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.


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One Response to “Medicare Ends Fox Insurance Drug Plan Contract”

  1. Judie Forsman says:

    RE: drug coverage,
    I am the Medicare Part D Rep. in a county LTC facility. I work every day with families both from our region and from surrounding regions. I would like to request, that in the interest of not upsetting families that do not have to be concerned with this, that you supply us all with a list of those effected regions that have been using this plan as one of their accepted plans. Many are unaware of what plans are accepted for their regions, and,( if they are not using the list regularly) are therefore panicked into believing that they have to immediately act to prevent a lapse in drug coverage.
    This plan is not one that has been an accepted plan, at least in the last couple of years, in my state and I have only had to transition one individual over to keep that individual covered in a plan upon entering our facility.

    It is for this reason that I request that you narrow the scope to areas effected only and not to everyone.

    Thank you for your time and for your information. This is the third email I have received on this topic of late:(1) from my administrator, (2) from my boss and (3) from you. As I deal with this daily, I can only imagine what others think who don’t have the constant exposure to this.

    Judie Forsman,CPC, Medicare Part D Coordinator, RCNH

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