Aetna has been administering claims for the 700,000-plus members of the State Health Plan for only 15 months, but State Treasurer Brad Briner is already looking ahead to perhaps replacing it.
The plan’s executive administrator, Thomas Friedman, recently briefed potential vendors about his expectations going forward.
Briner’s aides signaled their intentions to plan trustees late last year, saying they intended to launch an RFP process to “reflect [the] current administration’s values, [and] focus on health and changing market dynamics.”
Aetna received the State Health Plan’s business under Briner’s predecessor, former Treasurer Dale Folwell. Its three-year contract took effect at the start of 2025 and includes options for two one-year renewals.
Folwell justified the change on customer-service grounds, voicing dissatisfaction with Durham-based Blue Cross and Blue Shield of North Carolina, which had held the contract for decades and has long been among the state’s most influential companies. Aetna, whose publicly held owner CVS Health is much larger than Blue Cross, was awarded the contract after a lengthy review process that sparked an unsuccessful legal challenge from the N.C. insurer.
The plan spends more than $4 billion annually on healthcare for state employees, retirees and dependents. It represented about 17% of Blue Cross’ medical membership.
State officials need to kick off the RFP process now because it runs through the end of 2027, Friedman says. Officials say they’ll need “adequate implementation time” for open enrollment in the fall of 2027, and because it’ll coincide with a new pharmacy benefits manager contract for the plan, he said.
Its current PBM contract, with CVS Caremark, also runs through the end of 2027. It is part of the same corporate family as Aetna.
“We really want an excellent claims processor,” Friedman said during a recent briefing, during which he took no questions. “We really want to allow everyone to play to their strengths and help us lower the cost of healthcare for our members, first, to improve their health, and to make the state health of course sustainable.”
Here’s Aetna’s response to a request for comment about the treasurer’s RFP.
“We are proud to serve the members of the North Carolina State Health Plan. Over many years, Aetna has worked diligently to support communities across the state and improve health outcomes for members while containing costs in one of the most expensive health care markets in the country. In close partnership with State Health Plan staff, we successfully executed the first Third Party Administrator transition in decades, and we remain committed to improving the overall health and well-being of State Health Plan members.
“While requests for proposals are a routine part of the state’s procurement process, we do not comment on or speculate about potential participation in future bids, particularly prior to the release of an RFP.”
Blue Cross didn’t respond to a request for comment.
David Mildenberg is editor of Business North Carolina. Reach him at dmildenberg@businessnc.com.