Demand for generic pharmaceuticals has resulted in China and India becoming the largest producers of these products in the world. Pollution from pharmaceutical manufacturing in both of these countries is a recognized environmental and public health problem, and the release of residual antibiotics is a contributor to antimicrobial resistance, which is projected to result in 10 million deaths per year by 2050 unless significant action is taken. This Article argues that implementation of voluntary sustainability standards is needed to address pharmaceutical manufacturing wastewater pollution, that this approach would drive market demand for pharmaceuticals produced in this way, and that this market response should also drive other manufacturers to improve their operations.