Netherlands to adopt medical devices anti-corruption legislation

il_570xn-1096935598_e8z4As we say in Dutch: the day that you knew that would come is finally here. The legislative proposal to grant the Healthcare Inspectorate (IGZ) IGZ enforcement powers in the field of industry/HCP interactions (the “Wet van 17 mei 2017 tot wijziging van wetgeving op het terrein van de zorg in verband met het invoeren van een wettelijke regeling voor gunstbetoon bij medische hulpmiddelen en enkele bepalingen over transparantie tussen beroepsbeoefenaren en bedrijven op het terrein van geneesmiddelen en medische hulpmiddelen” – yes, we like very long descriptive titles for laws in the Netherlands) that was a long time in the making has finally been finally published. It amends the Act on Medical Devices and the Act on Healthcare Professions.


The aim of the law is twofold:

  • enable similar controls for the IGZ in the field of medical devices as it has regarding  industry/HCP interactions in the field of medicinal products and allow the IGZ to use these controls only in excessive cases where the current self-regulation under the GMH Code does not provide for sufficient control.
  • implement a legal basis for mandatory Sunshine type transparency reporting (which currently happens on a self-regulatory basis under the GMH Code).

A novelty is that contravention of the industry/HCP interactions rules is now subject to criminal enforcement in the Netherlands, and not only for industry but also for the persons accepting unlawful hospitality, i.e. HCPs but also healthcare insurance fund staff and employees of the purchasing department of healthcare institutions.


The scope of the law is not identical to that of the GMH Code. An important difference is that the law defines ‘hospitality’ (gunstbetoon), which the GMH Code deliberately does not do because of its special connotation as relevant to the medicinal products field. This is obviously not ideal, because it provides for a bad interface between the GMH Code and the law. Yet, the explanatory memorandum to the act says that the intention is that the act intends to follow the substantive provisions of the GMH Code. The act seeks to capture that entire scope regarding hospitality in one single short and rather generally worded article addressing:

  • meeting attendance (necessary costs)
  • consultancy (reasonable in relation to the work)
  • gifts (minor value and relevant to the practice)
  • purchase related bonuses / rebates

While the article is very general, there is of course a limitation in its generality and that is none of the preciseness of the GMH Code reflected in the amounts and hourly rates that industry can pay has found its way to the law. That means that the IGZ could theoretically have a completely different idea of what is necessary, reasonable or minor and relevant. It is expected however that the government will publish further policy regarding interpretation by the IGZ, so we will need to see how this will land in the end.


The act will enter into force at a date to be determined by implementing act, which no doubt will take place soon.

Companies already diligently implementing the GMH Code for the Netherlands (likely) will not see any substantive changes (we hope) as a result of this law and companies that do not have some additional compliance implementation work to look forward to.

Final MDR and IVDR texts published

agent-smith-matrix-hear-that-that-is-the-sound-of-inevitabilityAs Agent Smith said: “You hear that Mr. Anderson?… That is the sound of inevitability…”.

Today’s EU Official Journal contains the final final final texts of the MDR (finally numbered as Regulation (EU) 2017/745) and the IVDR (finally numbered as Regulation (EU) 2017/746), downloadable in any language that you could possibly like.

I wish you a pleasant weekend reading them in front of the fireplace with a good glass of wine. I for myself am glad I started with that more than four years ago.

Now is the time, and this is not an exaggeration. If you have not started getting to grips with these new rules, start immediately. You will find it’s  lot of work, especially if you are a small or medium sized company. You will literally need to redo all your technical files, redo all declarations of conformity, redo all clinical evaluations to a higher standard, implement all new definitions in the MDR and IVDR, deal with changes in classification and their consequences for renewed CE marking under the MDR and IVDR (especially in IVDs, software, substance based devices and nanomaterial containing devices!), implement UDI, amend your quality system, amend your vigilance and PMS procedures, implement PMCF where you not doing that already, implement new software design requirements, etc., etc., etc.

Schermafdruk 2017-05-05 13.00.06

And then there is of course the Brexit impact of which nobody even knows yet what it will entail.

Impact in costs/FTEs

This will all come at a cost. Basil Akra from notified body TÜV SÜD posted this simple rough calculation on his LinkedIn profile today:

Costs MDR

If you are not an SME then – well duh – the implementation costs will be a lot higher because more devices, so more FTEs and more costs. Where will we find all these people that we never needed before?

