Medical Devices
Regulation (EU) 2017/745 of the European Parliament and of the Council on medical devices (MDR) is applicable.
In accordance with MDR:
Royal Legislative Decree 1/2015 of 24 July 2015, approving the revised text of the Spanish Law on guarantees and rational use of medicines and medical devices, is also applicable, as the main national legal framework governing MD.
It is also applicable the recent Royal Decree 192/2023, of 21 March 2023 on medical devices (Spanish Decree on MD), which covers, amongst other matters:
PPE
Regulation (EU) 2016/425 of the European Parliament and of the Council, on personal protective equipment (PPE) is applicable.
In accordance with PPE Regulation:
In the case of Category II or III PPE, before the CE marking is affixed, a Notified Body intervenes during the Declaration of Conformity assessment procedure. Such a body will carry out an EU-type examination and issue an EU-Type Examination Certificate (module B).
PPE manufacturers must also have a manufacturing control process, the details of which vary depending on the category of PPE.
In Spain, Royal Decree 773/1997 of 30 May 1997 on minimum health and safety provisions concerning the use by workers of personal protective equipment is a general regulation applicable to all workers, not just health professionals.
As a final remark, products intended for use as MD, as well as for PPE, must comply with the regulations applicable to both types of products.
Medical Instruments
Medical instruments are subject to the MDR, as they fit into the MD definition.
Medical instruments are, on many occasions, reprocessed, and therefore the Spanish Decree on MD should be referenced, as it deals with the so-called “reprocessing of single-use products”. In such legislation, it is stated that reprocessing can only be carried out by the following entities:
Cosmetics
Regulation 1223/2009 of the European Parliament and of the Council on cosmetic products (the “Regulation on CP”) sets out the regime for the CP, by imposing certain safety requirements for their use under normal conditions. Some such requirements are the following:
Moreover, the Regulation on CP strengthens certain elements of the regulatory framework for cosmetics, such as in-market control, with a view to ensuring a high level of protection of human health.
From a national perspective, Royal Decree 85/2018, of 23 February on cosmetic products, is also applicable, and this sets out additional measures for public health protection to be taken by the local competent health authorities (in this case, the Spanish Agency for Medicinal Products and Medical Devices or AEMPS, and competent authorities of the autonomous communities) who may, at any time, ask the agents involved to implement the corrective measures they deem necessary, and even, in more serious cases, to recall products and even withdraw permits and licences to manufacture or import CP.
Biocides
Regulation 528/2012 of the European Parliament and of the Council of 22 May 2012, concerning the availability on the market and use of biocidal products, envisages that a high level of protection of human health will be ensured by strengthening certain regulatory elements, while simplifying, on the other hand, certain bureaucratic procedures.
The Spanish legal framework is contained in the Royal Decree 1054/2002 of 11 October 2002, on the process of evaluation for registration, authorisation and commercialisation of biocides. This establishes (with certain exceptions for low-risk products) that biocides can be commercialised in Spain only once they have been authorised and registered by the competent authority.
Food Supplements
Food safety general legislation is very widely regulated in Spain, covering different areas: (i) ingredients and processing aids; (ii) storage, preservation and transport; (iii) trade; and (iv) authority monitoring mechanisms.
Focussing on food supplements (FS), and from a national perspective, Royal Decree 1487/2009, of 26 September 2009 on FS, transposed Directive 2002/46/EC. It relates to vitamins and minerals and other nutrients used by consumers to complete nutrient intake. In particular, it deals with the composition and labelling requirements applicable to food supplements and it is applicable to companies involved in the manufacturing, transformation, packaging, storage, distribution, importation and marketing of food supplements.
Pharmaceuticals
Directive 2001/83/EC of the European Parliament and of the Council and Regulation 726/2004 of the European Parliament and of the Council constitute the basis of pharmaceutical legislation, and they lay down provisions related to medicinal product authorisation and post-authorisation requirements, pre-authorisation support schemes, regulatory incentives in terms of data and market protection, manufacturing and supply, and the European Medicines Agency (EMA). This main pharmaceutical legislation is complemented by specific legislation on medicinal products for rare diseases (Regulation 141/2000), medicinal products for children (Regulation 1901/2006) and advanced therapy medicinal products (Regulation 1394/2007).
In Spain, Royal Legislative Decree 1/2015, of 24 July 2015, approving the revised text of the law on guarantees and rational use of medicines and health products, is applicable.
There is also additional national legislation governing, among others, the following issues.
Blood Products
European legislation affecting blood products is currently being revised by the proposal for Regulation of the European Parliament and of the Council, on standards of quality and safety for substances of human origin intended for human application and repealing Directives 2002/98/EC and 2004/23/EC, dated 14 July 2022.
In Spain, there is additional legislation applicable to this type of product, among which the following can be highlighted:
Psychedelics
Narcotic drugs are subject to the legislation for pharmaceuticals referred to above.
