CMS terminates Fox Insurance Company Medicare Part D prescription drug plan

Agency emphasizes that patients’ medication needs will be met; pharmacists to use LI-NET Program

Effective March 10, CMS is terminating Fox Insurance Company of New York, a Medicare Part D prescription drug plan (PDP) that does business in 21 states. After March 9, 2010, CMS will no longer permit Fox to offer a Medicare PDP. 

Because the Fox plan is ending, CMS is enrolling all current Fox enrollees (both low-income subsidy [LIS] and non-LIS beneficiaries) into the Limited Income NET Program (LI-NET), which is administered by Humana, to make sure that these Part D eligible beneficiaries continue to have Medicare drug coverage. This temporary Medicare coverage under the LI-NET program begins on March 10 and will extend until April 30, 2010, unless an enrollee subsequently selects a different plan.  Beneficiaries who do not select a new plan will be enrolled into a new plan by CMS.

States with Fox coverage affected by this decision are 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.

Information for pharmacists

The LI-NET program is the only way for affected Fox members to receive their Medicare drug coverage during the transition period starting on March 10. As available for any Medicare beneficiary, an E1 inquiry may be initiated by a pharmacist to determine member eligibility in the LI-NET program. Along with presenting a new prescription or requesting a refill, eligible members may also present a letter from CMS that validates their eligibility during this transition period.
 
Pharmacists should submit a claim to the Limited Income NET Program through their standard claims program and use the following: BIN = 610649; PCN = 05440000; Cardholder ID = Beneficiary HICN (Medicare ID number); Group ID may be left blank. If pharmacists are unable to process a Limited Income NET claim, they can contact the Limited Income NET Program pharmacy benefits manager at the Humana help desk: 1-800-783-1307; then select option #1.
 
In February, CMS had directed Fox to suspend marketing and enrollment of new members in its PDP because the organization had “not met the prescription drug needs of its newest members,” according to a CMS news release dated February 26.

For additional information on today’s announcement, see CMS’s press release.
 
The LI NET Program webpage lists several CMS resources including “Four Steps for how pharmacists/pharmacies can bill for immediate need of prescription drug coverage” and a Pharmacy Tip Sheet.  Questions should be directed to 1-800-783-1307 or MedicareLINET@cms.hhs.gov.

Posted by Carli Richard (crichard@aphanet.org)
March 9, 2010