21 U.S.C. § 355a
Pediatric studies of drugs
As used in this section, the term “pediatric studies” or “studies” means at least one clinical investigation (that, at the Secretary’s discretion, may include pharmacokinetic studies) in pediatric age groups (including neonates in appropriate cases) in which a drug is anticipated to be used, and, at the discretion of the Secretary, may include preclinical studies.
The Secretary shall not extend the period referred to in paragraph (1)(A) or (1)(B) if the determination made under subsection (d)(4) is made later than 9 months prior to the expiration of such period.
The Secretary shall not extend the period referred to in paragraph (1)(A) or (1)(B) if the determination made under subsection (d)(4) is made later than 9 months prior to the expiration of such period.
The Secretary may, after consultation with the sponsor of an application for an investigational new drug under section 355(i) of this title, the sponsor of an application for a new drug under section 355(b)(1) of this title, or the holder of an approved application for a drug under section 355(b)(1) of this title, issue to the sponsor or holder a written request for the conduct of pediatric studies for such drug. In issuing such request, the Secretary shall take into account adequate representation of children of ethnic and racial minorities. Such request to conduct pediatric studies shall be in writing and shall include a timeframe for such studies and a request to the sponsor or holder to propose pediatric labeling resulting from such studies. If a request under this subparagraph does not request studies in neonates, such request shall include a statement describing the rationale for not requesting studies in neonates.
If, on or after
An applicant or holder that, on or after
The Secretary shall review and act upon a submission by a sponsor or holder of a proposed pediatric study request or a proposed amendment to a written request for pediatric studies within 120 calendar days of the submission.
Not later than 180 days after the submission of the reports of the studies, the Secretary shall accept or reject such reports and so notify the sponsor or holder. The Secretary’s only responsibility in accepting or rejecting the reports shall be to determine, within the 180-day period, whether the studies fairly respond to the written request, have been conducted in accordance with commonly accepted scientific principles and protocols, and have been reported in accordance with the requirements of the Secretary for filing.
Nothing in this subsection alters or amends section 331(j) of this title or section 552 of title 5 or section 1905 of title 18.
With respect to a drug that is a qualified countermeasure (as defined in section 247d–6a of title 42), a security countermeasure (as defined in section 247d–6b of title 42), or a qualified pandemic or epidemic product (as defined in section 247d–6d of title 42), the Secretary shall solicit input from the Assistant Secretary for Preparedness and Response regarding the need for and, from the Director of the Biomedical Advanced Research and Development Authority regarding the conduct of, pediatric studies under this section.
The Secretary shall publish a notice of any determination, made on or after
The Secretary shall publish a notice identifying any drug for which, on or after
The Secretary shall utilize the internal review committee established under section 355d of this title to review all written requests issued on or after
The committee referred to in paragraph (1) shall review all written requests issued pursuant to this section prior to being issued.
The committee referred to in paragraph (1) may review studies conducted pursuant to this section to make a recommendation to the Secretary whether to accept or reject such reports under subsection (d)(4).
The committee referred to in paragraph (1) may operate using appropriate members of such committee and need not convene all members of the committee.
For each drug, the committee referred to in paragraph (1) shall document, for each activity described in paragraph (2) or (3), which members of the committee participated in such activity.
The Secretary shall provide to the committee referred to in paragraph (1) any response issued to an applicant or holder with respect to a proposed pediatric study request.
Exclusivity under this section shall only be granted for the completion of a study or studies that are the subject of a written request and for which reports are submitted and accepted in accordance with subsection (d)(4). Written requests under this section may consist of a study or studies required under section 355c of this title.
The Commissioner shall consider the recommendations of the Pediatric Advisory Committee and, if appropriate, not later than 30 days after receiving the recommendation, make a request to the sponsor of the application to make any labeling change that the Commissioner determines to be appropriate.
If the sponsor of the application, within 30 days after receiving a request under subparagraph (C), does not agree to make a labeling change requested by the Commissioner, the Commissioner may deem the drug that is the subject of the application to be misbranded.
