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BCBSNC wins State Health Plan TPA, PBM contracts

In addition to voting on preferred provider hospital systems, benefit changes, and premiums for 2027 at its Friday board meeting, the North Carolina State Health Plan Board of Trustees also awarded the Third-Party Administrator (TPA) and Pharmacy Benefit Manager (PBM) contracts to Blue Cross Blue Shield of North Carolina (BCBSNC) effective January 2028.This will bring BCBSNC back as the TPA after a three-year hiatus. CVS Caremark is the current PBM for the SHP.

Theresa Opeka
News

State Health Plan OKs premium hikes, preferred providers

On Friday, the North Carolina State Plan Board of Trustees (SHP) voted on what are being called monumental changes to the Plan over the next few years, including preferred provider hospital systems, benefit changes, and premiums for 2027, and the announcement of a Third Party Administrator (TPA) and Pharmacy Benefit Manager (PBM) for 2028, in an effort to make improvements and reduce overall costs for the nearly 750,000 members covered by the Plan.

Theresa Opeka
News

Contingency plan set for state workers affected by Aetna-Duke negotiations

In the wake of the ongoing negotiations between Duke Health and Aetna, the North Carolina State Health Plan Board of Trustees on Friday approved procuring a transition services vendor to help plan members find new healthcare providers if an agreement can’t be reached by the Oct. 20 deadline.

Theresa Opeka
News

Duke Health: Requested Aetna rate hike would have small impact on state workers

In an emailed statement to Carolina Journal on Friday, Duke Health said it is “actively engaged in good faith negotiations” with health insurance company Aetna in response to a story that many patients, including over 750,000 state employees covered under the State Health Plan (SHP), will lose in-network coverage to Duke’s doctors, hospitals, clinics, and services on Oct. 20.

Theresa Opeka

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Duke–Aetna dispute could raise premiums, cut coverage for NC’s state employees

The clock is ticking on negotiations between health insurance company Aetna and Duke Health, which says that unless Aetna raises its reimbursement rates, many patients will lose in-network coverage to Duke’s doctors, hospitals, clinics, and services on Oct. 20, including over 750,000 state employees covered under the State Health Plan (SHP).

Theresa Opeka
News

Folwell demands BCBSNC pay over $2 million in legal fees following lawsuit

North Carolina State Treasurer Dale Folwell has sent a letter to Dr. Tunde Sotunde, President of Blue Cross Blue Shield of North Carolina, demanding that it pay more than $2 million in legal expenses that the Treasurer’s office incurred after successfully fighting a lawsuit by the health insurance giant.

Theresa Opeka
News

Blue Cross will not appeal judge’s State Health Plan ruling

Blue Cross and Blue Shield of North Carolina will not appeal a judge’s decision upholding the shift of a State Health Plan administrator contract to Aetna. Blue Cross’ decision to drop its legal complaint means the shift will take place as scheduled on Jan. 1.

CJ Staff
News

Judge rules for Aetna, against Blue Cross in State Health Plan dispute

An administrative law judge has upheld the decision to replace Blue Cross and Blue Shield of North Carolina with Aetna as third-party administrator of the State Health Plan for government workers and retirees. Blue Cross had challenged the process used to grant the TPA contract to Aetna.

CJ Staff
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