The mechanism: Since 2007, Congress has let the FDA hand out a strange kind of money: transferable Priority Review Vouchers (PRVs), awarded to sponsors that win approval of a drug for a rare pediatric disease, a neglected tropical disease, or a "material threat" medical countermeasure. A PRV lets its holder — or whoever buys it — cut a future FDA review from the standard ~10 months to about 6 months for any other drug in the pipeline, no relation to the original disease required. Because getting a blockbuster to market four months early can be worth hundreds of millions in exclusivity-period sales, PRVs trade as a real secondary asset, and the price has been climbing: Jazz Pharmaceuticals sold one for $200 million in January 2026 — the highest price in a decade — and Rocket Pharmaceuticals closed a $180 million sale the same quarter. This is policy design functioning as a bond market: Congress sets the incentive, FDA issues the paper, biotechs cash it or spend it.
Who cashes in: Gilead (GILD) is the program's single biggest historical buyer — it paid $125 million for a voucher in 2014 to speed Odefsey and $290 million in 2016 to accelerate Biktarvy, both now multi-billion-dollar HIV franchises. That willingness to pay up for months of exclusivity is the tell: for a company with a drug approaching a crowded launch window, a PRV is cheaper than the revenue lost to a slower review clock, and Gilead's balance sheet has repeatedly proven it will write nine-figure checks for exactly that optionality. Regeneron (REGN) ran the same play twice — splitting a $67.5 million voucher purchase with Sanofi in 2014 to leapfrog Amgen's Repatha with Praluent, then using a purchased PRV to get Eylea HD approved four months early in August 2023. Vertex (VRTX), with a deep rare-disease pipeline (its gene-editing and pain franchises are natural rare-pediatric-designation candidates), sits on the origination side: any qualifying approval mints a sellable $150M-plus asset almost as a byproduct of hitting its normal regulatory milestones.