On Wednesday, January 14, the State Health Benefits Commission (SHBC) held its regularly scheduled January meeting and heard presentations from Aetna and Optum.
Aetna’s representatives presented information regarding the first quarter of 2025. They stated that claims are trending up, but at a much slower rate than initially anticipated. They reported claims are increasing in utilization in areas such as inpatient services, prescriptions, ambulatory facilities, and specialists. The presentation was not publicly available.
Optum representatives presented information on quarters 1 through 3 of 2025. They discussed the largest prescription cost drivers being medications such as GLP-1, chemotherapy, medications for inflammatory illness, diabetes medications, migraine treatments, and COPD treatments. Optum’s presentation was also not publicly available.
The Division of Pension and Benefits (Division) reported that there are three Requests for Proposals (RFP) on NJ START. The RFP for Centers for Excellence is due on January 28 for a 3-year contract. The RFP for Medical and Pharmacy Claims Reviewer is due on February 18 for a 5-year contract with the option of two 1-year extensions. The Pharmacy Benefits Manager is due on February 5 for a 5-year contract with the option of two 1-year extensions.
Additionally, the SHBC proceeded to discuss other procurement issues in closed session.
The Division staff confirmed that 593 local government entities are still enrolled in SHBP. Out of 593, 195 municipalities opted for premium delays with 86 municipalities delaying for 30 days and 109 for 60 days. As of January 1, $16 million in outstanding premium payments are due.
The next regularly scheduled SHBC meeting is March 11.
Contact: Erin Knoedler, Legislative Analyst, eknoedler@njlm.org, 609-695-3481, x116.