Gap and impact assessment

In order to know what to do specifically for implementation of the new rules you have to find the gaps and assess them for impact. If you are not already doing this, start now. Otherwise you’ll be too late to for example complete any additional clinical studies you might need to do to meet the new burden of clinical data under the MDR and obtain a new CE mark under the new regulations. Especially for IVDs the new IVDR is an enormous step up in requirements for clinical data, clinical performance evaluation and dossier / procedural requirements. And for IVDs there are even less experts available in the market or at your competitors, so catch them while you can.

If you you have no idea where to start, or have an idea but would like to be inspired, I recommend you visit our seminar in Amsterdam this Wednesday (10 May) afternoon, which is only and specifically about transition and implementation.


MDR and IVDR to be published this Friday

agent-smith-matrix-hear-that-that-is-the-sound-of-inevitabilityMark 5 May 2017 in your calendar – this date will be a landmark for EU medical devices law because the MDR and IVDR will be published in the EU Official Journal.

This means that the MDR and IVDR will enter into force on the twentieth day following that of their publication and from that date the transitional periods under the regulations will start.

E-mailAnd the clock will then start ticking officially – if you still are not feeling a sense of urgency about getting ready for their implementation now is a good time to start feeling that urgency.

As I have been repeating like a broken record: not being compliant under the regulations in time equals to no more placing products on the EU market. There-is-no-grandfathering. Every device must be phased into the new system and meet all new requirements that apply to it.

You will be able to download the final texts from the Official Journal website yourself in any of the 24 official EU languages that you like, but I will of course also post them on this blog as well.

You are still welcome to join our timely 10 May seminar in Amsterdam to hear more about the MDR – we expanded capacity and can host a lot more people now. We will follow up with an IVDR specific seminar soon.

We are looking forward to meet you!

M58fdaa53-32b0-44c2-bf95-51c7c35ff8c2y apologies for the incidental self-promotion.

Our practice continues to grow and that means we are always looking for people to staff our firm. We currently have vacancies for a number of lawyers at different levels of seniority. I will therefore tap into the community and hope you can help.

So, if you know of any (Dutch law) qualified lawyers that would like to work at an excellent boutique firm and practice law at the top of their game for the most interesting companies in the life sciences field, please send them our way.

If you are one yourself, we’re very happy to talk to you and make you an offer you should not refuse.

By the way, if you need encouragement, lawyers ranking guide Chambers Europe again ranked us higher this year in a streak starting when we set up the firm five years ago, mainly on the authority of what our peers and our clients have said about us. So peers (I know you subscribe to this blog) and clients out there, we love you and thank you for your continued trust, support and respect.

If you’re interested in joining us, please contact me ( or our office manager (details below):

Schermafdruk 2017-04-24 15.54.06.png


MDR and IVDR seminars

By the way, the MDR seminar on gap assessment and transition planning announced in the previous blog has been fully booked in the mean time still has room because we were able to rent a bigger room. Keep those RSVPs coming!

The good news is (still) twofold.

First: yes, we will organise a separate seminar for the IVD industry about the IVDR. We have many requests for an IVDR specific seminar, which we were already planning in the background all along.

Secondly: yes, we will organise another MDR seminar for those that were too late for  could not make the first one – but the date will be much later in the year. The speaker line-up may vary but will be interesting.

Watch this space for the save-the-dates for both seminars!

MDR and IVDR adopted by Parliament – entry into force imminent

agent-smith-matrix-hear-that-that-is-the-sound-of-inevitabilityCompletely in line with expectations the Parliament adopted the texts of the MDR and the IVDR yesterday. I have nothing to add to that in addition to previous posts in this blog. It is what it already was. The texts can be found here.

This means that we are now looking at publication in the Official Journal beginning of May (you will finally have the final official texts) and entry into force 20 days later (expect beginning of June). It is now inevitable.

Transitional periods

The transitional periods of 3 years (MDR) and 5 years (IVDR) will start then and the train will leave the station and you will be on board, whether you like it or not. If you are still stuck in one stage or another of the classic stages of grief, you had better pick yourself up and move straight to the stage of acceptance. Many companies I know are stuck in anger, denial or depression, and are some still bargaining (we are past possibilities for lobbying on the regulations now, although there are some possibilities now in implementation)), but at this point this kind of drama is wasted energy.


