In 2004, the Institute of Medicine concluded that a global high-level subsidy was the best way to make effective antimalarial drugs--currently, artemisinin-combination therapies (ACTs)--widely available at affordable prices and at the same time substantially delay the emergence and spread of artemisinin-resistant strains of falciparum malaria. The subsidy would be available to manufacturers of all ACTs meeting pre-specified efficacy, safety, and quality criteria. Buyers would pay very low prices, allowing drugs to flow through existing channels, with the aim of reaching consumers at a similar price to chloroquine, the most frequently used (although no longer effective) malaria drug. Unsubsidized artemisinin monotherapies would be more expensive than subsidized ACTs (co-formulations), thereby largely eliminating their use through market forces. Conditions favoring the emergence of artemisinin-resistant malaria would be greatly reduced. The global high-level subsidy is a powerful idea that is moving from economic concept to pragmatic reality.