Besides, from the Spanish legal perspective, legislation is focused on the control of narcotics.
Cannabidiol (CBD) When Used for Medicinal Purposes
CBD is subject to the legislation for pharmaceuticals referred to above when CBD is incorporated into a medicinal product.
The European Union Court of Justice, by decision taken on 19 November 2020, held that CBD was not a narcotic. As a consequence, at European-level legislation, natural CBD was included in the list of ingredients allowed for cosmetics and novel food applications.
In Spain, therapeutic use of CBD is not yet regulated, although legislative initiatives are currently underway.
Medical Apps and Wearables
As far as they fit into the definition of MD, any medical app or wearable is subject to legislation on MD referred to above.
These products are to be in compliance with other EU and Spanish legislation which is applicable to such medical apps:
Telemedicine
There is no specific legislation in Spain dealing with telemedicine. There are only some references in the Medical Ethics Code issued by the Spanish Medical Association.
The Medical Ethics Code establishes that medical clinical practice by means of consultations made exclusively by letter, telephone, radio, press or internet is contrary to medical ethical standards. Correct practice inevitably involves direct, personal contact between doctor and patient.
Nevertheless, the Code considers that it is ethically acceptable, in the case of second opinions and medical reviews, to use e-mail or other non-face-to-face means of communication and telemedicine, provided that mutual identification is clear and privacy is ensured.
However, due to COVID-19, the use of Telemedicine is now widespread and the agents involved are calling for specific regulation to ensure that, while using telemedicine, the quality standard of patient care is maintained and that data confidentiality and patient autonomy are duly safeguarded.
Stem Cells
In Spain, Law 14/2007, on Biomedical Research, states in its preamble that, in the pursuit of therapeutic or research purposes, the utilisation of any technique for obtaining human stem cells is authorised. Moreover, it establishes the ethical principles that must guide research, the procedures for authorisation and evaluation of research projects, and the use of biological samples, amongst other aspects.
Although the Law 14/2006, on Assisted Human Reproduction Techniques, primarily focuses on assisted reproduction, it also regulates the use of stem cells in the context of reproductive medicine and embryo research.
Royal Decree-Law 9/2014 establishes the quality and safety standards for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells and approves the co-ordination and operational rules for their use in humans.
Medicines and Medical Devices
In April 2022, the European Medical Device Co-ordination Group issued “Guidance on borderline products between MD and medicines products under MDR” (the “Guidance”) which, while not reflecting the European Commission official position, and not being competent to classify products, is, at least, a practical guide to classify borderline products as medicines or MD.
The main problem lies with the identification of the regulatory status of the combination of a medicinal product and a MD.
The Guidance advises that when deciding on the regulatory status of a product combination, two aspects are to be considered.
If the principal intended action of the integral product is achieved by the medicinal product part, then the entire product is regulated as a medicinal product. However, if the principal intended action is achieved by the medical device part, the entire product is regulated as an MD incorporating a medicinal product that has an action ancillary to that of the device.
It will be the criteria of the AEMPS that will be relevant for the final classification between medicine and MD.
Personal Protective Equipment and MDs
In the case of MD and PPE, when products are intended for use as an MD and PPE, they must comply with the regulations applicable to both of them.
Medicines and Food Supplements
Food supplements fall under the competence of the Spanish Agency for Food Safety and Nutrition (AESAN), and in cases where some of these products have components in common to some medicinal products, the criteria to be used by the authorities to classify them as medicinal products or food supplements is based on their strength, properties or purpose.
Other Cases
In relation to other product classification difficulties affecting human or veterinary medicinal products, MDs, cosmetics, biocides and personal care products, it must be considered that all of them fall under the responsibility of the AEMPS, and therefore, it will be the criteria of this agency that will be relevant for their classification.
Manufacturing, Importing and Related Activities
All economic agents engaged in the manufacture, importation, packaging or sterilisation of medical devices and the facilities where such activities are carried out shall require a prior operating licence. This also applies to devices and instruments used in permanent or semi-permanent make-up or tattooing of the skin using invasive techniques, as well as to the non-medical products listed in Annex XVI MDR.
An import licence is required both for importers established in Spain who introduce a product from a third country into the EU (regular importer), and for those economic agents which are not considered importers in accordance with MDR but physically import a product into Spain (physical importer).
The prior operating licence shall also be required for those economic agents who carry out the complete manufacture of products for third parties. Complete manufacture means the entire manufacturing process, from raw materials until final product. Those subcontractors that carry out a non-substantial phase during the manufacturing process do not require a prior operating licence, as they are included in the operating licence of the manufacturer that is subcontracting such phase.
All these licences are granted by the Spanish Agency for Medicinal Products and Medical Devices (AEMPS).
The same licence shall cover the activities and the facilities where such activities are carried out.
All licences shall be valid for a period not exceeding five years and may be renewed prior to their expiry, if all the requirements are verified.
