Fox Insurance
Ordered by CMS to Stop Sales, Enrollment for Its Medicare Drug Plan
Many senior
citizens in 21 states using the plan qualify for low-income subsidy
under Part D
March 1, 2010 On
Friday the Centers for Medicare & Medicaid Services (CMS) directed Fox
Insurance Company of New York to immediately suspend marketing and
enrollment of new members in the organizations Medicare Part D
prescription drug plans. CMS imposed this immediate sanction because the
Fox drug plan has not been able to meet the prescription drug needs of
some of its newest members, actions which could pose serious threats to
their health and safety.
These
beneficiaries, many of whom qualify for the low-income subsidy under
Part D, are primarily located in 21 states.
The Fox plan is
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.
Current Fox drug
plan members who are having difficulty in getting their prescriptions
filled should contact 1-800-MEDICARE or their local state health
insurance assistance program for help, said Jonathan Blum, acting
director of CMS Center for Drug and Health Plan Choices.
The plan has
failed to fully meet its obligations to Medicare beneficiaries,
particularly new enrollees, by failing to provide timely access to Part
D drugs by imposing prior authorization and step therapy requirements
that were not approved by CMS, not meeting the necessary appeals
deadlines, and not meeting the requirements to transition new enrollees
to the covered drugs.
These failures
could result in improper delays in therapies and/or preventing access to
medically necessary drugs and therapies. Threats to enrollee health and
safety relate to Foxs non-Medicare compliant coverage determinations
involving protected class drugs and other needed drugs for the treatment
of cancer, HIV/AIDS and seizure disorders; as well as drugs for diabetes
and respiratory disease.
Fox problems were
raised to CMS by both plan members and their physicians. CMS will
closely monitor the plan to determine that corrective actions have been
taken. If Fox is not in compliance to Medicare requirements, penalties
that range from fines to the possibility of termination of the Fox
contract with Medicare could be imposed.
CMS encourages
plan members who may have concerns with their Part D coverage to contact
1-800-MEDICARE (1-800-633-4227) or the state health insurance assistance
program (SHIP) to help get them resolved.
