HR-7352-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Earl Carter (R-GA)
What it does
The PASTEUR Act would create a federal "subscription" contract program under the Public Health Service Act, allowing the Secretary of Health and Human Services to pay pharmaceutical companies between $75 million and $300 million per year — for up to 10 years — to develop and keep available new antimicrobial drugs that target drug-resistant pathogens. Payments would be adjusted downward based on a company's actual U.S. sales revenue, decoupling profit from sales volume. The bill would also establish grants for antibiotic stewardship programs in hospitals and outpatient settings, expand CDC surveillance of antimicrobial resistance, and create a 15-member expert advisory group. It appropriates $6 billion for fiscal year 2026, designated as an emergency requirement.
Who benefits
Patients with drug-resistant bacterial or fungal infections, who would gain access to new treatments that the current market does not adequately incentivize. Pharmaceutical and biotech companies developing novel antimicrobials, who would receive guaranteed federal payments reducing financial risk. Rural hospitals, critical access hospitals, safety-net hospitals, and Tribal health facilities, which are prioritized for antibiotic stewardship grants. Urgent care centers and retail clinics eligible for outpatient stewardship grants. The U.S. military, which depends on effective antimicrobials for battlefield medicine. Public health researchers and surveillance professionals who would gain expanded resistance data. Diagnostic device manufacturers who would receive guaranteed supply of test compounds. Indirectly, the broader public that benefits from slowing the spread of drug-resistant infections.
Who is hurt
Taxpayers who would fund the $6 billion appropriation, designated as emergency spending outside normal budget caps. Generic drug manufacturers, whose entry into the market triggers contract termination, potentially creating tension with their business interests. Competing pharmaceutical companies developing drugs outside the program's eligible categories, who would not receive similar support. Patients with conditions not covered by the program's eligible pathogen list. Potentially, companies whose applications are denied under the scoring methodology. Budget hawks and deficit-reduction advocates, as the emergency designation bypasses standard pay-as-you-go rules. Countries outside the U.S. that may face delayed access if companies prioritize domestic availability requirements.
Supporters argue
Supporters argue that antimicrobial resistance already kills an estimated 35,000 Americans annually and that the existing market fundamentally fails to incentivize new antibiotic development — because effective antibiotics are used sparingly to prevent resistance, limiting sales revenue and making them commercially unattractive. They contend that the subscription model directly solves this market failure by paying for availability rather than volume, and point to the near-total collapse of major pharmaceutical companies' antibiotic pipelines over the past two decades as evidence that voluntary market incentives have proven insufficient. Bipartisan support for prior versions of this legislation reflects broad agreement that the threat of untreatable infections poses a genuine national security and public health risk.
Opponents argue
Opponents argue that committing up to $300 million per drug per year — with payments largely shielded from public pricing disclosure — creates a taxpayer-funded windfall for pharmaceutical companies without adequate accountability for how those funds relate to actual research and development costs. They contend that the emergency spending designation, which bypasses standard budget offsets, sets a troubling precedent for circumventing fiscal discipline, and that the bill's confidentiality provisions prevent Congress and the public from verifying whether payments are proportionate. Critics also argue that the scoring methodology and contract terms give HHS broad, loosely defined discretion that could be subject to legal challenge under the major questions doctrine given the scale of spending involved.
Constitutional context
Congress's authority to appropriate funds and attach conditions to contracts rests on the Taxing and Spending Clause (Art. I, §8, cl. 1) and the Necessary and Proper Clause (Art. I, §8, cl. 18). The bill's broad delegation of scoring, payment calculation, and contract terms to HHS could face scrutiny under the post-Loper Bright (2024) framework, where courts now independently assess whether agency statutory interpretations are correct rather than deferring to the agency, and under the major questions doctrine from West Virginia v. EPA (2022), which requires clear congressional authorization for agency actions of vast economic significance — though the $6 billion direct appropriation with defined payment floors and ceilings provides more explicit authorization than typical regulatory delegations.
Checks and balances
The Executive Branch (HHS/Secretary) gains significant new contracting and payment authority; checks include the 15-member Advisory Group with conflict-of-interest rules, congressional oversight through required reporting, referral to both the Energy and Commerce and Budget Committees, and judicial review of agency rulemaking under the post-Loper Bright independent-judgment standard.
Historical precedent
The United Kingdom's National Health Service piloted a similar subscription-style payment model for antibiotics in 2019-2022, contracting with Pfizer and Shionogi for fixed annual payments; the U.S. has not previously enacted a comparable federal subscription contract program for antimicrobials, though prior versions of the PASTEUR Act were introduced in the 117th and 118th Congresses without enactment.