Any modification of the conditions under which the licence was granted must be authorised in advance by the AEMPS.
Licence Requirements
Custom-Made Products and Products Manufactured by Hospitals for Their use Only (In-house Manufacturing)
Custom-made product manufacturers must have a prior operating licence, granted by the competent regional health authority.
A recent development in Spanish legislation is the possibility for hospitals to manufacture their own medical devices under the following conditions:
Besides mandatory environmental regulations (eg, waste control and management), which are applicable to any product, there are no specific obligations regarding corporate social responsibility throughout the product life cycle applicable to medical devices and consumer health products.
That said, all companies with (i) more than 250 workers, and (ii) more than EUR20 million in assets or net annual turnover exceeding EUR40 million, are required to draw up and present an annual non-financial information statement to the competent Mercantile Registry. The non-financial information statement must include, amongst others, the following contents:
General Principles
Royal Legislative Decree 1/2015, of 24 July 2015, Royal Decree 1591/2009, of 16 October 2009 and Royal Decree 1616/2009 of 26 October 2009, contain the provisions applicable to the advertising of medical devices.
In fact, Royal Decree 1591/2009, of 16 October 2009, and Royal Decree 1616/2009, of 26 October 2009, have been repealed by the new Spanish Decree on MD, but the provisions related to advertising are still in force until the Spanish legislature comes up with a new piece of legislation to this effect.
As a general rule, any product or service which is intended for preventive, diagnostic or therapeutic purposes, as well as their advertising and commercial promotion, is subject to such legislation.
Royal Decree 1907/1996, of 2 August 1996, is also applicable to the advertising of other products with purported medical purposes.
Advertising of any product that is financed by public funds or that is in the clinical research or clinical trial phase is prohibited.
Advertising of MD shall be primarily scientific in nature and shall be targeted at, and generally distributed to, health professionals. Such advertising shall be made by persons adequately trained and possessing sufficient knowledge to provide accurate and comprehensive guidance on the advertised products, including technical data necessary to enable an objective judgement.
Medical devices intended for use or application exclusively by healthcare professionals must not be advertised to the public.
It is also expressly prohibited for all healthcare professionals and their associations or corporations to endorse any type of commercial promotion or advertising directed at the public in which they support preventive, therapeutic, rehabilitation or any other alleged health purpose.
Advertising aimed to the public must indicate the conformity of the product with the legislation in force, as well as the contraindications and possible side effects that may arise from the use of the products. Any reference to a health authority or to recommendations made by scientists, health professionals or other persons who may, by virtue of their reputation, encourage the use of the product, is prohibited.
Premiums, free gifts, discounts, prizes, contests, bonuses or similar methods in connection with the promotion or sale of medical devices to the public are also prohibited.
Cease and Desist Action in Respect of Advertising
There is a specific cease and desist action aimed at preventing or stopping illegal advertising of medical devices. This action may be brought by certain public bodies as well as by consumer and user associations and, in general, by any person with a legitimate interest.
Before bringing the action, the plaintiff must have requested the advertiser to cease the advertising activity. The advertiser can either accept the complaint and cease such activity or not accept it and risk being sued.
The cease and desist action is compatible with administrative fines arising from the relevant infringement.
Promotional Activities in Respect of Healthcare Professionals
It is prohibited to grant, offer or promise bonuses, pecuniary advantages or advantages in kind to health professionals who prescribe the products, as well as to their relatives or persons with whom they live.
Prizes, scholarships, contributions and subsidies for meetings, congresses, study trips and similar events donated by economic agents to healthcare professionals or organisations shall be applied exclusively to activities of a scientific nature.
Publications of papers and presentations at meetings, congresses and similar events shall declare the funds obtained for their realisation and the source of financing.
Prototypes
Products which are not yet in conformity with the legislation in force may be exhibited at fairs, exhibitions and demonstrations, provided that it is clearly and obviously indicated that such products are not in the market or into service until declared in conformity.
Conformity
As a general rule, all medical devices and related products that are to be put in the Spanish market must comply with MDR and have the “CE” marking.
Economic operators shall:
When the product is put in the market, the importer or distributor must ensure that the labelling and the technical instructions are in place and cover all the required information. That documentation must be in Spanish (at least).
Mandatory Registries
There are two mandatory registries under the authority of the AEMPS.
Registry of commercialisation
This is an important development of the latest Spanish regulation aimed to improve the transparency in the commercialisation of medical devices and related products.
The Registry shall contain the following information about the economic agent that commercialises products in the Spanish market: (i) identification of the economic agent, (ii) trade name of each of the products in Spain, (iii) product identifier (UDI-DI), (iv) labelling and instructions for use with which the product is to be marketed in Spain, (v) date on which the product is placed on the market in Spain, and (vi) for manufacturers reprocessing single-use devices, a declaration that the reprocessing activity is carried out within the European Union.
Registration must be previous to any commercialisation activity in Spain.
