According to Swets August eNotes newsletter, the New England Journal of Medicine has "significantly" changed its tiered pricing for 2006. I could not find anything on NEJM's website regarding this change. But according to Swets, "some tier definitions may allow some existing customers to fall into a lower priced tier. Additionally, separate rates have been established for Hospitals. These 2006 rates are effective July 1, 2005. The 2006 hospital rates supersede the following 2005 Tiers: 2, 4A, 5A and 5B."