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The Institute of Medicine, or IOM, estimates that more than half of all treatments are delivered “without clear evidence of effectiveness.” Unlike many other countries, the United States has not invested consistently in such research. For example, the U.S. Food and Drug Administration only evaluates whether new drugs are safe and work better than a placebo, not whether they are superior to other existing drugs that treat the same condition. Increased CER would arm health care consumers, providers, and payers with a greater understanding of how effective treatments truly are, which potentially would improve the quality of care and reduce health care costs.

As policymakers drafted the Affordable Care Act, or ACA, they were aware of these evidence gaps and built in a solution in the form of the private, nonprofit Patient-Centered Outcomes Research Institute, or PCORI. The ACA established PCORI with a clear mandate to carry out the “funding of comparative clinical effectiveness research” over 10 years. PCORI was to focus distinctly on CER and not duplicate the types of research funded by the Agency for Healthcare Research and Quality, the National Institutes of Health, or other entities. However, a Center for American Progress analysis in 2014 found that only one-third of PCORI’s funding was going toward CER.

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