The Centers for Medicare & Medicaid Services (CMS) terminated its contract with Fox Insurance Company on Tuesday March 9. After an onsite review of the plan and its services, CMS determined that the plan lacked even the basic standards of care. Fox’s violations, including improperly denying its enrollees coverage of critical HIV, cancer and seizure medications, posed a significant threat to the health and safety of its enrollees. CMS’ termination of the contract was effective immediately.
This termination will not impact drug access for the more than 123,000 Medicare beneficiaries enrolled in Fox plans. As of Tuesday March 9th, they can obtain their drugs through LI-NET, a program run by Medicare and administered by Humana, to ensure they receive their Medicare prescription drugs in a timely manner. Fox enrollees can choose a new Medicare Part D plan between now and May 1, 2010. Those who do not choose a new plan by then will be enrolled in one by Medicare.
CMS will send letters to all previous Fox enrollees explaining their continued access to prescriptions, and advising them to call 1-800-MEDICARE or their local state health insurance assistance programs if they have questions (which is HICAP – the Health Insurance Counseling and Advocacy Program – here in California).
During CMS’s onsite audit of Fox’s drug plans, they found Fox continuing to subject its enrollees to obstacles in getting needed and, in many cases, life–sustaining medicines, even after the enrollment and marketing sanctions CMS issued on the plan in late February. Fox enrollees were often required to have unnecessary and invasive medical procedures before being able to obtain their needed drugs.
Some of the violations CMS found in its audit as stated in their press release this week include:
- Failing to provide access to Medicare prescription drugs benefits by imposing unapproved prior authorization and step therapy criteria that made it more difficult for beneficiaries to get drugs that are protected by law.
- Not meeting the plan’s appeals deadlines.
- Not complying with Medicare regulations requiring enrollees to be transitioned to new drugs at the beginning of the new plan year.
- Failing to notify enrollees about prior authorization and step therapy determinations as required by Medicare.
California beneficiaries who were enrolled in a Fox plan and who have any concerns with drug coverage access can call 1-800-MEDICARE (1-800-633-4227) or HICAP (1-800-434-0222) to help get them resolved.
NOTE: States in which the Fox plan was available were: Arkansas, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland, Missouri, North Carolina, New Jersey, New York, Nevada, Ohio, Pennsylvania, South Carolina, Texas and West Virginia.