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As cash-strapped states across America struggle with their drug spending, the National Governors Association has suggested several ways to address the problem, from bulk purchasing and alternative payment plans to the use of metrics for assessing the value of medicines.

The ideas were released in a long-awaited report by the group, which has sought ideas from economists and public health officials for containing rising prescription drug expenses. The initiative was triggered, in particular, by two events over the past few years: revolutionary but pricey new medicines for combating hepatitis C, and the rising costs of coping with the ongoing opioid crisis.

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