Summary Healthcare reform fizzled out in both Kansas and Missouri in the past legislative sessions. A legislative revolt from his own party forced Missouri Gov. Matt Blunt to back off his Insure Missouri plan. And what few pieces from the Kansas Health Policy Authority proposal survived went largely unfunded. On the pharmacy benefit front, insurers are pushing expensive specialty drugs to high tiers, moving them from medical benefits to drug coverage and increasing copays or requiring coinsurance. Meanwhile, HMO enrollment continues to decline in both states with PPO market share growing; Preferred Health is moving into rural areas of Kansas and outside its home base of Wichita.