ALEXANDRIA, Va. Following an industry group's collection of Medicare payment complaints, the Centers for Medicare and Medicaid Services reached out to an insurer, reminding the company of its obligations to pay pharmacy precription drug claims.
CMS’ action to contact Fox Insurance -- which terminated its Medicare Part D contract in March -- followed the National Community Pharmacists Association's efforts to have CMS aggressively pursue insurance companies and pharmacy benefit managers that do not pay prescription drug claims submitted by pharmacies.
CMS paid Fox some $63 million to cover Part D enrollees for February and March, NCPA said.
“From the perspective of independent community pharmacies and their patients, Fox Insurance now has two strikes against it,” said Bruce Roberts, NCPA EVP and CEO. “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 [the insurer's pharmacy benefit manager] 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,” Roberts concluded.