Brokers predict that enrollment for 2010 will be flat and that insurers will bump up their revenue with premium increases and changes in benefit designs. Health plan enrollment went down only slightly in Virginia and Maryland the first half of 2009, with the big Blue plans in both states keeping numbers steady. Aetna and CIGNA showed enrollment gains, Kaiser remained about even and UnitedHealth Group plans lost enrollees. The high price of specialty drugs is a key driver of the overall cost of healthcare. Plans are spending 15 to 20 percent of their pharmacy dollars on specialty drugs used by only 1 to 2 percent of their members. But they're learning ways to better control costs by care management and other methods. Virginia Medicaid is keeping a grip on pharmacy expenses in the state-managed fee-for-service programs with the help of a strong advisory panel.