The PASTEUR Act: How Antibiotic Subscription Contracts Work

The PASTEUR Act would pay antibiotic developers a fixed federal subscription of $75 million to $300 million per year in exchange for keeping a qualifying drug available, instead of tying the manufacturer’s revenue to how many doses hospitals buy. Under the PASTEUR Act, antibiotic subscription contracts run for up to ten years or until a generic version reaches the market, whichever comes first, with the annual amount set by a point-based score that rates the drug’s clinical value, innovation, and public health benefit.¹

Why Antibiotics Get a Different Payment Model

Most drugs make money when doctors prescribe them widely. Antibiotics work the opposite way. A truly effective new antibiotic should be held in reserve and used only when older drugs fail, so bacteria don’t develop resistance to it too. That produces a financial squeeze: the better a new antibiotic works against resistant infections, the fewer units it sells, and the less revenue it generates. Several developers have gone bankrupt after winning FDA approval for genuinely needed drugs because hospitals didn’t buy enough doses to recover the cost of development. Drug-resistant infections kill more than 35,000 Americans each year.²

A subscription contract “delinks” payment from sales volume. The manufacturer receives a guaranteed annual payment for keeping the drug available and no longer has to push broad prescribing to stay afloat. Hospitals get reliable access to a treatment that might otherwise disappear from the market.

Which Antibiotics Qualify

Not every antibiotic can earn a subscription contract. The drug must treat a pathogen classified as an “urgent” or “serious” threat in the CDC’s most recent Antibiotic Resistance Threats in the United States report, or a pathogen the Secretary of Health and Human Services designates after consulting the bill’s advisory group. It must also address an unmet medical need, meaning existing treatments are inadequate for the infection it targets.¹

A developer can apply to HHS at the time of FDA approval or within five years after it. The application has to include clinical trial data, resistance modeling projections, manufacturing and supply chain assessments, and enough information for the Secretary to score the drug under the methodology below.

How the Annual Payment Is Set

The dollar figure isn’t negotiated case by case. Within 270 days of enactment, HHS must publish regulations establishing a point-based scoring methodology, developed with the Critical Need Antimicrobial Advisory Group, the Assistant Secretary for Preparedness and Response, the Director of BARDA, and the FDA Commissioner. A drug has to clear a minimum score to qualify for any contract, and a higher score produces a larger annual payment.¹

Points are awarded across three weighted categories:

Patient care contributions. Whether the drug improves outcomes for patients with multi-drug-resistant infections, offers better dosing schedules, reduces toxicity, or provides an oral option or multiple routes of administration.
Innovation. Whether the drug is the first approved treatment for a serious or life-threatening infection, contains a new active ingredient, belongs to a new drug class with a novel mechanism, or uses a novel chemical structure to fight resistance.
Public health benefit. Whether the drug avoids cross-resistance with existing treatments, can be manufactured domestically, has better storage stability, shows increased effectiveness against resistance mechanisms, or reduces the economic burden of antimicrobial resistance.

Each criterion carries an assigned weight, and the methodology itself has to be developed through public comment.

What the Contract Pays and For How Long

Annual payments range from $75 million to $300 million, adjusted each year for inflation using the consumer price index. Payments begin within 180 days of contract approval.¹

Over a full ten-year term, the total contract value could run from roughly $750 million to $3 billion. The actual payout is typically less, because each year’s subscription amount is reduced by whatever net revenue the manufacturer earns from actual U.S. sales, including all discounts, rebates, chargebacks, and free goods tied to purchase requirements. If a drug sells well commercially, the government pays less. The subscription functions as a revenue floor, not a bonus stacked on top of sales.

When the Contract Ends

The contract terminates on whichever date comes first: ten years after approval, or the date a generic or biosimilar version wins FDA approval and is actually marketed. Approval alone doesn’t end the contract; the competing product has to reach the market. Once it does, normal price competition takes over.¹

Stewardship Strings Attached

The subscription side of the bill sits alongside a stewardship program that shapes how antibiotics get used. The CDC would administer grants to help hospitals and other facilities build or strengthen antimicrobial stewardship programs, which enforce the right antibiotic at the right dose for the right duration.³

Facilities that take grant money have to report data on antibiotic use and resistance patterns to the CDC’s National Healthcare Safety Network, and that data must be made publicly available in a form that protects patient privacy.³ The 2026 version also funds pilot programs for stewardship in outpatient settings such as urgent care clinics and retail health centers, and gives priority for grants to rural hospitals and safety-net providers.⁴

Where the Bill Stands

The PASTEUR Act is not law. It was reintroduced on February 4, 2026, as H.R. 7352 by Rep. Buddy Carter (R-GA) with bipartisan cosponsorship and referred to the House Committee on Energy and Commerce and the Committee on the Budget. As of mid-2026, it has not passed either chamber.⁵ Earlier versions in the 116th and 118th Congresses, including H.R. 2940 and S. 1355, did not advance to a floor vote.⁶ The 2026 text authorizes $6 billion in federal funding to carry out the program.¹ Until Congress passes it and the President signs it, no subscription contracts can be awarded and none of the scoring, contract, or stewardship provisions take effect.

1
Congress.gov. Text – H.R.7352 – 119th Congress (2025-2026) PASTEUR Act of 2026
2
Centers for Disease Control and Prevention. Antimicrobial Resistance Facts and Stats
3
Office of Congressman Buddy Carter. PASTEUR Act
4
House.gov. The PASTEUR Act
5
Congress.gov. H.R.7352 – 119th Congress (2025-2026) PASTEUR Act of 2026
6
Congress.gov. H.R.2940 – 118th Congress (2023-2024) PASTEUR Act