Payers pre-commit to cover off-label generics when a definitive trial is positive

Uncertainty about reimbursement discourages trialists and clinicians and leaves proven repurposed treatments unused. The proposal is a formal coverage policy, adopted by public payers and large insurers, stating that any off-patent drug shown in a registration-quality randomised trial to improve survival or a validated patient-relevant endpoint in cancer will be covered for that use within six months of publication, subject to an independent evidence review, regardless of label status. The policy is published in advance so trial funders can rely on it.