The State Health Plan (Plan) has completed a difficult year, but now is projecting that the massive deficit it was facing on Jan. 1 has been addressed. Today the State Health Plan (Plan) Board of Trustees heard from Plan staff and consultants on where things stand now and strategies underway for 2026.
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The North Carolina Department of State Treasurer and CVS Caremark (Caremark) have successfully reached an agreement regarding their ongoing contract dispute, securing hundreds of millions of dollars on behalf of the members of the State Health Plan (Plan). This agreement provides certainty to both parties around pharmacy pricing and payments. Additionally, this agreement gives the Plan the ability to negotiate directly with manufacturers of GLP-1s to potentially restore coverage of weight-loss medications to members.
After months of negotiations, the North Carolina State Health Plan (Plan) is pleased that Duke Health prioritized continued service to its members. The deal reached between Duke Health and Aetna, which serves as the Plan’s third-party administrator, will deliver high-quality care with a focus on better outcomes and efficiency. We particularly want to thank Dr. Tom Owens of Duke Health for his role in seeking an innovative solution to these negotiations, and our partners at Aetna for their steadfast commitment to affordability.
The North Carolina State Health Plan (Plan) Board of Trustees approved a resolution today to direct Plan staff to take necessary actions if Duke Health and
Negotiations are still ongoing between Duke Healthcare and Aetna, with their contract set to expire in less than a month. The State Health Plan (Plan) is Aetna’s largest client in our state and is watching the talks closely. In preparation for potential failed negotiations, Plan members who use Duke Healthcare will be receiving a letter from the Department of State Treasurer this week to discuss next steps. In addition, State Treasurer Brad Briner released this statement to all Plan members this morning explaining why this negotiation is so important for everyone:
The North Carolina State Health Plan is following through on its promise to not only provide support when members are in need, but also provide the needed prevention tools to help members stay healthy. As part of these efforts, State Treasurer Brad Briner is announcing a new partnership targeting rural, more difficult to serve communities. Hello Heart, the digital leader in preventive heart health, will now work to empower eligible Plan members to better understand and improve their heart health.
The State Health Plan (Plan) Board of Trustees met today to set premiums for 2026. State Health Plan members include teachers, state employees and retirees. This is the final step in the three-pronged effort to provide financial stability as the Plan faces a half a billion-dollar deficit. The approved premiums include increases for active members and, notably, a cost reduction for some employees who choose to cover children on their plan. To lessen the financial burden on the state’s lowest paid employees, the Plan will be introducing salary-based premiums in 2026.
New no-cost, high-quality health care will soon be available for State Health Plan (Plan) members. Under a new agreement, set to begin in October, Plan members will have access to an innovative new surgical benefit as part of the efforts to reduce costs for members and help overcome the budget deficit. N.C. State Treasurer Brad Briner is announcing the Plan has signed into a partnership with Lantern, a Specialty Care Platform, giving members who need surgery access to Lantern’s network of the region’s top surgeons and specialists at no cost to them.
When the United States Supreme Court decided United States v. Skrmetti almost two weeks ago, we issued a press release notifying everyone we believed it would result in an order in Kadel v. Folwell, vacating the decision made by the U.S. Court of Appeals for the 4th Circuit. Today, the Supreme Court followed through as we expected. Once the full legal process is finalized in the coming weeks, we anticipate this will lead to the State Health Plan of North Carolina re-implementing the longstanding exclusion on transition-related medical care.