Yes, many things are still uncertain and unclear and still need to be fleshed out in more detail in implementing acts etc., but this is not an excuse to sit on your hands and wait while inevitability catches up with you in the worst possible way.

Actually, things are pretty clear already: you need to transition your products into the new system and we know what it looks like. If you don’t transition, or if you don’t manage in time – off the cliff you go: you cannot place the products on the market in the EU anymore. There is no grandfathering, only a hard stop.

So, what would Brian Boitano do?

He’d make a plan, and he’d follow through. I have discussed all the substantive requirements of both regulations in detail on this blog and they have been discussed by many others too, so you are familiar with them already, right? No need to repeat all of that.

The next step is to look at each of your products in detail and decide for each product if you will replace, retire or remediate it depending on what is required to bring it into compliance with the new regulations.

You may want to try and exploit the limited grace periods of four (MDR) and two (IVDR) years that are given after the transitional period for devices with a certificate that is renewed during the transitional period. However, relying on these comes at a cost that you need to be aware of (essentially you cannot change your device or intended purpose anymore).

Also, remember that this option is not available for any of the currently self certified devices (because they don’t have a certificate that can be renewed). This means that you may have a very steep and quick learning curve ahead if your device goes from class I MDD to class III MDR (which is the case for a lot of clinical decision support software and substance based devices) or from self-certified IVD to class D IVD under the IVDR (the large majority of currently self certified IVDs will need a notified body certificate under the IVDR). And these are just the most extreme examples.

And then there are the overall changes you have to make to basically everything you do with respect to the EU market, because the changes are not limited to products but also affect your quality system, risk management, vigilance procedures and so on.

So you do you make a plan like that?

Save the date of 10 May for a seminar on implementation and transition to MDR and IVDR at Axon

You can invent your own wheel or you can see how others are approaching the situation. That’s why I decided to organise a seminar at Axon Lawyers specifically regarding implementation and transition planning. I have teamed up with Gert Bos from Qserve and the Dutch Healthcare Inspectorate has graciously agreed to present its view on transition and implementation. This will be an afternoon of deep diving into how to get your organisation from the MDD to MDR and from the IVDD to IVDR in a meaningful and intelligent way.

The seminar will take place on Wednesday 10 May in the late afternoon. As always it’s free and you can bring as many colleagues / friends as you like. If you’re on our mailing list, you will receive an invitation. If you’re not but would like to be, let me know. Otherwise you can already RSVP to Marjon Kuijs, our office manager with the name of each person that will attend so we can plan for enough chairs and drinks and print everyone’s name on a badge.

This is it: MDR and IVDR texts now ready for final voting


The MDR and the IVDR in paper now that they finally final, printed on both sides mind you

The fat lady has her lines and is about to sing. After the lengthy legal linguist revision process (remember, these texts have to be consistent in 24 languages) the Council published the text for its first reading for the MDR and IVDR.


First reading only, after such a lengthy process in which we arrived at a ‘general approach’ sufficient for starting the trilogue.

After the trilogue we had many interesting last ditch lobby mini battles about some of the things that came out of the translation process and legal linguist review.

So now everybody (Council and Parliament) still needs to formally vote on this text but that should be – well – a formality now. Aim for entry into force this summer.

Texts and compares, and no changes?

If you haven’t got them already, the first reading texts are here for your download and perusal:

And here are the compares that I myself made versus the trilogue texts (warning: these are pdfs coming from a public Dropbox directory, so your security settings may not like this at all) – I hope they are useful:

Although the institutional actors in the legislative process keep saying nothing changed that was not in the trilogue agreed texts, I believe there was a bit more detail to this and so did others. Here we go:

No design dossier review after all for the class IIb active devices that transport medicines to and from the body

One of the things that came out of the legal linguist review and looked like more than minor goalpost moving was the unhappy surprise that class IIb active devices that transport medicines to and from the body would also be subjected to design dossier review under article 52(4) MDR. This was a very bad surprise for manufacturers of these devices, many of which are very well understood and proven technology. An important group of devices affected would only fall in the scope of this clause because of the (in my view weird) practice of qualification of gases used in medical setting as medicinal products.

