Payments from the $2.67 billion Blue Cross Blue Shield antitrust settlement began rolling out May 11, more than a decade after the original lawsuit was filed.
Six things to know:
1. The lawsuits alleged BCBS plans conspired to divide up markets
The litigation began in 2012, when health plan members filed a series of antitrust lawsuits against the BCBS Association and its affiliates, alleging the companies conspired to divide up markets and avoid competing with each other, thereby driving up costs for consumers. The cases were consolidated in 2013 and later proceeded as a class action. BCBS denied all allegations of wrongdoing.
2. A settlement was reached in 2020 and finalized in 2022
In October 2020, BCBS reached a $2.67 billion settlement, in which it admitted no wrongdoing. The class covered individuals and employers with BCBS coverage between 2008 and 2020.
A federal judge in Alabama gave final approval to the settlement in 2022. Though some litigants challenged the settlement, the 11th U.S. Circuit Court of Appeals upheld it in 2023, and the U.S. Supreme Court declined to hear the challenge in 2024.
3. The settlement required structural changes alongside the payout
In addition to the $2.67 billion fund, the settlement required BCBS companies to eliminate two association rules. The first mandated that two-thirds of national net revenues from health plans and related services come from Blue-branded products. The second required large employers to work with the Blue insurer covering their headquarters’ geography, which prevented BCBS companies from competing with one another for large contracts. The settlement created a mechanism by which certain large employers can now solicit bids from any BCBS plan in the country, known as the “second blue bid.”
4. The rule changes are already reshaping competition among BCBS plans
Elevance Health, which operates Anthem BCBS plans in 14 states, said in January that it bid on 11 national accounts in competing BCBS markets in 2025 and won nine of them, offering the first concrete look at how the second blue bid provision is reshaping competition within the Blues ecosystem. The provision is likely to primarily benefit BCBS plans with the existing scale and technology to compete nationally, and the dynamic could accelerate consolidation across the BCBS system and put smaller plans at risk, particularly those in states with a high concentration of national accounts.
5. A separate $2.8 billion provider settlement is proceeding on a different track
In October 2024, the BCBS Association and its affiliates agreed to pay $2.8 billion to settle antitrust claims from hospitals, physician practices and other providers, marking the largest settlement of its kind in the healthcare industry. A federal judge approved the settlement in August 2025. Nearly 6,500 providers opted out, however, including facilities owned by Mayo Clinic, Providence, University of Michigan Health and AdventHealth. Dozens of health systems subsequently filed new antitrust lawsuits alleging that anticompetitive practices are ongoing.
6. New lawsuits continue to mount
In February 2026, physician staffing groups filed a new federal antitrust lawsuit in California against the BCBS Association and its affiliates, alleging market allocation, reimbursement suppression and price fixing.
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.