Key Regulatory Priorities for US Medtech Startups in 2025 and 2026

The regulatory landscape for medtech startups is evolving rapidly. The FDA and other global regulatory bodies are intensifying their oversight of security, quality management, and AI implementation.

For medtech startups bringing innovative medical devices to market, staying ahead of these changes is essential for success.

Here is what you need to know and how to prepare effectively.

Increased FDA Focus on Security

Cybersecurity has moved from a secondary consideration to a cornerstone of regulatory compliance. The US FDA now emphasizes comprehensive security measures for connected medical devices, focusing on both patient data protection and device reliability.

This shift comes as exposure to the exchange of medical device-related health information and thus cyber threats continue to escalate, prompting the agency to demand more robust safeguards against potential vulnerabilities.

For medtech startups, this means demonstrating robust security measures in regulatory submissions. Regulatory submissions must now demonstrate sophisticated security measures from the ground up. The FDA specifically looks for evidence that companies are:

• Implementing proactive risk management strategies.
• Utilizing strong encryption protocols for sensitive data.
• Maintaining continuous monitoring systems for potential security breaches.

For example, here are some of the steps taken by our team at Enhatch for enhancing cybersecurity:

• We completed SOC 2 Type II and HIPAA/HITECH audits, reinforcing our data security and privacy commitment.
• Our development approach integrates security measures from the outset, ensuring patient data remains protected throughout the device's lifecycle.
• By focusing on security from the beginning, we complied with regulatory expectations while building trust with medical device companies, healthcare providers and patients.

Tips for Medtech Startups

Navigating the complex landscape of medical device cybersecurity requires a proactive and systematic approach. Here are key strategies to help ensure your regulatory compliance and protect patient data.

• Integrate security early: Incorporate encryption, access controls, and regular security assessments during the design phase.
• Develop a cybersecurity risk management plan: Create a dynamic plan based on safety by design that evolves with emerging threats, detailing how you will identify, assess, and mitigate risks.
• Stay informed: Regularly review the FDA's latest cybersecurity guidance for medical devices to ensure compliance.
• Stay on top of documentation: Ensure that your documentation clearly outlines your cybersecurity efforts and steps taken to protect data.

QMS Alignment With ISO 13485 by February 2026

A significant regulatory shift is underway as the US FDA transitions from its traditional Quality System Regulation (QSR) to the Quality Management System Regulation (QMSR).

This change brings U.S. requirements into closer alignment with the international standard ISO 13485, with compliance mandatory by February 2026.

For medtech startups, this transition demands a thorough evaluation of existing quality processes.

Companies already compliant with ISO 13485 are well-positioned for this change. However, those operating under the current QSR framework need to begin adapting their systems now to meet additional requirements.

Tips for Medtech Startups:

To ensure a smooth transition to the new QMSR framework and achieve compliance by the 2026 deadline, consider implementing these essential strategies:

• Conduct a gap analysis: Perform a comprehensive evaluation of your current QMS against ISO 13485 requirements. This assessment will reveal critical areas needing enhancement and help prioritize your adaptation efforts.
• Train Your team: Implement a robust training program to ensure your staff understands both the new requirements and their roles in maintaining compliance. Focus on practical applications of ISO 13485 principles within your specific operations.
• Engage expert support (if needed): Consider partnering with regulatory professionals who specialize in ISO 13485 implementation. Their expertise can be invaluable in navigating complex requirements and ensuring a thorough transition process.

AI in  Medtech: US FDA and EU Regulations

AI is transforming medtech, but with innovation comes regulation. The US FDA is refining its approach to AI-based medical devices, focusing on transparency, bias reduction, and continuous learning models.

In January 7, 2025, the FDA issued draft guidance for developers of AI-enabled medical devices. This guidance document includes recommendations for the design, development, maintenance, and documentation of these devices throughout their product lifecycles.

This heightened regulatory focus on AI in healthcare is not limited to the United States. The EU AI Act entered into force in Europe in August 2024 and will be applicable with full enforcement by August 2026. Under this act, AI-driven devices will face increased scrutiny, especially those used in high-risk medical applications.

Given these parallel regulatory developments in major markets, medtech startups need to ensure their AI models are explainable, reliable, and aligned with evolving regulatory expectations. Both the FDA and EU regulators are pushing for clear documentation on how AI-driven decisions impact patient outcomes.

At Enhatch, we have been at the forefront of AI-driven medtech solutions. We successfully received US FDA 510(k) clearance for our patient-specific AI-driven instrumentation system for total knee arthroplasty.

Our early commitment to regulatory compliance and integration of FDA requirements into our AI development process played a crucial role in securing 510(k) clearance.

Tips for Medtech Startups:

As AI regulations evolve in both the US and EU markets, medtech status should take proactive steps to ensure compliance and maintain market access. Here are key actions to implement:

Build a Regulatory Roadmap:

• Map out your compliance strategy for both FDA and EU requirements (if applicable).
• Stay current with regulatory updates through FDA's Digital Health Center of Excellence and EU regulatory authorities.

Design for Transparency:

• Develop AI models with built-in explainability features to better understand the reasoning behind automated decisions.
• Maintain clear audit trails of model performance and updates.

Establish Robust Validation Protocols:

• Create comprehensive testing frameworks that assess your AI system's reliability, accuracy, and potential biases across patient populations.
• Implement continuous monitoring systems to track performance in real-world settings.

Document Development Processes:

• Maintain detailed documentation of your AI development lifecycle, including data sources, training methodologies, testing procedures, and risk management strategies.
• This documentation will be crucial for regulatory submissions and ongoing compliance.

Final Thoughts

The regulatory environment is changing fast, and medtech startups must be proactive. Security, quality system alignment, and AI regulation are just a few key areas shaping the future of medical devices. By staying informed and taking early action, you'll position your startup for success in 2025 and beyond.