Updated

In a blow to the pharmaceutical industry, Ohio state officials have approved a controversial initiative designed to lower drug prices on the November ballot.

Known as the Ohio Drug Price Relief Act, the ballot measure would require state agencies to pay no more for medicines than the US Department of Veterans Affairs. The agency currently gets a 24 percent federally mandated discount off average manufacturer prices and the measure, if passed, would presumably benefit more than 3.4 million residents.

The decision by Ohio Secretary of State Jon Husted, which was released on Friday, follows a heated battle between the pharmaceutical industry and the AIDS Healthcare Foundation, an activist organization that also runs clinics and unsuccessfully spearheaded a similar measure in California. The two sides went to court in Ohio last year as they sparred over the fate of the initiative.

If the ballot passes, Ohio would become “the first state in the country to take on powerful drug companies that are spending millions of dollars in excess profits to run a campaign based on lies and misinformation,” said Dennis Willard, a spokesman for Ohio Taxpayers for Lower Drug Prices, who claimed the measure could save residents $400 million annually.

“This poorly written proposal won’t save money for the state or lower drug costs for anyone,” a spokesman for ‘No on 2: Deceptive Rx Issue.’ “In fact, every expert who has studied it says it is likely to do the exact opposite: raising drug costs for most Ohioans and reducing access to needed medications for some of our state’s most vulnerable citizens.”

Whether the ballot will succeed is uncertain. In California, drug makers last year contributed nearly $110 million to defeat the closely watched effort. At the time, it was seen as a litmus test for tapping consumer anxiety over drug prices, which is a pocketbook issue for a growing number of Americans. Poll after poll has shown voters want Washington, D.C., to address the issue.

Over the last several months, some members of Congress have introduced various bills, but few have gained traction. And while President Donald Trump accused drug makers of “getting away with murder,” a draft executive order that has circulated reads like an industry wish list for measures that would protect profits.

The Ohio campaign has hired several prominent political figures to win voters. Among them is Rex Elsass, a former executive director of the Ohio Republican Party; Greg Schultz, who ran President Obama’s Ohio campaign; Matt Borges, a former Republican state party chairman; and Ron Malone, a former Ohio union leader who is now a Democratic political consultant.

They are squaring off against the Pharmaceutical Research & Manufacturers of America, the industry trade group, which successfully used extensive advertising to convince California residents the measure was flawed. That view was fueled by the state legislative analyst’s office, which was uncertain whether the measure would have had “relatively little effect” or yielded “significant annual savings.”