Across the Midwest, colleges and universities are saving students millions of dollars through textbook affordability initiatives, primarily through OER creation and adoption programs and Inclusive Access bulk-purchase discount programs. Notable examples of textbook affordability initiatives include Indiana University's eTexts Initiative and Ohio's Open Ed Collaborative. The two initiatives take very different approaches to addressing textbooks costs, and each serves as a potential model for other states and institutions to adapt. State legislation has played a role in bolstering textbook affordability initiatives, with states such as Illinois, Indiana, Michigan, North Dakota, and Ohio passing or introducing OER or Inclusive Access related legislation since 2013. For policymakers and others who wish to support affordable alternatives to high-cost textbooks, it is helpful to understand the range of available alternatives, how these alternatives are typically implemented, and how policy might enable or incentivize that implementation. This report discusses the ongoing escalation of college textbook costs, the benefits and challenges of more affordable options, implementation examples for two key options, and policy recommendations for supporting textbook affordability at scale.