State Health Plan Asks Court to Block Atrium’s Affordability Program

Overview

• The State Health Plan and North Carolina Treasurer filed suit seeking emergency relief after Atrium announced a new copay-cutting program for plan members.
• Atrium unveiled the Affordability Protection Program on Oct. 6 and said it would give enrolled State Health Plan members lower copays at Atrium facilities starting Jan. 1, 2027.
• Plaintiffs allege the program unlawfully usurps the treasurer’s exclusive statutory authority to set copays and would undermine the plan’s recently adopted tiered provider structure.
• Atrium rejects that claim, says the program preserves patient access and lowers out-of-pocket costs for nearly 100,000 State Health Plan users, and is reviewing the court filing.
• The plan extended open enrollment to Nov. 6 and has a preliminary-injunction hearing scheduled for Tuesday as officials warn the dispute could raise premiums, reduce benefits, or increase taxpayer exposure for about 750,000 covered people.