Some 18 million people die annually from poverty-related causes. Many more are suffering grievously from treatable medical conditions. These burdens can be substantially reduced by supplementing the rules governing pharmaceutical innovation. Established by the World Trade Organization’s TRIPS Agreement, these rules cause advanced medicines to be priced beyond the reach of the poor and steer medical research away from diseases concentrated among them. We should complement these rules with the Health Impact Fund. Financed by many governments, the HIF would offer any new pharmaceutical product the opportunity to participate, during its first ten years, in the HIF’s annual reward pools, receiving a share equal to its share of the assessed global health impact of all HIF registered products. In exchange, the innovator would have to agree to make this product available worldwide at the lowest feasible cost of manufacture. Fully consistent with TRIPS, the HIF achieves three key advances. It directs some pharmaceutical innovation toward the most serious diseases, including those concentrated among the poor. It makes all HIF registered medicines cheaply available to all. And it provides an incentive to innovators to promote the optimal use of their HIF registered medicines. Magnifying each others effects, these advances would engender large global health gains.