Blue Cross and Blue Shield of North Carolina won the state’s third-party administrator and pharmacy benefit manager contracts for the state health plan effective Jan. 1, 2028.
Blue Cross NC previously lost its TPA contract and challenged Aetna’s 2025 contract award in 2023. The state court ultimately sided with Aetna over Blue Cross NC.
The state health plan has nearly 750,000 members, covering teachers, state employees and retirees. The board of trustees voted in favor of the Blue Cross NC contracts July 10. The contracts will run through Dec. 31, 2031, with two optional yearlong renewal periods.
“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,” Blue Cross NC told Becker’s July 13.
A state treasurer’s office news release from the same day said Blue Cross NC’s TPA bid enables possible savings of up to $1 billion throughout the contract’s duration, thanks to discounts and value-based payment potential coupled with the preferred provider approach. While Aetna, the current TPA, also bid, the state treasurer’s office previously told Becker’s that it did not anticipate the contract extending into 2028 due to the administration’s “different priorities.”
“We believe Aetna is the strongest partner for the state health plan, and our results have proven it,” a CVS Health spokesperson told Becker’s. “We will review this decision in the coming weeks and decide how best to move forward.”
Blue Cross NC beat several vendors for the PBM contract. The news release said the insurer was the only one to meet all minimum requirements. CVS Caremark — the current PBM, which has the same parent company as Aetna — previously faced tensions with the state treasurer over contractual obligations, but the issue was eventually resolved.
“From a pharmacy benefit management perspective, we lead the marketplace in advancing a PBM model built to improve transparency, lower costs and deliver a better member experience,” the CVS Health spokesperson said. “Not every client is prepared to move at this rate of progress, and we continue to focus on providing best-in-class service and market leading innovation to everyone we serve.”
The board of trustees also approved preferred provider contracts with Chapel Hill, N.C.-based UNC Health and Winston-Salem, N.C.-based Novant Health, effective Jan. 1, 2027.
Starting in 2027, providers will be considered preferred, access, non-preferred or out of network. Preferred provider use will result in lower deductibles, out-of-pocket maximums and copays. Access providers will be cost neutral or perhaps have lower out-of-pocket costs, while non-preferred provider use will cause increases.
The board greenlit 2027 premium rates and benefit changes, which include some decreased copays linked to the new tiered provider network. Members will have monthly increases from less than $2 to about $8 for individuals and less than $29 to $42 for families.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.