Andy Lucas @lukenlogs

🏒🏒🏒 youtu.be/c02SUitrEbQ

Thank you to the state of North Carolina for posting their benefits contracts. And again, to @claudeai for the simple summary of this and the next contracts. Here it is, written for anyone. The Aetna Contract, Explained The State Health Plan covers about 740,000 North Carolina teachers, state employees, retirees, and their families. The state pays the medical bills itself — your tax dollars and employee premiums fund it. The state hires an insurance company not to insure anyone, but to run the plan: build the network of doctors and hospitals, negotiate the prices, and process the claims. That hired company is called a third-party administrator, or TPA. In December 2022, the state took that job away from Blue Cross Blue Shield of NC — which had held it for over 40 years — and gave it to Aetna. Aetna’s contract runs from January 1, 2025 through December 31, 2027, with roughly $3.5 billion a year in medical claims flowing through it. Here’s the part taxpayers should understand. Aetna gets paid about $91 million a year in fees to run the plan. In exchange, Aetna made promises: how big a discount it would get from hospitals, and how slowly costs would grow. But if Aetna breaks those promises, the fine print says it pays back only pennies on the dollar — roughly 8 to 20 cents penalty, for every dollar the overspending costs the plan — and never more than a cap of about $40 million a year total, no matter how large the overspend. What’s worse, The fastest-growing costs, like specialty drugs and claims over $250,000, don’t count toward the overpayment penalties. To make matters worse, Aetna’s parent company is CVS Health, which owns the plan’s pharmacy benefit manager. So one corporation sat on both sides of the plan’s medical and drug spending — including handling appeals when its own sister company denied a claim. And, Aetna measures its own performance using its own data. Oops. Did it work out? The state’s answer came this month: officials say switching administrators will save about $1 billion — which is another way of saying the current arrangement was costing that much more than it should. Members also felt the turbulence in 2025, when Duke Health nearly left the network in a payment dispute before a last-minute deal. 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

Then I asked for a simplified version of the above : Here it is in plain English. Denver hired UnitedHealthcare to run its employee health plan. Denver pays the actual medical and drug bills itself — United just processes them. That’s what “self-funded” means. The problem is that Denver can’t see what it’s actually paying for drugs. 1. United buys the drug for one price and charges Denver a different price. It keeps the difference. Say the pharmacy gets paid $40 for a prescription. United bills Denver $100. United keeps $60. Denver never sees the $40. The contract says this out loud in three different places — it’s not hidden, it’s just written in language nobody reads. There’s no cap on how big that gap can be. 2. Drug companies pay rebates. United keeps all of them and hands Denver a flat number instead. United collects rebate checks from drug manufacturers. Instead of passing those through, it promises Denver a fixed amount per brand prescription (about $740 in 2023). If the actual rebate was $1,500, United keeps the extra $760. The contract literally says any rebates above the fixed amount belong to United. Denver has no right to know what the real number was. 3. United decides which drugs are “specialty” — and specialty drugs are where the money is. The contract defines a specialty drug as, essentially, “whatever United’s own specialty pharmacy sells.” United also reserves the right to reclassify drugs whenever it wants. Once a drug is labeled specialty and filled at United’s own pharmacy, it drops out of the normal price guarantees entirely. So the most expensive drugs are the least protected. 4. The most expensive drugs of all — the ones given in a doctor’s office or infusion center — have no price guarantee at all. The contract flatly excludes them. Cancer drugs, infusions, injections administered by a provider. Zero pricing protection. 5. Denver can’t shop around, and it can’t leave without a penalty. Denver isn’t allowed to negotiate directly with any drug manufacturer. It must use United’s mail-order pharmacy exclusively. And if Denver hires an outside vendor that steers employees to cheaper drugs or cheaper pharmacies, United can cancel all the pricing guarantees. If Denver ends the drug program early, United keeps every rebate it owes. 6. Denver can’t audit its way out of this. Denver is allowed one audit a year, capped at 300 prescriptions, using a random sample United has to approve. No auditors paid on commission. No computer-based searches for errors. You cannot find a pricing problem across hundreds of thousands of claims by randomly checking 300 of them. The audit rules exist to make sure nothing gets found. Is any of it illegal? Almost none of it. It’s a legal contract that Denver signed. The one thing that might cross a line: federal law since 2021 bans “gag clauses” — contract terms that stop an employer from seeing its own cost and claims data. This contract says United may let Denver see its pricing information, at United’s discretion. Federal regulators have said that “only if the vendor allows it” language is exactly what the gag-clause ban prohibits. And Denver has to certify to the government every year that it has no gag clauses in its contracts. The one thing Denver could actually do about it: Colorado banned this drug markup practice, effective January 2025, and self-funded employers like Denver can opt in. It’s an election, not a lawsuit. Somebody should check whether Denver ever filed it. The bottom line for an HR person: the drug program looks free. There’s no fee for it anywhere in the contract. That’s the tell. United isn’t working for free — it’s getting paid out of the drug prices, and the contract is built so Denver can’t measure how much.

@Buccigross Barclay Goodrow got me my last hat in 2019 against VGK (G7 WCF). Happy that a #gullsgrad got me hat #2!

@Buccigross Slavin / Theodore #bucciovertimechallenge

@Buccigross Theodore / Slavin #bucciovertimechallenge

@Buccigross Evans / Svechnikov #bucciovertimechallenge

@Buccigross Anderson / Zucker #bucciovertimechallenge

@Buccigross M.Foligno / Drury #bucciovertimechallenge

@Buccigross Zegras / Walker #bucciovertimechallenge

@Buccigross Guentzel / Texier #bucciovertimechallenge

@Buccigross @Buccigross Theodore / Kerfoot #bucciovertimechallenge

@Buccigross Harley / Hughes #bucciovertimechallenge My hat from 2019 (Barclay Goodrow - SJS-VGK Game 7) is almost falling apart

@Buccigross Laferriere / Drury #bucciovertimechallenge

@Buccigross Anderson / Hagel #bucciovertimechallenge

@ESPNPR @NHL @NHLPR @espnSteveLevy @PKSubban1 @espnbob @6ErikJohnson @StormBuonantony @Arda Why aren’t national games available on ESPN+? The trade-off of snagging more new premium cable subscribers over just higher viewership on Plus — that really worth it?

Those poor plushies when they get back to Canada

@sentientt_media Skills

Can someone grab the aux and plug the figure skaters' music into @NBCOlympics sound board? Ambient arena music is just silly. The announcers can get mixed in underneath, but the music should be #1

@godofprompt This is a great prompt. Thank you.