Economic agents must update their notification to the Registry annually, indicating the products they continue to market. Failure to update the notification will result in the removal of the products and the economic agent from the Registry.
Pharmacies and any other point of sale exclusively to the public are exempted from registration.
Registry of those responsible for placing custom-made products on the market
This Registry shall contain the following information about the manufacturer (or authorised representative in Spain): (i) identification of the manufacturer and address of its registered office, (ii) a list and description of the devices it manufactures, and (iii) a certificate of conformity issued by a notified body for implantable Class III devices.
These registries are entirely electronic and all communications must be made by electronic means, so a qualified electronic certificate must be in place. Also, any change to the data initially provided, as well as the cessation of marketing, shall be communicated and updated to the correspondent registry. These provisions apply to both registries.
It is important to note that these registrations are not free of charge and the applicant must pay the appropriate fees to the AEMPS. Discounts are available after a certain number of registrations, but if the volume of registrations is high, the registration process can be very costly and resource-intensive.
Distribution and Sale Activities
All distribution and sale activities must be carried out ensuring proper storage and preservation of the products.
Distributors and sellers must make a prior notification of commencement of activity to the health authority of the Spanish region (comunidad autónoma) where they are located, identifying: (i) identification of the distribution or sales establishment, where applicable, (ii) types of products it distributes or sells, and (iii) identification and qualification of the technician responsible, where applicable.
Any distribution activities shall be carried out:
The following sale activities are strictly forbidden:
Economic agents in the EU have an increasingly similar and harmonised regulatory framework, which helps to make internationalisation easier within the EU.
Spanish local regulation may be more complicated due to the fact that the central government has transferred almost all health competences to regions (comunidades autónomas) and to the concurrence of several official languages other than Spanish. Spanish manufacturers have similar challenges when they try to export their products within the EU.
Obviously, exportation beyond EU borders is subject to national legislation with entirely different regulatory frameworks.
In this regard, all products that are manufactured exclusively for export outside the EU and do not meet the requirements set out in MDR and/or Spanish legislation must be labelled in such a way that they are unequivocally identified as such, in order to avoid their use in the EU market.
Traceability
Any economic operator who places products on the market shall keep a documented record of the products they make available on Spanish territory, containing at least:
The documentation shall be kept at the disposal of the competent authorities for a period of at least ten years after the last unit of the device has been placed on the market or put into service. In the case of implantable devices, the period shall be at least 15 years.
Market Surveillance and Corrective Actions
The AEMPS is the public body responsible for co-ordinating the market control activities to be carried out in collaboration with the health authorities of the regions (comunidades autónomas) in order to comply with MDR, including the inspection and organisation of specific control programmes.
In order to ensure the protection of human health and safety, the AEMPS may adopt all necessary and justified measures with regard to a product or category of products, such as conditions of use of such products or on special monitoring measures, and may include the necessary warnings to avoid health risks in their use.
The AEMPS and other health authorities may also conduct inspections aimed to ensure compliance with the regulatory framework. Those inspections may result in corrective and/or preventive measures, as well as sanctions (see 3.2 Regulatory Enforcement Mechanisms and 4.1 Product Safety Offences below).
Manufacturers shall inform the AEMPS of any corrective safety action before such action is taken.
Mandatory Notifications
All manufacturers, health care organisations, health care professionals and public authorities that become aware of defects, adverse effects or serious incidents related to a medical device must communicate such facts to the AEMPS. Patients and users may also communicate those facts but it is not mandatory to them.
The AEMPS will register and evaluate such information and will adopt the measures mentioned above, if any.
Spanish Agency of Medicines and Medical Devices (AEMPS)
The main regulatory authority and the competent authority for the purposes of Article 101 of the MDR under Spanish national legislation is the Spanish Agency of Medicines and Medical Products (AEMPS).
Its competences are very broad, the most relevant being the following:
Regional Health Authorities (Autonomous Communities)
The regional health authorities are responsible for inspecting health facilities and must co-operate with the AEMPS for the purposes of market control, registries and vigilance over the medical device.
Ministry of Health
The Spanish Ministry of Health forms an integral part of the central government and is responsible for the notified bodies and for drafting and executing regulations pertaining to the pricing and reimbursement of medicinal products (ie, medical devices) financed by public funds, among its various other duties.
Spanish regulatory authorities (AEMPS, regional authorities and Ministry of Health, each within their responsibilities and competencies) have essentially two mechanisms to enforce compliance with the applicable legislation.
The AEMPS and other regional and central health authorities may impose fines on economic agents in case of non-compliance with medical device regulation.
Articles 112 and 113 of the Royal Legislative Decree 1/2015 of 24 July 2015, approving the revised text of the law on guarantees and rational use of medicines and medical devices, include the list of infractions for medical devices, cosmetic products and personal care products.
