Commercial markets in Colorado and Nevada have been shaken up by expansion of HMOs and, in the case of Las Vegas, new market entrants. At the same time, local brokers say employers are not likely to stick with their old health plans just to receive "grandfathered" status, and may opt for high-deductible and account-based designs in order to control cost. More health insurers are examining strategies for specific classes of specialty drugs, such as rheumatoid arthritis or oncology. Adults served by the Arizona Health Care Cost Containment System will undergo major benefit cuts, while Colorado Medicaid has seen strong uptake as a hospital fee allows it to open enrollment to new populations.