South Carolina's expanded Medicaid managed care program attracted a crowd of health plans interested in insuring beneficiaries, but the crowd is thinning with two MCOs throwing in the towel in 2009. The program now has more than 400,000 Medicaid recipients enrolled in managed care plans or a medical home network, meaning almost two of three South Carolinians in Medicaid is not in the fee-for-service system. The development means a swelling number of Medicaid members who are under prescription drug management by MCOs and their vendors. Blue Cross and Blue Shield of North Carolina reports greater medication adherence among members with chronic conditions as a result of its Medication Dedication program launched in 2008, while employer coalitions in the Carolinas expect additional classes of drugs to be moved into step therapy. The North Carolina Medicaid program is planning to move additional drugs into a prior authorization category in a cost-saving move. Meanwhile, insurers report that the extension of benefits in COBRA is mitigating enrollment losses in the Carolinas, which have been severely affected by job losses