However, this has been taken out again of the first reading text, likely after a last minute targeted lobby. Water under the regulatory bridge now.

But some changes in the transitional regime with potentially big consequences

Another interesting development that lead to a true change was the adaptation to the transitional regimes in articles 120(3) MDR and 110(3) IVDR and the associated recital 99 in both regulations. While these articles are new they clarify the transitional system that remained the same in the basis, except that reliance on the grace periods for certificates overrunning the date of application became a lot less attractive as a result.

The new provisions clarify requirements that apply to devices that are relying on the grace period of 4 (MDR) respectively 2 (IVDR) years with respect to PMS, market surveillance etc (MDR/IVDR instead of the old directives, which was unclear).

They also provide that during the grace period (and that’s an important one) no significant design or intended purpose changes are allowed anymore. In other words, the device is locked in its status quo at the date of application of the MDR/IVDR (the end of the transitional period).

This is very important for the manufacturers that will miss the boat for an MDR/IVDR certificate during the transitional period and will be forced to rely on a grace period MDD/AIMDD/IVDD certificate or are betting on using the grace period because they know that they won’t be ready for an MDR/IVDR certificate by the date of application. The penalty (or trade-off) for relying on that regime is that these devices cannot be subject to any significant changes in design or intended purpose (unless of course when the changed device is placed on the market under an MDR/IVDR certificate) for that period.

Manufacturers stuck in a grace period will therefore not be able to make any significant innovations or extend the scope of the device’s intended purpose until their notified body will be able to issue an MDR or IVDR certificate for the device. This is crucial for manufacturers in relation to transition planning: if you’re late in the day and won’t obtain your MDR / IVDR certificate during the transitional period and you are lucky enough to be able to extend your existing certificate past the date of application, your device innovation is essentially frozen until your notified body is able to issue an MDR / IVDR certificate. This will affect your competitive position in the market – see this article in MedTech Insight for more details on potential consequences of the choice to rely on the grace period.

Also, manfufacturers relying on the grace period must realise that they will be in a situation of concurrent application of MDR/IVDR and MDD/AIMDD/IVDD certificates. That means that the market can choose between competing products with an MDR/IVDR certificate or a MDD/AIMDD/IVDD certificate. Different standards, same intended purpose.  But some certificates may be more equal than others – what will you prefer if you are a hospital issuing a tender, or country in the Middle East or Asia relying on CE certificates? Certificates under the regulations or certificates under the directives? It will be interesting to see if the EU Court’s Medipac judgment (every CE marked device on the market is equally good from regulatory perspective and tendering entities may not discriminate between them) also holds when a hospital prefers MDR / IVDR certificates over ‘old’ certificates in a tender, given that it can be argued that the conformity assessment for MDR /IVDR certificates was to a higher standard (the whole idea of the new regulations in the first place). Moreover, while the Medipac judgment applies in the EU, it does not apply to tendering and regulating entities outside it.

schermafbeelding-2017-01-29-om-20-44-43Finally, don’t forget that the grace period referred to above is available only for devices with a notified body issued CE certificate – so not for all self-certified devices (which constitutes the majority of CE marked IVDs currently on the market for example). All self certified devices have to be compliant by the date of application of the MDR/IVDR – no grandfathering.

Manufacturers of self certified devices (class I MDD/self certified IVDs) also have to pay additional attention to whether their device remains self certified or not (not for most of the IVDs) in which case they have to be ready to deal with the bottlenecks at the end of the transitional period. For these manufacturers it will be sink or swim, because no MDR/IVDR certificate by date of application is no more placing of products on the market and off of the regulatory cliff you go.

IVD conformity assessment changes

Some amendments were made to conformity assessment for IVDs with respect to the procedures for companion diagnostics and class D devices – nothing shocking.

For companion diagnostics it was clarified that the notified body must consult a competent authority for medicines (makes sense for a companion diagnostic), as is set out in the new paragraph in article 48 (3):

“In addition to the procedures referred to in the first and second subparagraphs, for companion diagnostics, the notified body shall consult a competent authority designated by the Member States in accordance with Directive 2001/83/EC of the European Parliament and of the Council1 or the EMA, as applicable, in accordance with the procedure set out in Section 5.2 of Annex IX.”

