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Anticipation may be high that Medicare can wring lower prices out of drugmakers, but a handful of states are moving aggressively to slash costs for their residents, a clear sign the battle over affordable medicines in the U.S. is only going to escalate further.

These efforts involve Prescription Drug Affordability Boards, which are designed to function like a rate-setting authority. How so? Most boards seek to set upper payment limits, or ceilings, used for determining prices that are paid for medicines. And in some states, the plan is to set prices paid not just by state and local governments, but also by commercial health plans operating there.

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“We know drug costs are too high because our patients skip doses or cut them in half,” said Rob Davidson, an emergency room doctor who is also executive director of the Committee to Protect Health Care, a national organization that lobbied to pass legislation to create a state board in Michigan. “So we should be excited about any move that could decrease costs.”

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