Blue Cross Blue Shield of North Carolina will resume management of the State Health Plan — and a separate pharmaceutical benefits contract — returning to what had been the status quo for decades until 2023, when the board voted to shift management to Aetna.
Some health plan members had voiced complaints about Aetna. And earlier this year, Republican State Treasurer Brad Briner indicated he was ready for a change. The treasurer oversees the Health Plan. The change, approved by the health plan board on Friday, is set to take place in 2028.
“This is monumental for all our members,” Briner said Friday.
The 2023 decision to switch to Aetna happened under former Treasurer Dale Folwell. “This administration has different priorities and would prefer a contract that is more in line with those priorities,” Briner spokesperson Loretta Boniti told WRAL in March.
An Aetna spokesman said Friday that the company continues to believe it is the strongest partner for the State Health Plan.
“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,” Phil Blando, the Aetna spokesman, said in a statement. “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.” The contract ends at the end of 2027.
The switch back to Blue Cross could affect prices health plan members pay, services that are covered and which providers are considered in-network.
The decision to switch to Aetna three years ago was a contentious call that led to legal battles. Aetna prevailed and was awarded the multibillion-dollar contract. It’s possible the decision to back to Blue Cross could lead to similar legal wrangling.
“We will review this decision in the coming weeks and decide how best to move forward,” Blando said.
The State Health Plan board made a number of other changes Friday, including hiking premiums while also instituting a new system of preferred and non-preferred providers that will reward state employees with lower costs by visiting certain doctors, while charging them thousands of dollars extra if they insist on seeing other doctors.
