The managed care market in Oregon will be shaken up with the awarding of contracts for the Oregon Educators Benefit Board. Winning three-year contracts for medical and pharmacy coverage were Providence Health Plans, Kaiser Northwest and ODS Health Plans, with the huge Regence BlueCross BlueShield of Oregon failing to win a bid. In Washington, Group Health Cooperative is expanding its out-of-network product options to those purchasing insurance in the individual market. The so-called Balance plans have deductibles ranging from $1,000 to $5,000 for individuals. Disease management is taking on new wrinkles in the region with Regence expanding an integrated program for complicated medical conditions by offering it to small employers while Providence Health Plan is introducing a "patient activation" plan. Health insurers are honing their strategies to deal with the rising costs of specialty drugs by placing the drugs on benefit tiers that require coinsurance and equalizing plan designs for copayments for specialty drugs considered medical and pharmacy purchases.