Farm Bureau Essential Rx
2018 Coverage

About the Plan:

Our lower-premium plan covers a broad range of generic and brand name drugs. The plan’s five tiers of coverage give you cost sharing among generics and brand name drugs, as well as specialty drugs.

The plan has an annual deductible of $405.

For any preferred generic drug, you pay no more than $1 per month. And for any Preferred Brand drug, no more than $40 per month after deductible is met.

Highlights:

  • Monthly premium: $46.60
  • Annual deductible: $405
  • Tier 1 - Preferred Generics: $1 copay per fill
  • Tier 2 - Generics: $5 copay per fill
  • Tier 3 - Preferred Brands: $40 copay per fill
  • Tier 4 - Non Preferred Generic/ Non Preferred Brand: 40% coinsurance per fill
  • Tier 5 - Specialty Generics or Brands 25% coinsurance per fill
  • Per fill is equal to a 30 day supply

Prescription Drug Benefits
Drug Copay & Discounts

Prescription Drugs Benefits
Prescription Drugs Your Costs
Annual Prescription Deductible $405
Initial Coverage Stage   Standard Network Pharmacy Cost Sharing (30 days) Preferred Mail Order Pharmacy (90 days)
Tier 1: Preferred Generic Drugs   $1 Copay $3 Copay
Tier 2: Generic Drugs   $5 Copay $15 Copay
Tier 3: Preferred Brand Drugs   $40 Copay $120 Copay
Tier 4: Non-Preferred Generic/Brand Drugs   40% of the cost 40% of the cost
Tier 5: Special Tier Drugs   25% of the cost 25% of the cost
Coverage Gap Stage

Once a member’s total drug costs have reached $3,750, they move to the Coverage Gap Stage.

Generic Drugs

  • Member pays 44% of the price and the plan pays the remaining 56%. The amount paid by the plan (56%) does not count toward the members out-of-pocket costs. Only the amount paid by the member moves them through the coverage gap. 

Brand Name Drugs
  • Member pays 35% of the plans negotiated price and a portion of the dispensing fee. The manufacturer provides a 50% discount excluding any dispensing fee. The amount paid by the member and the manufacturer discounted amount count towards the members out-of-pocket cost. The amount paid by the plan (10%) does not count towards the members out-of-pocket cost.


Once the member’s out-of-pocket costs reach $5,000 they move to the Catastrophic Coverage Stage.

Catastrophic Coverage Stage

You enter the Catastrophic Coverage Stage after $5,000 is reached (excluding premiums), you will have to pay only one of the following through the end of the year: $3.35 copay for generic drugs, $8.35 copay for brand name drugs or a 5% co-insurance, whichever is greater. On January 1 each year, the five drug payment stages start over.

Footnotes

  • Members may use any pharmacy in the network but may not receive negotiated retail pharmacy pricing. Copays apply after deductible.
  • You are not required to use Farm Bureau Essential Rx mail order to obtain a 90-day supply of your maintenance medication. New prescriptions for Farm Bureau Essential Rx mail order should arrive within ten business days from the date the completed order is received and refill orders should arrive in about seven business days. Contact Farm Bureau Essential Rx anytime at (855) 540-4744 (TTY 711) 8am to 8pm, 7 days a week.
  • Farm Bureau Essential Rx (PDP) is an affiliate of Members Health Insurance Company. Copays and coinsurance apply for all tiers during initial coverage phase and do not apply during coverage gap. Different copays or coinsurance apply during the catastrophic stage.
  • Per fill equals a 30 day supply.

Plan Costs

Plan Costs
Cost Description Monthly Cost Annual Cost
Plan Premium

The monthly fee you pay to the plan for your health care. The amount shown does not include the Part B premium you already pay to the government. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

$46.60 $559.20

Plan Documents

Plan Documents
Plan Documents
The following documents can help you get more information about this Medicare Part D plan, enroll in a plan and more. All documents are PDF (Portable Document Format) files. They can be viewed with Adobe Reader. If you don’t already have this viewer on your computer, download it free from the Adobe website.
Document(s) English  
General Plan Information Enrollment Form (PDF)
Evidence of Coverage (PDF)
Summary of Benefits (PDF)
Annual Notice of Change (PDF)
 
Prescription Drug Coverage Comprehensive Formulary (PDF)
Prior Authorization Criteria (PDF) 
Step Therapy Criteria (PDF)
Quantity Limits (PDF)
 

Footnotes

  • Quantity Limits (QL)
    The plan will cover only a certain amount of this drug for a single copay or over a certain number of days. These limits may be in place to ensure safe and effective use of the drug. If your doctor prescribes more than this amount or thinks the limit is not correct for your situation, you and your doctor can ask the plan to cover the additional quantity.

  • Step Therapy (ST)
    There may be effective, lower-cost drugs that treat the same medical condition as this drug. You may be required to try one or more of these lower-cost drugs before the plan will cover your drug. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.

  • Prior Authorization (PA)
    The plan requires you or your doctor to get prior authorization for certain drugs. This means the plan needs additional information from your doctor to make sure the drug is being used correctly for a medical condition covered by Medicare. If you do not get approval, the plan may not cover the drug.


Once enrolled, you’ll have access to more than 67,000 pharmacies. Click here to view the Alabama Network Pharmacy Directory.

This document is a PDF (Portable Document Format) file. It can be viewed with Adobe Reader. If you don't already have this viewer on your computer, download it free from the Adobe website.
 

You may also use a pharmacy that is not in our network. However, if you go to a pharmacy outside the network, you may have to pay more for your prescriptions, and you may have to file a claim to be reimbursed. You will be responsible for payment of any difference between the non-network pharmacy’s charge and the amount the plan allows. 

If you would like to request a printed copy, please call 844-368-8739 (TTY 711), 8am to 8pm, 7 days a week.

Medicare beneficiaries with limited incomes may qualify for the Medicare Part D “Extra Help” program. This is also known as the Low Income Subsidy (LIS) program.

The program was designed to help people with limited incomes pay for prescription drugs. If you qualify for Medicare Part D Extra Help, you will pay less in drug premiums and copayments or coinsurance. You also will be covered during the Coverage Gap (the “Donut Hole”), and you will not have to pay late enrollment penalties. For more information on the LIS Extra Help Program, click here

Click Here for a 2018 summary of monthly plan premiums for those eligible for extra help.

If you have multiple chronic conditions you may be invited to participate in the Medication Therapy Management Program (MTM). The program is designed for those who have two (2) or more chronic conditions and take a minimum of six (6) different chronic/maintenance medications, or are likely to incur more than $3,697 in annual drug costs. The MTM program offers participants direct access to health care professionals to help them better manage their health and health care expenses. Participation is optional, and you may choose not to participate.

For more about who is eligible for MTM and how the program can help you, click here.


Medicare beneficiaries may also enroll in Farm Bureau Essential Rx or Farm Bureau Select Rx through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

Members Health Insurance Company is a Part D plan with a Medicare Contract. Enrollment in Members Health Insurance Company depends on contract renewal. You must continue to pay your Medicare Part D premium. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.
 

Beneficiaries generally must use network pharmacies to access their prescription drug benefit. Benefits, formulary, pharmacy network, premium and or copayments/ coinsurance may change January 1 of each year. The Formulary and/or Pharmacy Network may change at any time. You will receive notice when necessary.