Nothing in this subsection limits the authority of the United States to bring an enforcement action under this chapter when a drug lacks appropriate pediatric labeling. Neither course of action (the Pediatric Advisory Committee process or an enforcement action referred to in the preceding sentence) shall preclude, delay, or serve as the basis to stay the other course of action.
If, on or after
Not later than 210 days after the date of submission of a report on a pediatric study under this section, the Secretary shall make available to the public the medical, statistical, and clinical pharmacology reviews of pediatric studies conducted under subsection (b) or (c).
Beginning on
Nothing in this subsection alters or amends section 331(j) of this title or section 552 of title 5 or section 1905 of title 18.
Beginning on
Following the 18-month period described in paragraph (1), the Secretary shall, as appropriate, refer to the Office of Pediatric Therapeutics all pediatric adverse event reports for a drug for which a pediatric study was conducted under this section. In considering such reports, the Director of such Office may provide for the review of such reports by the Pediatric Advisory Committee, including obtaining any recommendation of such Committee regarding whether the Secretary should take action in response to such reports.
Nothing in this subsection shall prohibit the Office of Pediatric Therapeutics from providing for the review of adverse event reports by the Pediatric Advisory Committee prior to the 18-month period referred to in paragraph (1), if such review is necessary to ensure safe use of a drug in a pediatric population.
The requirements of this subsection shall supplement, not supplant, other review of such adverse event reports by the Secretary.
The Secretary shall give the public notice of a decision under paragraph (1)(A) not to require an assessment under section 355c of this title and the basis for such decision.
Nothing in this subsection alters or amends section 331(j) of this title or section 552 of title 5 or section 1905 of title 18.
A drug for which an application has been submitted or approved under subsection (b)(2) or (j) of section 355 of this title shall not be considered ineligible for approval under that section or misbranded under section 352 of this title on the basis that the labeling of the drug omits a pediatric indication or any other aspect of labeling pertaining to pediatric use when the omitted indication or other aspect is protected by patent, or by exclusivity under clause (iii) or (iv) of section 355(j)(5)(F) of this title, clause (iii) or (iv) of section 355(c)(3)(E) of this title, or section 360cc(a) of this title, or by an extension of such exclusivity under this section or section 355f of this title.
2021—Subsec. (c)(1)(A)(i)(II). Pub. L. 117–9 substituted “(c)(3)(E)” for “(c)(3)(D)”.
2017—Subsecs. (b), (c). Pub. L. 115–52, § 505(b)(2)(A), substituted “subsection (d)(4)” for “subsection (d)(3)” in introductory provisions of par. (1) and in par. (2).
Subsec. (d)(3) to (6). Pub. L. 115–52, § 505(b)(1), added par. (3) and redesignated former pars. (3) to (5) as (4) to (6), respectively.
Subsec. (f)(3). Pub. L. 115–52, § 505(b)(2)(A), substituted “subsection (d)(4)” for “subsection (d)(3)”.
Subsec. (f)(7). Pub. L. 115–52, § 505(a), added par. (7).
Subsec. (h). Pub. L. 115–52, § 505(b)(2)(A), substituted “subsection (d)(4)” for “subsection (d)(3)”.
Subsec. (o). Pub. L. 115–52, § 608(1), struck out “under section 355(j)” after “approval of drugs” in heading.
Subsec. (o)(1). Pub. L. 115–52, § 608(2), substituted “under subsection (b)(2) or (j) of section 355 of this title” for “under section 355(j) of this title” and “, or by exclusivity under clause (iii) or (iv) of section 355(j)(5)(F) of this title, clause (iii) or (iv) of section 355(c)(3)(E) of this title, or section 360cc(a) of this title, or by an extension of such exclusivity under this section or section 355f of this title” for “or by exclusivity under clause (iii) or (iv) of section 355(j)(5)(F) of this title”.
Subsec. (o)(2). Pub. L. 115–52, § 608(3), in introductory provisions, inserted “clauses (iii) and (iv) of section 355(c)(3)(E) of this title, or section 360cc of this title,” after “section 355(j)(5)(F) of this title,” and substituted “drug approved pursuant to an application submitted under subsection (b)(2) or (j) of section 355 of this title” for “drug approved under section 355(j) of this title”.
