What was old is new again – Blue Cross NC will return to processing State Health Plan benefit claims as its third-party administrator, replacing Aetna in 2028.
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Aetna has been the health plan’s third-party administrator since 2025, after health plan trustees, guided by former state Treasurer Dale Folwell, decided to stop working with Blue Cross, which had administered the health plan for decades. Folwell fought with the company over price transparency.
Aetna was the other bidder for the new third-party administration contract, but this time lost to Blue Cross.
After the new contract with Blue Cross NC was announced on Friday, state Treasurer Brad Briner, Folwell’s successor, said the differences in the two companies’ proposals were stark.
“The decision was very, very clear, both from a cost perspective, from a member-service perspective, as well as from every other dynamic we can think of,” he said “There really wasn’t much of a contest, to be honest.”
In a statement, Aetna spokesman Phil Blando said, “We continue to believe Aetna 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.
“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, December 31, 2027,” Blando continued. “We will review this decision in the coming weeks and decide how best to move forward.”
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Tom Friedman, State Health Plan executive administrator, said there was almost a $1 billion difference in cost between the two companies’ proposals.
The State Health Plan insures more than 750,000 North Carolina state employees, dependents, and retirees. About 10,000 claims are processed each day.
When the State Health Plan trustees decided to drop Blue Cross in 2023, the break-up was messy.
Blue Cross challenged the change, but an administrative law judge upheld the State Health Plan trustees’ decision to switch.
State Health Plan trustees also voted Friday to have Blue Cross take over as pharmacy benefit manager from CVS Caremark in 2028. CVS Caremark has been the Health Plan’s pharmacy administrator since 2017.
Both contract terms run from Jan. 1, 2028, through Dec. 31, 2031, with two optional one-year renewal periods.
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