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One of most controversial sections would set up a nationwide experiment, scheduled to start in 2017, to test a handful of ways to slow spending on drugs provided in doctor’s offices, clinics, hospitals and cancer infusion centers. The proposal would not affect most prescriptions patients get through their pharmacies.

The aim, the government says, is to maintain quality while slowing spending in Medicare Part B by more closely tying payments to how well drugs work, using methodsdrugmakers, insurers and benefit managers are already trying in the private sector.

One of the approaches included in the proposal would allow Medicare to earmark “therapeutically similar” drugs and set a benchmark, or “reference price,” that it would pay for all drugs in that category. That amount might be the cost of the drug the agency considers the most effective in the group, or some other measure. It’s aimed at narrowing the wide variability — often hundreds or thousands of dollars a year — in what is paid for similar drugs.

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