The penalties applicable to those infringements are the following:
The final amount depends on a wide variety of factors such as negligence and intent of the offender, fraud, collusion, failure to comply with prior warnings, turnover, number of persons affected, damage caused, profits made as a result of the infringement, permanence or transience of the risks and recidivism.
The authorities may impose other non-pecuniary penalties such as suspension (or even revocation) of the market authorisation or mandatory closure of the facilities involved.
The AEMPS has imposed important penalties in the past, such as the following:
Besides the administrative penalties, the Spanish Criminal Code sets out both pecuniary penalties and imprisonment for individual persons implicated in particular serious offences. It is important to note that the Spanish Criminal Code also establishes significant non-pecuniary penalties for legal entities implicated in such offences (including, but not limited to, suspension of activities, closure of premises, disqualification for contracting with the public sector and for obtaining any public awards or subsidies).
Under Spanish law, the main legal bases on which product liability claims can be brought in respect of medical devices and the other product categories listed in 1. Applicable Product Safety Regulatory Regimes are:
Consumer Protection Legislation
The consumer protection legislation is mandatory and every agreement, written or verbal, that goes against that legislation shall be deemed null and void.
A consumer may bring legal action against the economic agent that makes a product available in the market and also against the manufacturer on the following grounds.
Non-conformity
A product shall be deemed to be in conformity if it meets the applicable subjective and objective requirements, provided that, where applicable, the product has been properly installed or integrated. If the product is not in conformity during the first three years from the date of supply, the consumer may claim that the lack of conformity be remedied, the price be reduced or the contract be rescinded. In any of these cases, the consumer may also claim damages, if applicable.
The limitation period is five years from the date on which the non-conformity became apparent.
This legal action is not compatible with other civil actions based on non-conformity reasons (saneamiento por vicios ocultos).
Damages
As a general rule, the manufacturers shall be liable for damage caused by defects in the products which they manufacture or import. If the economic agent that makes a defective product in the market is aware of the defects, the economic agent shall be also liable for such damage.
A product is considered to be defective when it does not provide the safety conditions which may legitimately be expected.
The limitation period is three years from the date on which the consumer suffered the damage.
This legal action is compatible with other civil actions that the consumer may have for damages, including moral damages, arising from contractual liability, based on lack of conformity of the goods or services, or from non-contractual liability (if any).
Spanish Civil Code
According to the Spanish general law of obligations, a claimant may bring legal actions against a defendant when:
Lastly, the seller shall be liable to the buyer for any hidden defects or faults during the six months following the delivery of the product. The seller may claim a reduction in the price, termination of the agreement and/or claim for damages, if applicable.
Technological advancement in medical devices and consumer health products impacting the application of product liability laws
The global trend towards digital health such as telehealth or telediagnosis has been accelerating and it has the potential to improve the quality of healthcare and patient experience.
These new technologies may cause problems in terms of product liability laws. These regulations were conceived and designed in a context where medical devices were not as complex and interconnected as they are today. The complexity of medical devices makes it increasingly difficult to determine who is responsible for potential harm to patients.
A clear example would be a diagnostic application that qualifies as a medical device. It is essential that the owner or distributor of such an app clearly delineates what is the algorithm on which the diagnosis is based and what is information that the app collects from the patient or from other sources. If the boundaries are not clear, the app owner may end up being liable for damages that are not necessarily their responsibility.
There is still no clear legislation on machine learning and AI, but we should expect that the European legislature will come up with a piece of legislation that clarifies the situation and offers the best possible guarantees for patients and economic actors involved.
Civil Claims
A person that is part of a civil proceeding must be represented by a procurator and assisted by a lawyer.
The aforementioned is not mandatory in case of oral proceedings where the amount is determined by reason of the value of the claim and the amount does not exceed EUR2,000 euros and the initial application for payment order proceedings (monitorio).
As a general rule, the Spanish civil courts have jurisdiction to resolve civil claims if the defendant is domiciled in Spain. The territorial jurisdiction lies with the defendant’s domicile.
Criminal Claims
Any person may report a crime before the authorities without the assistance of a lawyer or any other professional.
If a person is part of criminal proceedings, they must be represented and assisted by a lawyer.
If a person files a criminal complaint against other person, the plaintiff (private accusation) must be represented by a procurator and assisted by a lawyer.
As a general rule, the Spanish criminal courts have jurisdiction to resolve criminal claims if the crime has been committed in Spain. The territorial jurisdiction lies with the place where the crime was committed.
The main judicial costs that the parties may have to consider when filing legal proceedings in Spain are as follows.
As a general rule, Spanish courts abide by the “loser pays” principle. That means that the losing party may be liable for the winning party’s judicial and legal fees, as well as any disbursements for witnesses and expert evidence.
There is no mechanism to displace the costs rules by way of “without prejudice” settlement offers or lodgements.
As a general principle, all administrative resolutions or decisions (including sanctions) issued by Spanish administrative bodies may be challenged before a judge or court.
