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CMS Suspends Fox Insurance Drug Plan for Medicare Part D Issues

John Commins, for HealthLeaders Media, March 2, 2010

CMS has immediately suspended Fox Insurance Co. of New York from marketing and enrolling new members in its Medicare Part D prescription drug plan, after physicians and beneficiaries complained that Fox's drug plan hasn't met the prescription drug needs of some of its newest members.

"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," CMS said in a news release.

CMS learned of the problems from Fox drug plan members and their physicians, and will monitor the plan to determine that corrective actions have been taken. If Fox is not in compliance to Medicare requirements, CMS may fine or even terminate Fox's contract with Medicare, CMS said.

Fox was reportedly not compliant with Medicare coverage in areas that involved protected class drugs for the treatment of cancer, HIV/AIDS, seizure disorders, diabetes, and respiratory disease, CMS said.

Fox Insurance Co. did not return calls seeking comment Monday.

The Fox drug plan has members 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.


John Commins is a senior editor with HealthLeaders Media.

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