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LEVELAND — Facing annual spikes in pharmaceutical costs, major hospitals nationwide are curtailing use of expensive drugs and rejecting new additions to their formularies, sometimes triggering tense debates with clinicians who want to offer cutting-edge medications to their patients.

The conflict, involving a wide array of drugs, is bound to become more intense amid the specter of a GOP-led health care overhaul that could further undermine hospital finances. Already, hospitals are cutting down on use of certain pain medications and carefully scrutinizing requests to add expensive new drugs to treat conditions ranging from epilepsy to cancer.

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