k-12 Tax & $pending Climate: “What’s worse, The fastest-growing costs, like specialty drugs and claims over $250,000, don’t count toward the overpayment penalties”
But wait. North Carolina seems to know it’s not the perfect deal.
On July 10, 2026, the plan’s board voted to hand the job back to Blue Cross Blue Shield of NC. The new contract starts January 1, 2028 and runs through December 31, 2031, with two optional one-year extensions. Until then, Aetna keeps running the plan through the end of 2027.
What we know: Blue Cross won both jobs this time — medical administrator and pharmacy benefit manager, replacing CVS Caremark. The state expects roughly $12 billion in costs over three years and claims about $1 billion in savings. The state also toughened the process: it canceled the first bidding round in April 2026 because no bid met its minimum requirements, and on the pharmacy side Blue Cross was the only bidder that met them all. Separately, new “preferred provider” deals with UNC Health and Novant Health start in 2027, steering members toward those systems with lower out-of-pocket costs.
What we don’t know yet — because the actual contract documents haven’t been made public: whether the new deal fixed the pennies-on-the-dollar problem, what Blue Cross actually promised on discounts and cost growth, what happens if it breaks those promises, and what the pharmacy pricing terms look like. We also don’t know what it means for one company to now hold the medical contract, the drug contract, and the network design all at once — less conflicted than the CVS arrangement, but a lot of eggs in one basket. Last time, the state posted every contract document publicly about seven weeks after the award. If it does that again, taxpayers will be able to check the fine print for themselves by early fall.
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All you need to know is that after all the legal changes and scrutiny thrown at PBMs and insurance companies, NOT A SINGLE ONE has said they will result in lower costs for employers or patients.
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Healthcare cost are putting an extreme pressure on school districts’ finances ($94,500,000 in Madison!)
More.
