Thomas Friedman

The agenda for this special meeting, convened by the Chair, included roll call for attendance and a conflict of interest statement. The primary substantive item for consideration and approval involved contract review for Preferred Primary Care Provider Network Contracts with three entities: Aledade, Community Care Physician Network, and UNC Health Alliance. The meeting concluded with adjournment.

The meeting agenda focused primarily on the State Health Plan's strategy following the conclusion of the Clear Pricing Project on December 31, 2025. The core discussion revolved around implementing strategies to ensure statewide access to high-quality, local primary care by supporting independent practices. This involved presenting a program designed to align incentives between the practices, the member, and the Plan, which is the central part of Phase One of the Preferred Provider Strategy aimed at improving health, reducing costs, and sustaining partner providers. Key incentives discussed for providers included lower copays, removal of medical prior authorization, better reimbursement, and reduced administrative burden. The Board was asked to vote on approving provider network contracts for Aledade, Community Care Physician Network, and UNC Health Alliance, as these contracts exceeded the three million dollar threshold requiring Board approval under N.C.G.S. 135-48.33(a). Future phases will focus on Specialty Clinically Integrated Networks, Maternity, Dermatology, and Independent Pharmacy.

The State Health Plan Board of Trustees held a meeting to discuss several key topics. The agenda included a year in review, a local government discussion, a population risk report, financial reports, a retiree health benefit OPEB report, and the 2027 benefit strategy. The year in review covered financial sustainability efforts, a refocused provider strategy, health improvements, and population health returns. The local government discussion focused on employer contributions, employee contributions, and the retiree health benefit fund. The population risk report included key findings from the 2025 report, medical and prescription drug summary trends, and emerging cost trend drivers.

The meeting included updates to the formulary, including additions, utilization management criteria, product exclusions, and tier movements effective October 1, 2025. Five new molecular entities were proposed for addition to the formulary: FRUZAQLA, NEMLUVIO, SYFOVRE, OJJAARA, and EMBLAVEO. The committee approved the formulary additions of NEMLUVIO, SYFOVRE and OJJAARA along with the proposed utilization management. The SGM update on RA products was approved. The formulary exclusion of VYVANSE was approved, and a tier change for NAFTIN from preferred to non-preferred status was also approved.

The meeting included updates on the formulary and programs, effective from January 1, 2026. Key discussion points covered a biosimilar strategy involving the exclusion of a reference product (Stelara) and a biosimilar product (Pyzchiva-Cordavis), as well as downtiering a clinically equivalent biosimilar product (Yesintek). The committee also discussed the formulary evaluation framework, value-added therapy, and pending additions from the August 20, 2025, meeting. New molecular entities were reviewed for formulary additions, including EMBLAVEO and FRUZAQLA, with specific utilization management considerations.