Fox Kicked Out of Medicare Drug Program; Seniors
with Fox Need to Choose New Plan
Senior citizens in 21 states enrolled in the Fox plan will be
provided access to drugs; need to choose new Medicare prescription
drug plan by May 1
March 11, 2010 – Fox Insurance Company of New York
this week became the first insurance company to be terminated from the
Medicare prescription drug program (Part D). The Centers for Medicare &
Medicaid Services (CMS) said the company was “not meeting Medicare’s
requirements to provide enrollees with prescription drugs according to
recognized standards of care,” and this “jeopardized the health and
safety of Fox enrollees.” Fox operates in 21 states (list below).
The immediate termination will not impact or delay
access to drugs for the more than 123,000 Medicare beneficiaries
currently enrolled in Fox plans, according to CMS.
Medicare Rights Center says seniors should know
Medicare private health plan will not work with a supplemental ‘Medigap’
plan as with Original Medicare
March
5, 2010 – Senior citizens have one last chance to change their Medicare
health plan before they are locked into their plan for the rest of 2010.
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.
Beginning Wednesday, all enrollees will obtain
their drugs through LI-NET, a program run by Medicare and administered
by Humana, to ensure that beneficiaries receive their Medicare
prescription drugs.
Fox enrollees will be able to choose a new Medicare
prescription drug plan through May 1, 2010. Current enrollees who do not
choose a plan will be enrolled into a new plan by Medicare.
On Friday, February 26, CMS directed Fox to
immediately suspend marketing and enrollment of new members in the
organization’s 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.
After an onsite review of the plan and its
services, CMS determined that the plan’s “significant deficiencies” were
just too great. CMS found that Fox committed a series of violations,
including improperly denying its enrollees coverage of critical HIV,
cancer, and seizure medications.
“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. 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. We will be sending letters explaining the steps we are taking
to ensure they continue to get their medicines. They can also call
1-800-MEDICARE or their local state health insurance assistance programs
if they have questions.”
What Fox Says About Itself
On their Website, Fox described its philosophy by
stating, “we understand how important prescription benefits are to the
Medicare-eligible population. We are reaching out to you with an
extensive list of covered drugs and the gold standard for customer
service. Medicare beneficiaries can feel confident in the coverage
provided by our plans, because we take your care personally.”
In a news release last March, Fox said, “Fox
Insurance Company (the Company), a New York-based Medicare Part D
provider was recognized by leading health care business insurance
analysis company, Mark Farrah Associates as one of the top growing
stand-alone prescription drug plans in the United States.
According to
the analyst’s newsletter, Healthcare Business Strategy, Fox Insurance
Company experienced the largest percentage gains (more than 800 percent)
among top growth plans over the last year. The analyst observed that Fox
Insurance Company’s strategy, which is to focus on its Employer Group
Waiver Plans (EGWP), appears to be working, citing the Company’s recent
agreement with Premier Consulting.
From 2008 to 2009, Fox Insurance
Company has increased its membership by 500 percent, which, among other
programs to be announced in the near future, will contribute to
anticipated 2009 revenue of $200M.”
CMS issued an enrollment and marketing sanction to
Fox on Feb. 26, 2010, because the organization was not following
Medicare’s rules for providing prescription drug coverage to its
enrollees.
After the onsite audit, which ran between March 2
and March 4, CMS found Fox’s problems persisted and it continued to
subject its enrollees to obstacles in getting needed and, in many cases,
life–sustaining medicines.
CMS also found that many of the obstacles were in
place to limit access to high-cost drugs, which could have led to
enrollees’ clinical needs not being met. In many cases, Fox enrollees
were required to have unnecessary and invasive medical procedures before
they were able to obtain drugs. Fox was unable to satisfactorily
address these compliance concerns and furnish medicines to its Medicare
enrollees.
Among the audit findings CMS found 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.
According to CMS auditors, Fox was unable to
satisfactorily address compliance concerns cited in the enrollment and
marketing sanction and meet contractual obligations to provide medicines
to Medicare beneficiaries enrolled in their plans.
“We take our oversight role of Medicare
prescription drug plans seriously,” said Blum. “We review and take
action on all complaints received about Medicare health and drug plans
and will take appropriate and immediate actions wherever necessary.”
CMS encourages Medicare prescription drug plan
enrollees having concerns with access to drug coverage to contact
1-800-MEDICARE (1-800-633-4227) or the state health insurance assistance
program (SHIP) to help get them resolved. Medicare enrollees, their
families and their caregivers can contact a SHIP near them by visiting:
http://www.medicare.gov/Contacts/staticpages/ships.aspx
Keep up with the latest news for senior citizens, baby
boomers
March 11, 2010 – Fox Insurance Company of New York
this week became the first insurance company to be terminated from the
Medicare prescription drug program (Part D). The Centers for Medicare &
Medicaid Services (CMS) said the company was “not meeting Medicare’s
requirements to provide enrollees with prescription drugs according to
recognized standards of care,” and this “jeopardized the health and
safety of Fox enrollees.” Fox operates in 21 states (list below).