Spanish civil procedural law allows popular or collective action when a group of consumers is affected by a harmful event and where the individuals making up the group are identified or easily identifiable.
There are also certain associations or bodies duly authorised according to EU law to bring an action for injunctions for the protection of the collective and diffuse interests of consumers and users.
At the date of writing in July 2023, the authors are not aware of any significant examples of these kinds of proceedings regarding medical devices in Spain.
The following alternative dispute resolution (ADR) mechanisms are available in Spain:
Self-regulatory mechanisms also exist for medical devices and drugs advertising. These mechanisms operate through associations of economic operators who submit to arbitration disputes over the advertising of their products, which is much quicker and more effective than through the court process. The resolutions adopted by arbitrators are not legally binding (an economic operator may bring the matter to the judicial system) but create a precedent that is often considered by judges and tribunals. Not abiding by these extra-judicial resolutions may also have reputational consequences for the economic operator.
In general, the same facts may constitute an administrative infraction and serve, at the same time, as grounds for a product liability claim (civil and/or criminal).
The administrative bodies cannot impose a double sanction for the same facts and based on the same protected public interests. Those administrative bodies must report any potential criminal conduct found during an administrative proceeding to the public prosecutors.
If there is an ongoing criminal cause, the administrative proceedings based on the same facts shall be suspended until there is a firm judicial decision.
In April 2022, the new Law 7/2022 of 8 April on waste and contaminated land for a circular economy came into force. This law, in line with European environmental developments, aims to promote the transition to a circular economy, in which waste generation is reduced and available resources are used more efficiently.
Law 7/2022 transposes Directive 2008/98, which establishes the framework regulation for waste management, as well as Directive 2019/904, which focuses on tackling the problem of single-use plastics. One of the most outstanding and innovative measures of this new law is the creation, with effect from 1 January 2023, of the special tax on non-reusable plastic packaging.
This tax is levied on the use in Spanish territory of non-reusable packaging containing plastic.
However, there are certain sectors that will benefit from exemptions and refunds of the tax.
One of these sectors is the pharmaceutical sector, in which non-recyclable plastics intended for packaging for medicines, MD, foodstuffs for special medical purposes or hazardous waste of medical origin will be exempt from the tax.
In order for this exemption to be applicable, companies marketing these products must provide a prior declaration to the producers or importers of packaging, specifying the destination of such packaging.
The exemption for medicinal products also extends to active substances used in the manufacture of pharmaceutical products.
The EU Commission adopted a proposal for a new Directive and a new Regulation, in April 2023.
Such proposal revises and replaces the existing general pharmaceutical legislation (Regulation 726/2004 and Directive 2001/83/EC) and the legislation on medicines for children and for rare diseases (Regulation 1901/2006 and Regulation 141/2000/EC, respectively).
The proposal, in addition to strengthening the requirement for common standards of quality, safety and efficacy – the backbone of the medicines system – aims to achieve the following:
In Spain, it is quite possible that the announced reform of the Royal Legislative Decree 1/2015 of 24 July 2015, approving the revised text of the Law on guarantees and rational use of medicines and health products, will be affected by the revision of European legislation, and it is to be expected that such reform will be undertaken when there is a new European framework for medicines.
Competences over drug pricing and reimbursement policies are exclusive to each member state of the European Union, and it will therefore be necessary to wait for the reform of Spanish pharmaceutical legislation to ascertain the scope of the review of the pricing system, which is demanded by all the agents involved.
Spanish regulation on promotion of medicines (currently governed by RD 1416/1994) and on medical devices is also in the course of being amended.
The advent of AI will undoubtedly impact the development of medicines and medical devices.
In a highly regulated sector, the European legislation in this area announced by the European Commission, will be welcomed, as a balance between innovation and safety must be sought.
It is worth noting the high potential of AI in data and pattern analysis, which will accelerate the development and invention of new products.
There is currently no specific regulation for AI in Spain, although Law 15/2022, of 12 July 2022, on equal treatment and non-discrimination, introduces a reference when obligating public administrators to minimise biases and ensure transparency and accountability in the use of automated decision-making mechanisms.
The Ministry of Economic Affairs and Digital Transformation has designed, within the Recovery, Transformation and Resilience Plan, a National Artificial Intelligence Strategy to structure the action of the different administrations and to provide a framework of reference for the public and private sectors.
Spain Digital Strategy 2026
This plan is aimed at implementing certain measures and actions in the field of AI and the Data Economy:
Spain Charter of Digital Rights
As is covered in the Trends and Developments section of this guide, in 2021, the Spanish government published the Charter of Digital Rights, which is actually a non-regulatory and non-binding government document that serves as a statement of intentions of the authorities in relation to AI.
This document establishes in its Title XXV a list of rights in relation to AI, which may reflect the basis (albeit non-binding) for future legislation.