Subsec. (o)(3). Pub. L. 115–52, § 608(4), amended par. (3) generally. Prior to amendment, text read as follows: “This subsection does not affect—
“(A) the availability or scope of exclusivity under this section;
“(B) the availability or scope of exclusivity under section 355 of this title for pediatric formulations;
“(C) the question of the eligibility for approval of any application under section 355(j) of this title that omits any other conditions of approval entitled to exclusivity under clause (iii) or (iv) of section 355(j)(5)(F) of this title; or
“(D) except as expressly provided in paragraphs (1) and (2), the operation of section 355 of this title.”
2016—Subsec. (p). Pub. L. 114–255 struck out subsec. (p) which related to Institute of Medicine study.
2013—Subsec. (d)(5). Pub. L. 113–5, § 307(a)(1), added par. (5).
Subsec. (n)(1)(C). Pub. L. 113–5, § 307(a)(2), added subpar. (C).
2012—Subsec. (d)(1)(A). Pub. L. 112–144, § 502(b), inserted at end “If a request under this subparagraph does not request studies in neonates, such request shall include a statement describing the rationale for not requesting studies in neonates.”
Subsec. (h). Pub. L. 112–144, § 502(a)(1), amended subsec. (h) generally. Prior to amendment, text read as follows: “Notwithstanding any other provision of law, if any pediatric study is required by a provision of law (including a regulation) other than this section and such study meets the completeness, timeliness, and other requirements of this section, such study shall be deemed to satisfy the requirement for market exclusivity pursuant to this section.”
Subsec. (k)(2). Pub. L. 112–144, § 509(a)(1), substituted “subsection (f)(6)(F)” for “subsection (f)(3)(F)”.
Subsec. (l)(1). Pub. L. 112–144, § 509(a)(2)(A), substituted “first 18-month period” for “year one” in heading and “18-month” for “one-year” in text.
Subsec. (l)(2). Pub. L. 112–144, § 509(a)(2)(B), substituted “periods” for “years” in heading and “18-month period” for “one-year period” in text.
Subsec. (l)(3), (4). Pub. L. 112–144, § 509(a)(2)(C), (D), added par. (3) and redesignated former par. (3) as (4).
Subsec. (n). Pub. L. 112–144, § 509(a)(3)(A), substituted “submitted” for “completed” in heading.
Subsec. (n)(1). Pub. L. 112–144, § 509(a)(3)(B)(i), substituted “have not been submitted by the date specified in the written request issued or if the applicant or holder does not agree to the request” for “have not been completed” in introductory provisions.
Subsec. (n)(1)(A). Pub. L. 112–144, § 509(a)(3)(B)(ii), inserted “, or for which a period of exclusivity eligible for extension under subsection (b)(1) or (c)(1) of this section or under subsection (m)(2) or (m)(3) of section 262 of title 42 has not ended” after “expired” and struck out at end “Prior to making such a determination, the Secretary may not take more than 30 days to certify whether the Foundation for the National Institutes of Health has sufficient funding at the time of such certification to initiate and fund all of the studies in the written request in their entirety within the timeframes specified within the written request. Only if the Secretary makes such certification in the affirmative, the Secretary shall refer all pediatric studies in the written request to the Foundation for the National Institutes of Health for the conduct of such studies, and such Foundation shall fund such studies. If no certification has been made at the end of the 30-day period, or if the Secretary certifies that funds are not sufficient to initiate and fund all the studies in their entirety, the Secretary shall consider whether assessments shall be required under section 355c(b) of this title for such drug.”
Subsec. (n)(1)(B). Pub. L. 112–144, § 509(a)(3)(B)(iii), substituted “no unexpired listed patents and for which no unexpired periods of exclusivity eligible for extension under subsection (b)(1) or (c)(1) of this section or under subsection (m)(2) or (m)(3) of section 262 of title 42 apply,” for “no listed patents or has 1 or more listed patents that have expired,”.
