Still reeling from a weak job market, the insurance industry in the Tristate is looking under every stone for cost controls and efficiencies. Carriers still challenged in growing their commercial business, although UnitedHealthcare will increase its footprint with the assumption of Health Net of the Northeast's commercial business. Meanwhile, some carriers are drastically streamlining their product offerings to eliminate unpopular products and focusing on those that are cost-effective. One health plan is attacking costs by taking the drastic step of removing the expensive brand-name drugs treating acid reflux and high cholesterol from the formulary. Several health insurers are stepping up their care management programs, resulting in a new medical home project downstate and a new company being formed in New Jersey. In New York, health plans are scrambling to file rate increases for 2010 as the state ushers in a new era of prior approval. In the Medicaid arena, New York State is getting ready to pull some levers in negotiations with pharmaceutical companies to boost volume discounts, or rebates, on drug purchases, while Connecticut is still debating whether to convert Medicaid MCOs to administrative-only contracts.