It was further clarified that companion diagnostics need to go through the Assessment of the technical documentation procedure in Annex IX, 4.1-4.8 (see addition to Annex IX, 5.2 (a)).

None of this was new, but now it has been written down more clearly.

For class D devices it was clarified that:

“Manufacturers of class D devices, other than devices for performance study, may, instead of the conformity assessment procedure applicable pursuant to paragraph 3, choose to apply a conformity assessment as specified in Annex X coupled with a conformity assessment as specified in Annex XI.”

This is also not stunning new logic, as type examination combined with production quality assurance is a normal combination as alternative to full quality system based conformity assessment procedure for high risk devices (see article 52 (3) MDR in relation to class III devices, but also article 11 (1) (b) MDD provided this already – obviously the IVDD did not have this logic yet as it relied on another conformity assessment logic).

Other (little) details

I haven’t been able to go through both of the texts in complete detail but I spotted the some things that may be worth mentioning for each regulation – more may be forthcoming in future blogs. You will see that the numbering of articles and sections and even whole annexes has changed compared to the trilogue text, so we all will have to learn new numbering.


  • New recital 18 added that “this Regulation should include requirements for devices’ safety and performance characteristics which are developed in such a way as to prevent occupational injuries, including protection from radiation.”
  • Free nomenclature for use of Eudamed (recital 45)
  • Scientific advice is possible for the IIb devices that are also subject to the clinical  (recital 57 and article 61 (2) MDR)
  • “directly or indirectly” was taken out of rule 11 (classification of software) in Annex VIII – not sure what that means yet.
  • Article 52 (9), (10) and (11) conformity assessment procedures for device-drug combinations, devices incorporating tissues and cells and substance-based devices have been clarified
  • Article 78 (14) is new, giving member states more room not to apply the coordinated assessment procedure for multi-jurisdiction clinical trials yet.
  • New recital 73 stating that “the principles of replacement, reduction and refinement in the area of animal experimentation laid down in the Directive 2010/63/EU of the European Parliament and of the Council should be observed. In particular, the unnecessary duplication of tests and studies should be avoided.”, which is well and good except that this recital is not operationalised in the MDR.
  • New recital 99 reflecting the changes to article 120 (3) transitional regime described above.


  • New recital 16 that “this Regulation should include requirements for devices’ safety and performance characteristics which are developed in such a way as to prevent occupational injuries, including protection from radiation.”
  • Additional recital language on home brew IVDs (recitals 28 and 29)
  • Free nomenclature for use of Eudamed (recital 42)New recital 73 stating that “the principles of replacement, reduction and refinement in the area of animal experimentation laid down in the Directive 2010/63/EU of the European Parliament and of the Council should be observed. In particular, the unnecessary duplication of tests and studies should be avoided.”, which is well and good except that this recital is not operationalised in the MDR.
  • New recital 74 stating that “the principles of replacement, reduction and refinement in the area of animal experimentation laid down in the Directive 2010/63/EU of the European Parliament and of the Council should be observed. In particular, the unnecessary duplication of tests and studies should be avoided.”, which is well and good except that this recital is not operationalised in the IVDR.
  • Article 78 (14) is new, giving member states more room not to apply the coordinated assessment procedure for multi-jurisdiction clinical trials yet.
  • Changes to recitals 98 and 99 reflecting the changes to article 110 (3) transitional regime described above.

Full steam ahead!

So, now it’s full steam ahead to publication, entry into force, the implementation circus and the mother of all bottlenecks towards the end of the transitional period when the newly notified MDR/IVDR notified bodies will need to push as many devices already on the market as they can through certification, with the additional burden of the new devices entering the market towards the end of the transitional period. This will not look nice, especially not for the manufacturers that are not well-prepared. More about that in a next blog!

Where would we be without good people?

Nowhere of course – that’s why it’s so important to keep them motivated and retained.

My firm is organising a seminar in Amsterdam on 1 March on Motivation and Retention Strategies in the Life Sciences Industry, with a focus on possibilities under employment, corporate and tax law.

You are most cordially invited to attend with as many people as you like.

As always attendance is free, parking easy, presentations in English and the drinks afterwards will be good networking – just make sure to RSVP please so we can plan for space and catering (see details below).19-006-seminaruitnodiging_loyens_1b

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