Subsec. (o)(2)(B). Pub. L. 112–144, § 509(a)(4), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: “a statement of any appropriate pediatric contraindications, warnings, or precautions that the Secretary considers necessary.”
Subsec. (q). Pub. L. 112–144, § 501(a), struck out subsec. (q). Text read as follows: “A drug may not receive any 6-month period under subsection (b) or (c) unless—
“(1) on or before
“(2) on or before
“(3) all requirements of this section are met.”
2010—Subsec. (p)(4) to (6). Pub. L. 111–148 added pars. (4) to (6) and struck out former pars. (4) and (5) which read as follows:
“(4) review and assess the pediatric studies of biological products as required under subsections (a) and (b) of section 355c of this title; and
“(5) make recommendations regarding appropriate incentives for encouraging pediatric studies of biologics.”
2007—Pub. L. 110–85 amended section generally. Prior to amendment, text consisted of subsecs. (a) to (n) relating to pediatric studies of drugs, including market exclusivity, conduct of pediatric studies, delay of effective date for certain applications, notice of determinations on studies requirement, limitations, research requirements, labeling supplements, dissemination of information, prompt approval of drugs, report to Congress not later than
2003—Subsec. (b)(1)(A)(i). Pub. L. 108–173, § 1104(1), substituted “(j)(5)(F)(ii)” for “(j)(5)(D)(ii)” in two places.
Subsec. (b)(1)(A)(ii). Pub. L. 108–173, § 1104(2), substituted “(j)(5)(F)” for “(j)(5)(D)”.
Subsec. (b)(2). Pub. L. 108–155, § 3(a), substituted “355(j)(5)(B)” for “355(j)(4)(B)” in two places.
Subsec. (c)(1)(A)(i). Pub. L. 108–173, § 1104(1), substituted “(j)(5)(F)(ii)” for “(j)(5)(D)(ii)” in two places.
Subsec. (c)(1)(A)(ii). Pub. L. 108–173, § 1104(2), substituted “(j)(5)(F)” for “(j)(5)(D)”.
Subsec. (c)(2). Pub. L. 108–155, § 3(a), substituted “355(j)(5)(B)” for “355(j)(4)(B)” in two places.
Subsec. (e). Pub. L. 108–173, § 1104(3), substituted “355(j)(5)(F)” for “355(j)(5)(D)”.
Subsec. (h). Pub. L. 108–155, § 2(b)(2), substituted “pediatric research requirements” for “regulations” in heading and “by a provision of law (including a regulation) other than this section” for “pursuant to regulations promulgated by the Secretary” in text.
Subsec. (i)(2). Pub. L. 108–155, § 3(b)(1), struck out “Advisory Subcommittee of the Anti-Infective Drugs” before “Advisory Committee” wherever appearing.
Subsec. (l). Pub. L. 108–173, § 1104(3), substituted “355(j)(5)(F)” for “355(j)(5)(D)” wherever appearing.
2002—Subsec. (a). Pub. L. 107–109, § 19(2), (3), redesignated subsec. (g) as (a). Former subsec. (a) redesignated (b).
Subsec. (a)(1)(A). Pub. L. 107–109, § 19(1)(A), (B), substituted “(j)(5)(D)(ii)” for “(j)(4)(D)(ii)” in two places in cl. (i) and “(j)(5)(D)” for “(j)(4)(D)” in cl. (ii).
Subsec. (b). Pub. L. 107–109, § 19(2), (3), redesignated subsec. (a) as (b).
Pub. L. 107–109, § 2(1), struck out heading and text of subsec. (b). Text read as follows: “Not later than 180 days after
Subsec. (c). Pub. L. 107–109, § 2(2), in introductory provisions, inserted “determines that information relating to the use of an approved drug in the pediatric population may produce health benefits in that population and” after “the Secretary” and struck out “concerning a drug identified in the list described in subsection (b) of this section” after “such studies)”.
Subsec. (c)(1)(A). Pub. L. 107–109, § 19(1)(A), (B), substituted “(j)(5)(D)(ii)” for “(j)(4)(D)(ii)” in two places in cl. (i) and “(j)(5)(D)” for “(j)(4)(D)” in cl. (ii).
