Some plans are also raising deductibles and co-payments for doctor visits and even adding co-payments for hospital stays.

Secure Horizons, the nation's largest operator of Medicare H.M.O.'s, is raising co-payments for drugs in the eight states where it operates.

The governor, who created the program, is continuing to push for cutting some benefits and raising co-payments in the program, officials said.

Employers are pushing more of the costs onto their workers, raising co-payments and deductibles.

Some are raising co-payments and requiring the use of generic drugs.

Those steps include raising Medicare premiums, co-payments and other charges to beneficiaries.

As most employer-sponsored health plans have raised co-payments sharply for drugs in recent years, employer drug spending has slowed.

Congress can also raise co-payments, adjust premiums for income or do both, approaches advanced by Mr. Kasich in the past.

In addition, companies that raised co-payments that consumers face for certain costly drugs experienced a greater moderation in spending.

Mr. Clinton made a start when he proposed raising some deductibles and co-payments.