What’s Coming: European Union AI Regulation
On 14 June 2023, the European Parliament approved its version of the draft EU Artificial Intelligence Law (the “EU AI Law”, also called the “AI Act”).
Now Member States will need to reach agreement on the final text, so final and approved adoption of the EU AI Law is not expected until well into 2025, at the earliest.
The approval of this text could have a direct impact on the regulation of medical devices based on AI, given that the draft itself establishes that AI-based medical devices may be considered high-risk products.
It states in this respect that AI systems that are safety components of products or that are products themselves falling within the scope of certain EU harmonisation legislation should be classified as high risk if the product in question is subject to the conformity assessment procedure with a third party conformity assessment body under such relevant Union harmonisation legislation. Such products are, among many others of different nature, medical devices and in vitro diagnostic medical devices.
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The entry into force in Spain in March 2023 of a new regulation on medical devices (MD) (Royal Decree 192/2023, of 21 March 2023 on medical devices, called “Spanish Decree on MD”) is the most important new development that has occurred this year. The controversy and doubts raised by some of the aspects it regulates are and will be the subject of debate in the upcoming months.
In addition to this new regulation, specific regulations are currently in the course of being drafted, such as (i) in vitro diagnostic medical devices and (ii) advertising of medical devices. With regard to the latter, please note that there is currently no regulation governing particularly the advertising of medical devices (ie, it is regulated in a scattered manner throughout several old regulations).
The Spanish Decree on MD was approved in order to adapt Spanish legislation to the European Medical Device Regulation 2017/745 (MDR), which entered into force on 26 May 2021. Although the aforementioned MDR is directly applicable in Spain, there are certain aspects on MD left for further development by each EU Member State. Among these aspects left to national regulation, some of the most controversial which we are covering here are:
We also refer in this article to the lack of any provision in the Spanish DEcree on MD in relation to artificial intelligence sanitary technology and evaluate law trends in Spain.
Cases in Which the Necessary Prior Operating Licences are Extended
A prior operating licence for facilities was already required under past legislation, but this requirement has been expanded in the following terms.
Spanish Decree on MD increases the control measures to guarantee the traceability of medical devices (which was exactly the intended purpose), but as usual when a new regulation comes into force, many doubts will arise during its application.
Some of them could be that, in some cases, it will be difficult to determine who in practice is the physical importer of a product, when more than one economic operator may be involved in this activity. Similarly, the status of the technically qualified person (when not holding a university degree) may lead to a subjective assessment in the hands of whoever hires him to act as such.
Possibility for Hospitals to Manufacture Medical Devices for Their Exclusive Use
The MDR already allows hospitals located in the European Union to manufacture in-house medical devices for their exclusive use in hospitals and establishes a series of requirements to this effect. However, the Spanish Decree on MD lays down a few additional requirements.
The AEMPS will proceed to carry out inspections in hospitals to corroborate that this in-house manufacturing is carried out in accordance with the requirements of the Spanish Decree on MD.
Language Issues in Labelling of Medical Devices
The Spanish Decree on MD has indicated that when medical devices are put into service in Spain, they must contain the requirements detailed in the MDR “at least” in Spanish language.
There is some concern in the industry as the expression “at least” leaves the door open for some of the autonomous communities of Spain, that have co-official languages, to demand that not only Spanish but also the corresponding co-official language of the autonomous community be included in the labelling. Such a situation would imply the need to make special labelling for the Spanish market, which would be burdensome for companies, and they may even consider whether or not it is worth entering the Spanish market.
Reprocessing of Single-Use Medical Devices
One of the most relevant changes brought about by MDR is the implementation of a regulated system for the reprocessing of single-use medical devices but providing to the Member States a high level of freedom to delimit this activity.
This practice had been carried out throughout the EU without regulation. In Spain, there was a certain legal vacuum, although the restrictive interpretation of the regulations strongly discouraged the performance of this practice.
The EU has admitted this practice as long as the safe reuse of single-use medical devices is possible, and as long as it can be guaranteed that (i) safety and (ii) performance are equivalent to the original product.
The reasons that have led to the controlled authorisation of the reprocessing of single-use medical devices are fundamentally economic and environmental, although these advantages are weighed against other risks (not disadvantages) such as (i) patient safety, (ii) ethical reasons and (iii) again, environmental reasons, since on one hand reuse avoids the generation of waste, but some reprocessing activities may entail other environmental externalities that must be taken into account.
As a general idea, the regulation in Spain of this practice developed by the Spanish Decree on MD is more restrictive than the MDR. Some of the particularities that manufacturers, hospitals and external reprocessors must take into account are the following.
Having said the above, it is of utmost importance to note that currently, neither hospitals nor external reprocessors will be able to carry out the activities of reprocessing of single-use medical devices in Spain, given that the Spanish Decree on MD itself establishes that this activity will require a prior regulation development by the Spanish Ministry of Health when conducted by hospitals and external reprocessors.
