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As Purdue Pharma faced serious challenges to OxyContin sales, the company was advised to consider paying rebates of up to $14,000 to health insurers for each patient who was harmed by its opioid painkiller in order to maintain those crucial business relationships, according to court documents.

The suggestion was contained in a proposal made three years ago by McKinsey consultants as the drug maker faced a fast growing number of lawsuits from state and local governments, federal guidelines about limiting opioid prescribing, and restrictions placed by some health insurers on formularies, the lists of medicines eligible for coverage.

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