Medicare Ends Fox Insurance Drug Plan Contract
The Centers for Medicare & Medicaid Services (CMS) terminated its contract with Fox Insurance Company, March 9, after an onsite review of the drug plan and its services confirmed suspected noncompliance. More than 123,000 Fox enrollees have until May 1 to choose a new Medicare prescription drug plan. In the interim, beneficiaries can obtain their prescription drugs through the Limited Income Newly Eligible Transition (LI NET) program, run by Medicare and administered by Humana.
According to CMS, Fox committed a series of violations, including improperly denying its enrollees coverage of critical HIV, cancer, and seizure medications. Fox was issued an enrollment and marketing sanction by CMS on Feb. 26. After on onsite audit, which ran between March 2-4, CMS found Fox’s problems persisted.
Among the audit findings, CMS found that Fox:
- Failed to provide access to Medicare prescription drug benefits by imposing unapproved prior authorization and step therapy criteria.
- Did not meet the plan’s appeals deadlines.
- Did not comply with Medicare regulations requiring enrollees to be transition to new drugs at the beginning of the new plan year.
- Failed to notify enrollees about prior authorization and step therapy determinations as required by Medicare.
“CMS’s immediate action was essential to protect members’ health and safety — an integral part of our contract with all Medicare beneficiaries,” said Jonathan Blum, acting director of CMS’ Center for Drug and Health Plan Choices. “Fox enrollees also need to know that they are not losing their drug coverage and will continue to have access to needed medicines.” Blum said a letter will be sent to all Fox enrollees explaining the steps CMS is taking to ensure they continue to get their medicines.
Medicare prescription drug plan enrollees are encouraged to contact 1-800-MEDICARE (633-4227) or their State Health Insurance Program (SHIP) with questions or concerns.