For the time being, the content of this development regulation is unknown. According to the information provided by the AEMPS, a period (currently uncertain) will be given for the authorities to analyse the manufacturers’ reprocessing experience. Therefore, until July 2023, the date of publication and the content of this implementing regulation are unknown.
New National Registry of Commercialisation of Medical Devices
The Spanish Decree on MD introduces a Registry of Commercialisation for all medical devices (regardless of their class) for any economic agent that markets medical devices in Spain (however, pharmacies and retail outlets are excluded from this obligation).
This obligation to register medical devices in the Registry will not apply until this Registry is fully operational.
Since this new registry will be directly related to the EUDAMED database, the Spanish Decree on MD itself establishes a maximum period of six months, from the time the product is notified to EUDAMED, to communicate the product to the Registry of Commercialisation.
This marketing registry must be updated annually by the economic agents.
Until both registries EUDAMED and the Registry of Commercialisation are operational, there is still an obligation to notify the marketing and putting into service of medical devices (known as “CCPS”).
The controversy arises as it is not clear what the function of this Registry of Commercialisation will be, given that the EUDAMED database created with the MDR has already been set up. Furthermore, it will inevitably mean an increase in cost for all the economic agents who wish to market medical devices in Spain, not only because it implies the existence of an additional registry to EUDAMED with the obligation to pay the corresponding fees, but also because each medical device will have to be registered one by one (without being able to be registered, for example, by category).
In addition, the AEMPS has declared that there will not be, for all the medical devices already in the current CCPS database, a migration of information to the Registry of Commercialisation, but that this information will have to be entered “manually”, which casts even more doubt on the value of the creation of this registry.
The Absence of Specific Regulations on AI-Based Medical Devices and Current Legal Trends in the EU
First of all, it is necessary to specify what can legally be understood as AI. To that end, the most appropriate approach would be to refer to the definition given by the High-Level Expert Group on Artificial Intelligence of the European Commission, which defined AI in the following terms:
“Artificial intelligence (AI) refers to systems that display intelligent behavior by analyzing their environment and taking actions – with some degree of autonomy – to achieve specific goals. AI-based systems can be purely software-based, acting in the virtual world (eg, voice assistants, image analysis software, search engines, speech and face recognition systems) or AI can be embedded in hardware devices (eg, advanced robots, autonomous cars, drones or Internet of Things applications).”
Bringing the above definition down to earth, it is interesting to see that AI can be a software (and it will be in most cases), but is interesting to note that the AI itself can be embedded in hardware devices. We therefore interpret that an AI-based medical device could be defined both by the term “software” and the term “apparatus”, as defined in Article 2 of MDR.
The Spanish Decree on MD does not establish any provisions regarding AI and it will be necessary to reach out to MDR for all matters related to software-based medical devices (which include, totally or partially together with hardware, those based on AI).
Additionally, there is no new development nor specific national regulation in Spain regarding artificial intelligence in the healthcare sector, particularly in relation to healthcare technology.
In 2021, the Spanish government published the Charter of Digital Rights, a non-regulatory and non-binding document which establishes the rights which must be covered as a basis of future legislation.
In addition to the challenges already posed, the biggest challenge for authorities in Spain (and in the rest of the EU) is to deal with the balance between, on one hand, the enormous health potential of AI and, on the other hand, the already-mentioned risks that its implementation in the healthcare market could entail.
It is with respect to those risks, above all, where the focus is being placed both on the Spanish health authorities and, more actively, on the EU administration. Some of these risks are:
Having said the above, the regulation in Spain of AI and its implementation in the healthcare technology sector will be absolutely harmonised with the provisions arising from within the EU, and, from there, provisions aimed at complying with the standards identified above can be expected from a highly protective perspective.
In the EU context, and although there is a lack of specification with respect to AI in relation to the definition of medical devices in MDR, there are various provisions relating to software as a medical device that will be fully applicable to AI software-based medical devices.
Furthermore, the very recently approved draft of the EU AI Regulation (the so-called AI Act) provides for AI-based medical devices to be considered as high-risk products and that will have a decisive influence on the regulation of such AI-based medical devices, both at EU and national level (including in Spain).
It is expected, among other matters, that there will be a profound discussion on machine learning and on how medical devices that are designed to be self-completing and therefore self-modifying are going to be audited, controlled, and approved. This is undoubtedly an unprecedented challenge for the legislature and a risk for development companies, due to the legal uncertainty that currently exists, together with the certain restrictiveness that the European and national legislature is showing.
Therefore, both the Spanish and the EU approach to AI is from a clear perspective of risk reduction and close control. A perspective that, although necessary, is perhaps not the most adequate (or the only one) to cover the infinite and still unknown possibilities of AI. In fact, there are already platforms that have proposed the establishment of sectoral self-regulation to provide the necessary flexibility and dynamism while ensuring protection. We will undoubtedly have to be on the lookout for new developments in 2023 and the years to come in the exciting field of AI.
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