NCPA Applauds CMS Action Urging Fox Insurance to Reimburse Pharmacies

Alexandria, Va. - May 19, 2010

 

The U.S. Centers for Medicare & Medicaid Services (CMS) has sent a letter to Fox Insurance Company, which had its Medicare Part D contract terminated in March, reminding the insurer of its obligations to pay pharmacy prescription drug claims. CMS' action came shortly after the National Community Pharmacists Association (NCPA) collected and transmitted to CMS a flood of complaints from pharmacies about the delinquent payments. 

Those efforts were further aided by the aggressive efforts of ProCare Pharmacy Benefit Manager, Inc., the pharmacy benefit manager (PBM) that administered pharmacy claims for Fox. ProCare filed a request for a temporary restraining order as result of Fox's non-payment, which left the PBM unable to reimburse community pharmacies, seeking the segregation of the funds that Fox received from CMS in an effort to assure funding for pharmacy reimbursement. CMS paid Fox some $63 million to cover Part D enrollees for February and March. 

In response, Bruce T. Roberts, RPh, NCPA executive vice president and CEO, issued the following statement: 

"From the perspective of independent community pharmacies and their patients, Fox Insurance now has two strikes against it. The first strike was a result of behavior egregious enough to warrant having its contract terminated by CMS. The second strike has come from Fox's refusal to honor its commitment to pay ProCare, so that it could reimburse millions of dollars in outstanding pharmacy claims. That behavior has now resulted in CMS demanding payments be made immediately. 

"We sincerely hope Fox avoids getting that third strike by paying for these services. It is the right thing to do and the bare minimum that was expected of the company when seniors paid their premiums and pharmacists filled their prescriptions."

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 http://ncpanet.wordpress.com.

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