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WASHINGTON — Alex Azar might have big plans to overhaul how Medicare pays for drugs.

At a congressional hearing at the end of November, the nominee to be secretary of Health and Human Services wondered aloud about how to modify a government health insurance program that helps tens of millions of Americans over the age of 65 pay for medicines. Such changes might impact the price of the drugs across the board.

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His comments were nonspecific and wonky — “How can we take the learnings from Part D maybe into Part B?” — and have largely flown under the radar, in part because many health policy experts aren’t quite sure what he meant. But any changes to Medicare Part B are likely to generate controversy — as they have in the past.

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