Blue Cross NC awarded 2 State Health Plan contracts

(Carolina Journal) – Third-party administrator and pharmacy benefit manager contracts have been awarded to to Blue Cross Blue Shield of North Carolina effective January 2028.

Also in its meeting Friday, the North Carolina State Health Plan Board of Trustees voted on preferred provider hospital systems, benefit changes and premiums for 2027.

This will bring Blue Cross North Carolina back as the third-party administrator after a three-year hiatus. CVS Caremark is the current pharmacy benefits manager for the State Health Plan.

“Blue Cross NC is grateful to be selected to serve the teachers, state employees, retirees, and families on the State Health Plan beginning in January 2028,” a statement from Blue Cross NC said. “As North Carolina’s only not-for-profit health insurer serving all 100 counties, we’re committed to working together with the state, hospitals, providers and members to make health care more accessible and affordable. In the months ahead, our focus is on ensuring a seamless experience for members and partnering with Plan leadership to deliver practical solutions that reduce costs and support better health outcomes.”

In April, the State Health Plan announced that it had canceled the request for proposal for third party administrator services. None of the bids received met the minimum requirements.

According to a release, Blue Cross NC and Aetna were the only companies to submit bids for the third party administrator.

It further states that Blue Cross NC’s bid gives the plan the opportunity to save up to a $1 billion over the life of the contract through deeper discounts and value-based payment opportunities on top of the plan’s Preferred Provider strategy.

Reports say the total value of the contract to the plan over three years would cost over $12 billion.

“We continue to believe Aetna is the strongest partner for the State Health Plan,” Phil Blando, a speaking for Aetna, told Carolina Journal in an emailed statement. “Our expertise and service have helped the State Health Plan to advance its cost containment goals, successfully implement the Plan’s complex provider tiering strategy, and provide members access to high-quality care. Aetna has been a trusted partner in North Carolina for decades, and that commitment remains steadfast in continuing to support the Plan and its members through the end of the current contract, Dec. 31, 2027. We will review this decision in the coming weeks and decide how best to move forward.”

The State Health Plan awarded Aetna as the third party administrator two years ago. Aetna replaced Blue Cross and Blue Shield of North Carolina in January 2025 after it served as the third party administrator for more than 40 years.

The change occurred in 2023 under former State Treasurer Dale Folwell, who characterized the deal with Aetna as a “partnership that focuses on transparency and lower costs.”

After several appeals by Blue Cross NC, along with court cases, the company said in July 2024 that it would not appeal a judge’s decision upholding the shift of a State Health Plan administrator contract to Aetna.

“Unfortunately, Blue Cross NC was a sore loser in thinking that it was entitled to nearly a half century monopoly on the State Health Plan’s business,” Folwell added in a June 2024 release. “They decided to try a ‘sue till you’re blue’ strategy, costing the state over $1 million in legal fees, for which taxpayers would welcome a reimbursement from Blue Cross NC. Thankfully, Judge Lassiter saw through their legal gymnastics.”

Judge Melissa Owens Lassiter, chief administrative law judge of the North Carolina Office of Administrative Hearings, presided in the case.

Both contract terms with BCBSNC run from Jan. 1, 2028, through Dec. 31, 2031, with two optional one-year renewal periods.