CMS cuts ties with Part D drug insurer

Less than two weeks after the Centers for Medicare and Medicaid Services (CMS) directed Fox Insurance Company of New York to suspend marketing and enrollment, CMS has ended its contract with the Medicare Part D prescription drug plan company. This termination, which is effective March 9, marks the first time an insurer has been cut from Medicare Part D since the program's inception, notes the Huffington Post.

"The immediate termination of Fox as a Medicare prescription drug plan demonstrates our commitment to protecting the health of some of their most vulnerable enrollees from getting necessary drugs, in some cases life-sustaining medicines," says Jonathan Blum, acting director of CMS' Center for Drug and Health Plan Choices. "CMS's immediate action was essential to protect members' health and safety--an integral part of our contract with all Medicare beneficiaries."

The path toward termination began on Feb. 26 when CMS issued the enrollment and marketing sanction because Fox wasn't following Medicare rules for providing prescription drug coverage to enrollees. CMS conducted an on-site audit from March 2 to March 4, determining that Fox made a habit of creating obstacles to prevent enrollees from obtaining necessary drugs, particularly high-cost medications.

Among the key findings, CMS verified that Fox failed to:

  • Provide access to Medicare prescription drugs benefits. The company imposed unapproved prior authorization and step therapy criteria that hindered enrollees from obtaining drugs that are protected by law.
  • Meet the plan's appeals deadlines.
  • Comply with Medicare regulations requiring enrollees to be transitioned to new drugs at the beginning of the new plan year.
  • Notify enrollees about prior authorization and step therapy determinations as required by Medicare.

More than 123,000 Medicare beneficiaries are currently enrolled in Fox Part D plans, which were available in 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.

These enrollees won't face delayed access to drugs as a result of the immediate termination. Effective today, all Fox enrollees will obtain drugs through LI-NET, a Medicare program administered by Humana. Enrollees will have through May 1 to choose a new Part D plan, and those who don't will be enrolled into a new plan by Medicare. Fox enrollees who have questions about the impact of the termination--or enrollees of other Part D plans who have problems accessing their drug benefits--can call 1-800-MEDICARE or their local state health insurance assistance program for assistance.

To learn more about the termination:
- read the CMS press release
- here's the Huffington Post article