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The Centers for Medicare & Medicaid Services (CMS) announced on Tuesday, March 9, that it was terminating its Part D contract with Fox Insurance Company, effective immediately.  The announcement came about two weeks after CMS announced it was suspending enrollment in the plan.

CMS took the extraordinary action to protect plan enrollee safety.  An audit of the plan found that enrollees were denied access to medically necessary prescriptions through the imposition of unapproved prior authorization and step therapy requirements; the failure of the plan to meet appeals deadlines; the failure to comply with transition fill requirements; and the failure to notify enrollees of prior authorization and step therapy requirements.

Over 123,000 Medicare beneficiaries were enrolled in a Fox plan offered in the following states: 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.  The majority of Fox plan enrollees are eligible for the low-income subsidy (LIS).

Everyone enrolled in a Fox plan, regardless of whether they are LIS-eligible, has been enrolled in LI-NET.  This program, which is administered by Humana under a contract with CMS, operates as a temporary prescription drug plan for LIS-eligible beneficiaries who are not enrolled in a drug plan but who are entitled to drug coverage.  Fox plan enrollees have until April 30, 2010, to elect another prescription drug plan. Enrollees who do not choose a new plan on their own will be enrolled into a plan by CMS.   CMS will be sending a letter to Fox plan enrollees to explain their new drug coverage and their rights. 

Plan enrollees can contact their state health insurance assistance program (SHIP) if they have concerns about drug coverage and for assistance in choosing a new plan.  Beneficiaries can find contact information for their SHIP by going to www.shiptalk.org or by calling 1-800-Medicare.