Maine, the State has authorized organs of State Government to begin negotiating with specialty pharmacy providers to capture the greatest savings possible on specialty pharmaceuticals and therapies. In Maine, attempts to implement a dual source contract where two providers would service all Mainers enrolled in the state’s prescription plan “Dirigo Health.” Recent personnel changes at the Capitol in Augusta have thrown the current plan into limbo. In Rhode Island, the State is in negotiations with Caremark, but due to the ongoing nature of the negotiations, it is unclear whether Hemophilia and Bleeding Disorders. Industry sources have stated that it is not their intention to include Hemophilia, but until a deal is announced by the parties nothing is final. Georgia public health officials also have publically announced their interest in possibly introducing a PDL in the last few weeks about a proposed preferred drug list. The most stunning development from the District of Columbia is considering an ordinance that would mandate replacement with a generic med even if the brand name was explicitly called for the prescriber. At the core of all of these concerns, is the public health systems intention to drive down costs, but in doing so—one can’t help whether their zeal for savings might have unintended consequences for people with bleeding disorders across the country.