NC’s State Health Plan moves to block Atrium program it calls an ‘unlawful pricing scheme’

North Carolina’s State Health Plan announced Friday it had requested a temporary restraining order in Wake County Superior Court to halt Atrium Health’s new “affordability program.”

State Treasurer Brad Briner, whose office oversees the State Health Plan, said while Atrium’s new program could lower out-of-pocket costs for some state employees at Atrium facilities, it is intended to destabilize the state’s own Preferred Provider Program and could push the plan into bankruptcy.

The State Health Plan has said that its new tiered provider system is designed to keep the plan that serves 750,000 members financially stable.

UNC Health and Novant have agreed to lower their pricing for state employees to be designated as preferred hospital systems. Atrium has not.

Instead, Charlotte-based Atrium Health announced a new “Affordability Protection Program Tuesday,” saying it addresses the higher copay  costs created for patients seeking care at Atrium Health.

According to Atrium, the program will ensure lower out-of-pocket costs for plan members who use its services. But Atrium did not say it has  committed to lowering what it will charge the state plan for those services.

The State Health Plan says it was “blindsided” by Atrium’s announcement, which it says could confuse members as open enrollment begins.

Premiums rise, but overall costs could fall for NC State Health Plan members under a new system

“We think this proposal is a violation of various state and federal laws,” Briner said during Tuesday’s Council of State meeting. “It will never become reality.”

Atrium said in a statement Friday it does not agree “that offering discounts to NC State Health Plan members is somehow unlawful.”

Atrium is also in the process of merging with WakeMed, the largest medical system in Wake County, where the highest number of state employees work. Briner has said he is “profoundly concerned” about that possible merger.

“Every taxpayer in the state will have to bear the burden of Atrium’s proposal when additional funding is needed for the [State Health Plan] at the expense of other public programs, pay raises and COLA’s,” Briner’s office warned in its statement Friday.

“We share the concerns about the solvency of the NC State Health Plan, so it’s unclear to us why the Plan rejected our offers to save money for taxpayers and members,” Atrium said in Friday’s response.

So that members of the state plan don’t feel rushed in selecting insurance coverage next year, the open enrollment period is being extended through Nov. 6, 2026.