Since the 1990s, the FDA has collected fees from drug companies to help fund additional staff and to speed reviews, but the agency has not paid workers directly for meeting or exceeding its own review targets. On Thursday, FDA Commissioner Marty Makary told agency staff it would change, describing a pilot program that would provide bonus payments to drug reviewers who complete work ahead of schedule, according to slides and a recording of the presentation obtained by The Associated Press.
Makary told the staff that his job as commissioner is “to be your advocate and to fight for you,” and said FDA staff had done “some wrangling” to get approval for the payments. In remarks included in the presentation, Makary said that if staff did not like the proposal, “we can get rid of it,” adding, “but usually everybody loves money.”
The plan raises questions about how the bonuses would be distributed inside large, multi-disciplinary review teams, and which staff would qualify. According to the AP, the FDA said employees who are not directly involved in drug reviews—such as factory inspectors—would not be eligible. The agency also acknowledged ethical concerns that could arise if the public or staff see the program as rewarding speed over the careful work needed to confirm drug safety and effectiveness.
FDA slides presented to staff framed the initiative as a recognition program tied to both efficiency and standards. The slides said the effort is intended “to recognize and reward staff who find ways to be more efficient delivering high-quality work activities that ultimately benefit patients.” One slide also stated, “This program values speed, but never at the expense of quality,” and officials said the payments would be based on “weighted time savings” along with ratings-based measures of “work quality and work complexity.”
The announcement came amid signs of staffing strain and other changes to FDA review practices. AP reported that the agency’s drug and biologics centers—responsible for prescription drugs, vaccines and biotech drugs—have lost about 20% of their employees since President Donald Trump took office a year ago, according to agency records. AP also reported that some reviewers cannot work on certain projects because they are interviewing for jobs in the pharmaceutical industry.
Makary’s comments about speeding reviews align with other steps he has announced since arriving at the agency last April. AP reported that Makary said the FDA would shorten review timelines in some cases, including offering one-month assessments for new medications that serve “national interests.” In the last two weeks before the AP report, Makary said the agency would drop a longstanding requirement for two clinical trials for drug reviews and create a new pathway for therapies that can be tested in only a handful of patients.
The proposal also arrives as the FDA faces broader criticism about how it has handled vaccines, gene therapies and other specialty treatments. AP reported that the FDA’s chief scientist and vaccine director, Dr. Vinay Prasad, had personally overruled staff rejections of multiple experimental therapies and biotech drugs, citing a need for additional studies and more definitive evidence, including an earlier refusal to accept Moderna’s application for a new mRNA flu shot before the agency reversed course after Moderna agreed to conduct additional study in older people.
Health Secretary Robert F. Kennedy Jr., who oversees the agency, has described the FDA staff as “a sock puppet” of industry since becoming the nation’s top health official last February. Against that backdrop, AP said the bonus program could also hurt public perception of the FDA, which has often been viewed as too closely aligned with drug companies it regulates.
In the Thursday presentation, Makary positioned the incentives as an internal way to improve performance. The AP reported that senior officials said the plan would evaluate both time saved by reviewers and the complexity of their work, with payments intended to encourage efficiency while maintaining quality—an aim that will be tested when the first quarterly bonuses begin going out to employees around August.