Subsec. (d)(1). Pub. L. 107–109, § 19(4), substituted “subsection (b) or (c)” for “subsection (a) or (c)” in introductory provisions.
Subsec. (d)(2). Pub. L. 107–109, §§ 18(a), 19(4), substituted “subsection (b) or (c)” for “subsection (a) or (c)” and inserted “In reaching an agreement regarding written protocols, the Secretary shall take into account adequate representation of children of ethnic and racial minorities.” after first sentence.
Subsec. (d)(3). Pub. L. 107–109, § 19(4), substituted “subsection (b) or (c)” for “subsection (a) or (c)”.
Subsec. (d)(4). Pub. L. 107–109, § 4, added par. (4).
Subsec. (e). Pub. L. 107–109, § 19(1)(C), (4), substituted “section 355(j)(5)(D)” for “section 355(j)(4)(D)” and “subsection (b) or (c)” for “subsection (a) or (c)”.
Subsec. (g). Pub. L. 107–109, § 19(2), (3), (5), redesignated subsec. (h) as (g) and substituted “subsection (b) or (c)” for “subsection (a) or (b)” in introductory provisions. Former subsec. (g) redesignated (a).
Pub. L. 107–109, § 7, inserted “(including neonates in appropriate cases)” after “pediatric age groups”.
Subsec. (h). Pub. L. 107–109, § 19(2), (3), redesignated subsec. (i) as (h). Former subsec. (h) redesignated (g).
Subsec. (i). Pub. L. 107–109, § 19(2), (3), redesignated subsec. (l) as (i). Former subsec. (i) redesignated (h).
Subsec. (j). Pub. L. 107–109, § 19(2), (3), redesignated subsec. (m) as (j). Former subsec. (j) redesignated (n).
Pub. L. 107–109, § 8, added subsec. (j) and struck out heading and text of former subsec. (j). Text read as follows: “A drug may not receive any six-month period under subsection (a) or (c) of this section unless the application for the drug under section 355(b)(1) of this title is submitted on or before
“(1) the drug was in commercial distribution as of
“(2) the drug was included by the Secretary on the list under subsection (b) of this section as of
“(3) the Secretary determines that there is a continuing need for information relating to the use of the drug in the pediatric population and that the drug may provide health benefits in that population; and
“(4) all requirements of this section are met.”
Subsec. (k). Pub. L. 107–109, § 19(2), (3), redesignated subsec. (n) as (k). Former subsec. (k) redesignated (m).
Subsec. (l). Pub. L. 107–109, § 19(2), (3), redesignated subsec. (o) as (l). Former subsec. (l) redesignated (i).
Pub. L. 107–109, § 5(b)(2), added subsec. (l).
Subsec. (m). Pub. L. 107–109, § 19(2), (3), redesignated subsec. (k) as (m). Former subsec. (m) redesignated (j).
Pub. L. 107–109, § 9, added subsec. (m).
Subsec. (n). Pub. L. 107–109, § 19(4), which directed substitution of “subsection (b) or (c)” for “subsection (a) or (c)” in subsec. (m), was executed by making the substitution in introductory provisions of subsec. (n), to reflect the probable intent of Congress.
Pub. L. 107–109, § 19(2), (3), redesignated subsec. (j) as (n). Former subsec. (n) redesignated (k).
Pub. L. 107–109, § 10, added subsec. (n).
Subsec. (o). Pub. L. 107–109, § 19(2), (3), redesignated subsec. (o) as (l).
Pub. L. 107–109, § 11(a), added subsec. (o).
Pub. L. 112–144, title V, § 509(g),
Pub. L. 110–85, title V, § 502(a)(2),
Amendment by Pub. L. 108–155 effective
Pub. L. 107–109, § 11(b),
Pub. L. 110–85, title IX, § 901(e),
Pub. L. 115–52, title V, § 505(c),
Pub. L. 115–52, title V, § 505(d)(2),
Pub. L. 112–144, title V, § 503,
Pub. L. 112–144, title V, § 504,
Pub. L. 107–109, § 16,
Pub. L. 107–109, § 18(b),