The Food and Drug Administration (FDA) is set to launch a pilot program offering bonus payments to agency drug reviewers who complete their work ahead of schedule, marking a significant shift in longstanding operational norms. FDA Commissioner Marty Makary announced the initiative during a staff presentation on Thursday, February 26, 2026, with the first quarterly bonuses expected to be distributed around August.
Incentivising Efficiency in Drug Assessments
Commissioner Makary described the effort as a pilot program designed to reward staff for efficiency while maintaining high-quality standards. In slides and a recording obtained by The Associated Press, Makary stated, "My job as your commissioner is to be your advocate and to fight for you," noting that securing approval for the payments required "some wrangling." He added, "If you don't like it, we can get rid of it, but usually everybody loves money."
The bonus program aims to recognise and reward employees who find ways to deliver high-quality work more efficiently, ultimately benefiting patients. According to presentation materials, payments will be based on "weighted time savings" achieved by teams, alongside ratings for "work quality and work complexity." One slide emphasised, "This program values speed, but never at the expense of quality."
Ethical and Operational Questions
The plan raises several questions, including how payments will be distributed across large teams involved in drug reviews. Employees not directly engaged in reviews, such as factory inspectors, are ineligible. Additionally, the pilot presents potential ethical dilemmas if FDA reviewers are perceived as being incentivised to rush steps critical for confirming drug safety and effectiveness.
Since the 1990s, the FDA has collected fees from drug companies to fund extra staff for faster reviews of new prescription drugs and vaccines. While the agency has timelines and metrics under industry agreements, it has never directly paid workers for meeting or exceeding these goals until now.
Staff Losses and Industry Tensions
The announcement comes as the FDA faces significant staff attrition in its drug review divisions. Agency records indicate that the FDA's drug and biologics centres, which oversee prescription drugs, vaccines, and biotech drugs, have lost approximately 20% of employees since President Donald Trump took office a year ago, due to retirements, resignations, and broader layoffs.
Furthermore, some reviewers are unable to work on specific projects because they are actively interviewing for positions in the pharmaceutical industry. This staff shortage compounds challenges in maintaining review timelines.
Public Perception and Regulatory Concerns
The bonus program could negatively impact public perception of the FDA, an agency often criticised for being too closely aligned with the drug companies it regulates. Health Secretary Robert F. Kennedy Jr., who oversees the FDA, has described agency staffers as "a sock puppet" of industry since assuming his role last February.
About 70% of the FDA's drug program is financed by user-fee payments from drug companies submitting products for review. This arrangement has enabled the hiring of thousands of additional scientists and reduced review times by more than half compared to pre-funding levels.
Recent FDA Policy Changes
Since arriving at the agency last April, Commissioner Makary has introduced a series of measures aimed at shortening FDA reviews. These include offering one-month drug assessments for medications serving "national interests." In recent weeks, the FDA announced it would drop its long-standing requirement for two clinical trials in drug reviews and open a new pathway for therapies testable only in small patient groups.
These moves toward faster, streamlined approvals occur as the agency faces criticism over its handling of vaccines, gene therapies, and other specialty treatments. Dr. Vinay Prasad, the FDA's chief scientist and vaccine director, has personally overruled staff in rejecting experimental therapies, citing needs for additional studies and more definitive evidence.
Earlier this month, Prasad refused Moderna's application for a new mRNA flu shot, deeming its clinical trial insufficient. However, less than a week later, the agency reversed course, agreeing to review the vaccine after Moderna committed to an additional study in older individuals.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education and the Robert Wood Johnson Foundation, though the AP remains solely responsible for all content.
