to pay ‘full price’ for a higher level of service. There will be change.
Stop trying to preserve your audiology practices and do what is right for the Americans who currently have no access to even the most basic hearing care.
I submitted a report to the FTC: “Report to the Federal Trade Commission (FTC): Testimony for the FTC’s Issues in Hearing Health Care Workshop”. You can read the report in total at the following link.
The report summary reads:
The President’s Council of Advisors on Science and Technology (PCAST) and the National Academies of Sciences, Engineering, and Medicine (NAS) have brought forth recommendations on how to, among others, improve hearing aid accessibility and affordability for hearing impaired adults. Most of the recommendations are sound and reasonable. The Food and Drug Administration (FDA) has already acted on the recommendation to eliminate the Medical Clearance requirement for adults wanting to purchase hearing aids that was established in 1977. Recently, several Senators re-introduced the Over-the-Counter Hearing Aid Act of 2017.
There are major problems identified and discussed in this report to the Federal Trade Commission (FTC) regarding some of the above efforts. Additional information and clarification is provided in this report to justify and support the recommendations and request to abandon efforts surrounding the implementation of an OTC HA system and to not allow self-diagnosing and self-treatment of any type and degree of hearing loss by unskilled, untrained, and unregulated consumers. This report also offers additional ways of improving hearing healthcare for consumers.