Until recently, comparative effectiveness research (CER) was a term that only surfaced in conversations among health policy specialists, academicians, and other observers of the healthcare marketplace. No longer. The allocation of $1.1 billion to CER in the American Recovery and Reinvestment act (ARRA, 2009) rep-resented a paradigm shift. And the inclusion of CER in every healthcare reform bill introduced since, including the final Patient Protection and Affordable Care Act (PPACA, 2010), suggests that it’s seen as a key solution to healthcare cost containment. With PPACA’s establishment of the Patient-Centered Outcomes Research Institute (PCORI) to fund research into the relative health outcomes, clinical effectiveness, and appropriateness of different medical treatments, CER has gone from a policy theory to a standing institution.

The implications of the recent increase in focus on CER for pharma are many. With a set of guidelines in place that specifies what drugs will be prescribed for whom and in what sequence, backed by the threat of non-reimbursement, the ability to change physician behavior through education efforts will be limited. This doesn’t mean that detailing will end, but it will be limited to specific providers who have shown a willingness to buck reimbursement guidelines either by justifying exceptions or by catering to patients who are willing to pay out of pocket for premium drugs. Nevertheless, the prospects for large sales forces of recent years are dim.