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Blue Cross and Blue Shield of North Carolina won the state contract for third-party administrator and pharmacy benefit manager services for the state health plan, effective Jan. 1, 2028. The award marks a significant reversal for the insurer, which previously lost its TPA contract and challenged Aetna’s 2025 contract award in 2023, only to have the state court side with Aetna at the time.
The History Behind the Blue Cross NC State Contract Win
Blue Cross NC previously lost its TPA contract and challenged Aetna’s 2025 contract award through legal action in 2023. The state court ultimately sided with Aetna over Blue Cross NC, making this new state contract a notable turnaround following that earlier legal setback.
Scope of the State Health Plan
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 on July 10, with the agreements set to run through Dec. 31, 2031, with two optional yearlong renewal periods.
Blue Cross NC’s Response to the Contract Award
“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, framing the state contract around member transition and cost management priorities.
Projected Savings From the Deal
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.
How Aetna and CVS Caremark Lost Out on the Blue Cross NC State Contract
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 Also Wins the PBM Contract
Blue Cross NC beat several vendors for the PBM contract as well, with the news release stating the insurer was the only bidder to meet all minimum requirements. CVS Caremark, the current PBM, which shares the same parent company as Aetna, previously faced tensions with the state treasurer over contractual obligations, though the issue was eventually resolved in 2025.
CVS Health’s Response to Losing the Blue Cross NC State Contract
“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.”
New Preferred Provider Partnerships
The board of trustees also approved preferred provider contracts with Chapel Hill-based UNC Health and Winston-Salem-based Novant Health, effective Jan. 1, 2027, adding another structural layer to the broader state contract arrangement ahead of the TPA and PBM transition.
A New Tiered Provider Network Structure
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, a structural shift tied closely to the broader state contract transition.
Premium and Benefit Changes for 2027
The board greenlit 2027 premium rates and benefit changes, which include some decreased copays linked to the new tiered provider network. Members will see monthly increases from less than $2 to about $8 for individuals and less than $29 to $42 for families.
What This Means for North Carolina State Health Plan Members
With the state contract now finalized for TPA and PBM services, alongside new preferred provider agreements with UNC Health and Novant Health, North Carolina’s state employees, teachers and retirees will see a significantly restructured health plan experience beginning in 2027 and continuing through the TPA and PBM transition in 2028. How smoothly that multi-year transition unfolds, particularly given Blue Cross NC’s prior legal dispute over a previous contract loss, will likely be closely watched by state officials and plan members alike.
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