North Carolina’s State Health Plan is shaking up its future line-up. On Thursday, officials said they will pass on optional contract extensions for Aetna and CVS Caremark and instead throw both administrative and pharmacy services open to fresh competitive bids for contracts starting in 2028. The move touches roughly 750,000 state employees, teachers, retirees and their dependents who rely on the plan for health coverage.
According to The News & Observer, plan staff told members in an email that they will decline Aetna’s optional extension and will also let CVS Caremark’s pharmacy contract end without renewal. The reporting notes that the State Health Plan intends to issue formal requests for proposals for a third-party administrator and a pharmacy benefits contract that would both take effect on Jan. 1, 2028.
Procurement already under way for pharmacy services
The State Health Plan’s website shows that information is already posted for a pharmacy benefits manager request for proposals, and it flags a vendor “silent period” while that procurement unfolds. Coverage from EdNC reported that Treasurer Brad Briner’s team briefed trustees and vendors on an RFP timeline meant to provide “adequate implementation time” before the fall 2027 open-enrollment window.
Where Aetna and CVS stand now
Aetna states that it began administering claims for the State Health Plan on Jan. 1, 2025 and has been building out implementation teams and provider connections since winning the award. The Department of the State Treasurer has said CVS Caremark has served as the plan’s pharmacy benefit manager since Jan. 1, 2017 and that the current PBM contract runs through Dec. 31, 2027. The plan provides benefits to roughly 750,000 members.
What members should expect
Reporting from InsuranceNewsNet notes that plan statements and court filings indicated claims would continue to be paid and that members should not lose access to care during transitions. Coverage by BPR/NC Newsroom also points out that pharmacy procurement decisions and PBM contract terms have already influenced the plan’s approach to GLP-1 weight-loss medications and could shape formularies under any future agreement.
Legal and procurement questions
Blue Cross and Blue Shield of North Carolina previously mounted protests and formal appeals over the 2022 third-party administrator procurement, according to AP News. As reported by The News & Observer, the State Health Plan spent roughly $1.9 million defending the resulting case at the Office of Administrative Hearings, a reminder that any new procurement round could again draw protests or legal challenges.
What comes next
The State Health Plan says it will continue through a formal RFP process in the coming months, and its PBM information page notes that the plan is currently in a vendor silent period for that solicitation, according to the State Health Plan. Trustees and staff have told reporters they want sufficient time to put any new contracts in place before open enrollment, which officials say is why the procurement calendar is geared toward a Jan. 1, 2028 contract start, per reporting from EdNC.
