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AKRON, Ohio — A ballot proposal to rein in drug costs was soundly defeated in Ohio Tuesday after an expensive ballot fight that drew tens of millions of dollars from the pharmaceutical industry.

The ballot proposal, known as the Drug Price Relief Act, was rejected by nearly 80 percent of voters in final results. It would have required that state agencies pay no more for medicine than the U.S. Department of Veterans Affairs, which gets a 24 percent discount off average manufacturers’ prices.

Tuesday’s vote was the second defeat for the proposal, which was also voted down in California last year. Many voters said they were confused about its impacts on consumers and didn’t feel comfortable supporting it.

….The ballot proposal sought to reduce spending on prescription drugs and save money for public agencies. But its bottom-line impacts on taxpayers and consumers were unclear. Opponents funded by the pharmaceutical industry argued it could actually increase prices for most Ohioans because drug companies would shift costs onto Medicare patients and privately insured individuals. However, the extent of that cost shifting was speculative, leaving voters to sift through competing claims about the proposal with little objective information.

In this year’s election, Ohio was seen as a key battleground in a nationwide fight over drug prices. PhRMA, the drug industry’s powerful lobbying arm, funded the opposition campaign. It contributed nearly $60 million to the effort, forming a subsidiary to shield the identities of the companies that gave donations.

…In the last few weeks, both sides invested heavily in prime-time advertising. The no campaign hammered the airwaves with argument that most Ohioans, including seniors and people with private insurance, would end up paying more because of possible cost shifting. The campaign was endorsed by the Ohio State Medical Association, which lobbies on behalf of thousands of physicians, and the Ohio Hospital Association.

…The proposal would have affected prices paid by a range of state agencies. The biggest impact would have been felt by the state’s Department of Medicaid, which purchases drugs distributed to low-income beneficiaries.

Proponents predicted approval of the measure would save taxpayers about $400 million, while opponents argued those savings were illusory because it is difficult to tell whether the VA’s prices are much better than those paid by Medicaid, which negotiates its own discounts.

The state’s Office of Budget and Management released a report concluding that the measure could save some money for the state, but the report also found that it was impossible to accurately predict how much.

As she walked into her polling station Tuesday, Kathleen Barber, 56, said she still wasn’t sure which way she was going to vote.

“I work in health care and some of these [prices] are just outrageous,” she said, adding, on the other hand, that it seemed likely the measure would actually raise prices on some people. “Somebody’s got to pay for it.”