Massachusetts' largest health insurer, Blue Cross Blue Shield, is embracing one of the latest trends in pharmacy benefit management, that of value-based benefit design. The Boston-based health plan, already the only state HMO offering the design to self-insured accounts, will become the first HMO in Massachusetts to offer a VBBD to the fully insured group market beginning Jan. 1, 2010. Also embracing the VBBD concept is the state of Maine, which is seeing a strong return on investment from its VBBD program revolving around diabetes for state employees. The strong results prompted the state to expand to new disease states. Meanwhile, a growing concern for health insurers across New England is rising costs of specialty drugs, prompting heatlh plans to implement a variety of strategies to control those costs. In Massachusetts, Bay State officials have been working to keep its landmark near-universal healthcare reform afloat amidst severe economic turmoil. A $5.4 billion state deficit and tax collections down by almost $3 billion forced state officials to institute cutbacks to the state's reform, shifting around 31,000 legal immigrants to a less generous—and less costly—benefit.