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Japan’s effort to rein in soaring health-care costs threatens to become a source of tension in economic relations with the U.S. after running into opposition from the American pharmaceutical industry.

While the U.S. Commerce Department sees Japan’s drug market, the world’s third-largest, as the top near-term growth opportunity for its pharmaceutical exporters, the view from Tokyo is of crippling medical bills as the ranks of the elderly swell and the working-age population declines.

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