The Association for Diagnostics & Laboratory Medicine (ADLM, formerly AACC) released the results of a survey that ADLM conducted to determine how the Food and Drug Administration’s (FDA’s) final laboratory developed tests rule will impact patient access to essential tests.
The survey found that, in spite of certain tests being exempt from the rule, it will still force many laboratories, particularly those in hospitals, to discontinue critical tests, including those needed to identify prescription and illegal drug use.
View the full survey results here: https://www.myadlm.org/lp/ldts-survey
On April 29, the FDA published a final rule on laboratory developed test regulation that will place these tests under FDA oversight, in addition to the Centers for Medicare & Medicaid Services (CMS) oversight that they are already under. ADLM has long contended that labs do not have the resources to meet the FDA’s regulatory requirements on top of CMS’, and that this duplicative regulation will push many labs to stop performing these essential tests. The FDA, on the other hand, has emphasized that the final rule exempts certain categories of laboratory developed tests from the agency’s full review process, though exempt tests will still be subject to other regulatory requirements. These exempt tests include so-called grandfathered tests that were offered prior to the publication of the rule, as well as tests that fill an unmet need that no FDA authorized test addresses. After the rule is phased in, which will happen over the course of 4 years, the FDA claims that these exemptions will ensure that patients have the same access to testing that they do in the present.
ADLM conducted a survey to learn directly from labs whether the FDA rule’s exemptions will help or hurt their testing capabilities. The survey went out to clinical laboratories across the U.S. and received responses from 128 of them. In spite of the rule’s exemptions, the majority of respondents said that they do not have the staff or resources to fulfill the FDA requirements that exempt laboratory developed tests will still have to meet. And more than half of the labs that won’t be able to comply with these requirements anticipate discontinuing some of their exempt tests.
The tests that labs could end up discontinuing include essential toxicology tests for fentanyl, methamphetamine, barbiturates, and cocaine. These laboratory developed drug tests are crucial because, unlike their FDA approved counterparts, they are able to detect these drugs at their lowest concentrations. Labs can also modify their laboratory developed tests quickly, enabling them to detect designer drugs as soon as they emerge. This makes these tests indispensable in the fight to curb substance abuse and overdose deaths, which surpassed 100,000 for the third straight year in 2023.
