# Escrow a share of adult revenue until the paediatric study is done

Source: https://onco.cc/ideas/idea-fund-paediatric-deferral-escrow/  
OnCo record `idea-fund-paediatric-deferral-escrow` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Companies often delay the childhood cancer studies they are required to do. A slice of the adult drug's revenue would be held back until the paediatric trial is completed.

## Summary

Under the US RACE for Children Act and EU Paediatric Regulation, companies must plan paediatric studies for molecularly relevant cancer drugs, but deferrals and waivers are common and completion lags years. A rule would place a small percentage (for example 2%) of adult sales into escrow from launch, released on completion of the agreed paediatric study or forfeited to a paediatric oncology trials fund after the deadline. This aligns commercial interest with timely paediatric evidence without new appropriations.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Revenue escrow reduces the median delay from adult approval to paediatric study completion by at least two years and lifts on-time completion above 75% for drugs approved under the rule.
- Rationale: Deferral without financial consequence is why paediatric plans drift; financial holdbacks are standard tools in construction and procurement contracts. The RACE Act closed the loophole of indication-based exemption but left timing weakly enforced.
- Proposed test: Implement in one jurisdiction for newly approved oncology drugs with paediatric requirements and compare completion timelines with the prior cohort.
- Maturity: speculative
- Actor: regulator

## Sources

- FDA Oncology Center of Excellence pediatric oncology: https://www.fda.gov/about-fda/oncology-center-excellence/pediatric-oncology

## Connected records

- ideas: [Advance market commitments for paediatric and rare cancer drugs](https://onco.cc/ideas/idea-fund-amc-paediatric-rare/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Neuroblastoma (paediatric)](https://onco.cc/cancers/neuroblastoma/), [Sarcomas (soft tissue, bone, GIST)](https://onco.cc/cancers/sarcoma/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Rare and paediatric cancers without markets](https://onco.cc/bottlenecks/b-rare-cancers/)
- roadmaps: [Paediatric oncology roadmap: cooperative-group cures → engineered immunity → drugs developed for children first](https://onco.cc/roadmaps/paediatric-oncology-roadmap/)

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