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WASHINGTON – The Centers for Medicare & Medicaid Services has terminated its contract with the Fox Insurance Company.
After an onsite review of the plan and its services, CMS officials determined that it fell short of Medicare’s requirements to provide enrollees with prescription drugs according to recognized standards of care. This jeopardized the health and safety of Fox enrollees, officials said.
CMS has charged Fox with committing several violations, including improperly denying its enrollees coverage for critical HIV, cancer and seizure medications
The termination of the contract is effective immediately. It will not, however, impact or delay access to drugs for the more than 123,000 Medicare beneficiaries currently enrolled in Fox plans. 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. Those who do not choose a plan will be automatically enrolled in a new plan.
“CMS’ 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.”
CMS issued an enrollment and marketing sanction to Fox on Feb. 26 because the organization wasn't following Medicare’s rules for providing prescription drug coverage to its enrollees. After an onsite audit from March 2-4, CMS officials said Fox’s problems persisted and that it continued to subject its enrollees to obstacles in getting needed and, in many cases, life-sustaining medicines.
CMS officials also found obstacles to access to high-cost drugs, which could have led to enrollees’ clinical needs not being met. In many cases, officials said, Fox enrollees were required to have unnecessary and invasive medical procedures before they were able to obtain drugs.
“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.”
