Medicare Kicks Out Fox Insurance

And therein lie some lessons for the press

The Centers for Medicare and Medicaid Services (CMS) took strong action the other day when it kicked Fox Insurance out of the Medicare program. The small, New York-based insurer had carved out quite a business for itself selling stand-alone prescription drug benefits to some 124,000 seniors. But it apparently didn’t treat those seniors very well.

CMS said that there were “significant deficiencies” that “jeopardized the health and safety of Fox enrollees.” The Medicare regulator noted that the company improperly denied seniors access to critical medicines to treat HIV, cancer, and seizures. Fox did not tell them about prior authorization requirements for some drugs, or that they would have to use step therapy first. That’s the process of using a cheaper drug to see if it works before moving on to a more expensive medication.

CMS said that “Fox was unable to satisfactorily address compliance concerns” when it came to marketing and enrolling new customers. So the agency pulled the plug, making it the first time it has banned an insurer from selling stand-alone prescription drug plans since the Medicare drug program began in 2006.

Such drastic action is rare in the world of regulatory agencies, and you’d think it would have merited more press coverage—especially since there has been so much hype over the Anthem Blue Cross rate increases, which brought howls and scowls from members of Congress and noisy public demonstrations this week engineered by the advocacy group HCAN. But, alas, the coverage of the CMS action was sparse.

The AP moved a story about the Fox termination that described an example of the insurer’s indiscretions. A doctor requested approval of an HIV medication that required Fox to respond within twenty-four hours. But the company approved the drug five days later. The South Florida Sun-Sentinel ran a short piece saying that Fox customers in the area had been automatically enrolled in a new Medicare in-house plan and that their coverage would continue. Not much detail about what Fox did wrong. Most of the coverage showed up in business media outlets like Medical News Today, Healthcare Finance News, and Pharmacy Choice. But how many Medicare beneficiaries read the business press?

Was the news media too distracted by the horses galloping to the Washington finish line to notice the regulatory action—and the need to tell seniors about it? Or is it that the press doesn’t care much when a regulatory problem finally plays out? Or is it just that there is so much news that the media, like their audiences, are simply overwhelmed and cannot easily sort through what is useful to report on and what is not?

Consider the implications for the media if health reform passes. After all, the sine qua non of the legislation is insurance market reform. Just think of all the mischief insurance companies can get into if no one is watching them, and if no one is following the regulators when they try to do what’s best for the public.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.