Health plans in the Carolinas are managing specialty pharmacy costs at virtually every step of the process, from negotiating prices with manufacturers to creating special convenient networks. Blue Cross and Blue Shield of North Carolina has developed its own specialty pharma network and is aligning specialty reimbursement with the actual time and expertise needed to process and store the drugs. Medical Mutual continues to expand its footprint in South Carolina with the acquisition of a PPO work. CMS is piloting personal health records for Medicare members in South Carolina. In the North Carolina legislature, most healthcare bills are taking a back seat to mental health care reform, while South Carolina lawmakers kept the state's cigarette tax at the lowest level in the nation.