This brief outlines actionable steps the U.S. government can take to hold Cepheid accountable for transparent, fair, and equitable pricing of GeneXpert tests and ensure public return on public investment for health technologies developed using U.S. government funding.

This brief examines the background and unexpected consequences of the Xpert MTB/RIF buy-down; applies lessons learned to the ongoing development of COVID-19 diagnostic tests and efforts to scale up access to these tests; and provides recommendations and pro-access conditions that should be applied to R&D funding, buy-down, and other market intervention agreements for COVID-19 diagnostics.