Those on state health plan could see provider change again

The North Carolina State Health Plan could be seeking a new insurance provider just over a year into a contract with Aetna.

Any change in the plan administration would mean a change in coverage for 750,000 people as soon as January 2028.

Aetna took over the State Health Plan in January 2025 after officials voted to take the multi-billion dollar contract away from Blue Cross Blue Shield, which had managed the plan for decades. Officials said Aetna scored better on a series of questions about costs and technical capabilities.

But that was under the leadership of former State Treasurer Dale Folwell. He was replaced in office last year by State Treasurer Brad Briner.

"This administration has different priorities and would prefer a contract that is more in line with those priorities," Briner spokesperson Loretta Boniti said.

The State Health Plan already started the search for new Pharmacy Benefit Services last month.

A spokesperson for Aetna parent company CVS, Phillip Blando, said requests for proposals like this are routine and said the company does not comment on potential future bids.

"In close partnership with State Health Plan staff, we successfully executed the first Third Party Administrator transition in decades, and we remain committed to improving the overall health and well-being of State Health Plan members," Blando said.

The decision to re-open bidding doesn't necessarily mean Aetna will lose the contract, or that if it does, the state would go back to Blue Cross NC.

"The Plan is seeking partners who support the alignment of incentives between members, providers, and the Plan. Future partners will assist us with improving health, delivering an excellent member and provider experience while fostering financial sustainability," Boniti said.

Blue Cross had sometimes clashed with Folwell, who raised concerns about pricing and transparency. In 2023, under Folwell's leadership, the State Health Plan board voted to move the multi-billion-dollar contract to Aetna starting in 2025. Blue Cross sued, claiming the decision was made due to errors and an unfair scoring process used by the state.

But Blue Cross lost that lawsuit in 2024, and the plan shifted to Aetna in 2025, the same year Briner took office.

Some of the major differences between the two companies were that Blue Cross had a larger network of doctors and other providers in rural areas, whereas Aetna had a larger network in urban areas. Aetna proposed charging the state a higher rate than Blue Cross, but also agreed to pay higher penalties for missing goals.

The State Health Plan anticipates awarding the new contracts in July.