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Judge Upholds $3.3 Million Judgment In Favor of Fox Insurance Company Against Former Pharmacy Benefit Manager
Date:5/22/2012

NEW YORK, May 22, 2012 /PRNewswire/ -- Fox Insurance Company, a Medicare Part D provider with offices in New York, NY, announces the confirmation of a judgment in the arbitration between the company and ProCare, its former pharmacy benefit manager, in excess of $3.3 million, following a suit against ProCare based on Fox's allegations of negligence and breach of contract.  On May 21, 2012, the U.S. District Court for the Northern District of Georgia, Atlanta Division, issued its decision confirming the arbitration award after its May 7th rejection of ProCare's request to vacate the award.

Nathan M. Barotz, chairman of Fox Insurance Company commented: "Fox Insurance is gratified that the judgment in the arbitration was upheld. Fox stands by its assertion that it was ProCare's failure to carry out its duties under its contract with Fox, and not any failure of Fox Insurance Company, that resulted in the improper denial of enrollee claims."

United States District Court Judge Thomas W. Thrash ruled that the arbitration panel acted within the scope of its authority in issuing the November 22, 2011 award, and that ProCare is bound by that decision.  The arbitration award includes a finding that ProCare breached the Client Services Agreement (CSA) between the companies. ProCare was cited as failing to have software to carry out Fox's instructions (as well as Centers for Medicare & Medicaid Services (CMS) requirements) regarding prior authorization and high cost edits, and incorrectly informing Fox that it had fixed the problems with its software.

Fox had presented evidence that ProCare's claims processing system returned thousands of drug claims to pharmacies with the message that prior authorization was required, when no such requirement was in place – including on certain "protected class" medications that would never have such a designation.  This caused the rejection of thousands of claims.<
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SOURCE Fox Insurance Company
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