Fox Insurance Company agreed July 9 to wire $13.6 million in overdue payments for Medicare Part D prescription drug claims to the administrators of its plan - ProCare Pharmacy Benefit Management, Inc. - which is currently closing claims and beginning to process payments for claims from the period of Feb. 16-28, 2010 in order to provide long-awaited reimbursements to independent community pharmacies for providing prescription drugs to seniors. Fox Insurance still owes tens of millions of dollars in unpaid Fox insurance claims from March, and is promising to clarify a few lingering issues to fulfill its remaining obligations. This entire ordeal began when the Centers for Medicare and Medicaid Services (CMS) terminated Fox Insurance's Part D contract as a result of "significant deficiencies" in its operations on March 9, and Fox proceeded to withhold outstanding claims around that time period.
The effort to resolve this issue began in earnest when the National Community Pharmacists Association (NCPA) sent a May 9 letter on behalf of independent community pharmacies to CMS asking the agency to instruct Fox Insurance to make these delinquent payments. That effort led CMS to send Fox Insurance a letter urging the insurer to honor its obligations on May 17. However, it apparently took the interventions of the chairman and ranking member of the U.S. Senate Finance Committee, Sens. Max Baucus (D-MT) and Charles Grassley (R-IA), who sent a letter to Fox Insurance on July 6, to prompt action from Fox Insurance. In response Douglas Hoey, RPh, NCPA acting executive vice president and CEO, issued the following statement:
"We want to thank Senators Max Baucus and Charles Grassley for their strong leadership in resolving the issue of the withholding of payments for rightful Medicare Part D prescription drug claims from independent community pharmacies that contracted with Fox Insurance. Even though CMS terminated its Part D contract, Fox had a responsibility to honor these claims. Surprisingly, the foot dragging continued despite CMS' admonition to Fox. Community pharmacies and ProCare, the PBM administrator, were left holding the bag, which is now being rectified with the first wave of payments being sent out.
"Medicare Part D is relied upon by seniors to access the medications they need. Independent community pharmacies comprise 40 percent of the retail pharmacy industry, and are often located in underserved rural and urban areas. For the program to work all of the participants need to work as a team, and that includes fulfilling their financial obligations. That's why it was incumbent on Fox Insurance to stop with the delays and legal wrangling. Finally, independent community pharmacies that serve seniors through the Fox Insurance plan, and operate off of thin profit margins, can get paid for their honest services. We appreciate Fox Insurance's recent efforts to set things right. It is a first step, but only a step, in solving the problem. We will be watching to make sure every penny owed is paid, and hope no Part D plan sponsors will require this amount of attention in the future. That's the only way for the Medicare Part D program to be truly successful."
The National Community Pharmacists Association (NCPA®) represents America's community pharmacists, including the owners of more than 22,700 independent community pharmacies, pharmacy franchises, and chains. Together they represent an $88 billion health-care marketplace, employ over 65,000 pharmacists, and dispense over 40% of all retail prescriptions. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at ncpanet.wordpress.com.