Farm Bureau Select Rx 2019 Coverage

About the Plan:

This $0-deductible plan covers a broad range of generic and brand name drugs.

With five tiers of coverage, the plan gives you options among generics and brand name drugs, as well as specialty drugs.

For any preferred generic drug, you pay no more than $8 per fill. And for any Preferred Brand drug, no more than $45 per fill.

Farm Bureau Select Rx Plan offers preferred pharmacy cost sharing at no additional cost to the member. Please see the table below for a comparison of Standard Network Pharmacy Cost Sharing to Preferred Pharmacy Cost Sharing. Farm Bureau Select Rx Preferred Pharmacy network utilizes Kroger and Walmart as its two preferred pharmacies.

Highlights:

  • Monthly premium: $99.00
  • Annual Deductible: $0
  • Tier 1 - Preferred Generics: $8 copayment per fill
  • Tier 2 - Generics: $13 copayment per fill
  • Tier 3 - Preferred Brands: $45 copayment per fill
  • Tier 4 - Non Preferred Generic/ Non Preferred Brand: 50% coinsurance per fill
  • Tier 5 - Specialty Generics or Brands: 33% coinsurance per fill
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Note: Per fill is equal to 30 day supply

This plan also features a Preferred Pharmacy Network that when used reduces your copayments.
 

Prescription Drug Benefits
Drug Copay & Discounts

Prescription Drugs Benefits
Drug Co-pay & Discounts
30 Day Supply
Prescription Drugs
30 Day Supply
Your Costs
Annual Prescription Deductible $0
Initial Coverage Stage   Standard Network Pharmacy Cost Sharing (30 days) Preferred Pharmacy Cost Sharing (30 days)
Tier 1: Preferred Generic Drugs   $8 Copay $3 Copay
Tier 2: Generic Drugs   $13 Copay $8 Copay
Tier 3: Preferred Brand Drugs   $45 Copay $40 Copay
Tier 4: Non-Preferred Generic/Brand Drugs   50% of the cost 45% of the cost
Tier 5: Special Tier Drugs   33% of the cost 33% of the cost
Prescription Drugs Benefits
Drug Co-pay & Discounts
90 Day Supply
Prescription Drugs
90 Day Supply
Your Costs
Annual Prescription Deductible $0
Initial Coverage Stage   Standard Network Pharmacy Cost Sharing (90 days) Preferred Pharmacy Cost Sharing (90 days)
Tier 1: Preferred Generic Drugs   $24 Copay $9 Copay
Tier 2: Generic Drugs   $39 Copay $24 Copay
Tier 3: Preferred Brand Drugs   $135 Copay $120 Copay
Tier 4: Non-Preferred Generic/Brand Drugs   50% of the cost 45% of the cost
Tier 5: Special Tier Drugs   33% of the cost 33% of the cost

Coverage Gap Stage

Once a member's total drug costs have reached $3,820, they move to the Coverage Gap Stage.

Generic Drugs

- Member pays 37% of the price and the plan pays the remaining 63%. The amount paid by the plan (63%) does not count toward the members out-of-pocket costs. Only the amount paid by the member moves them through the coverage gap.

Brand Drugs

- Member pays 25% of the plan's negotiated price and a portion of the dispensing fee. The manufacturer provides a 70% discount excluding any dispensing fee. The amount excluding any dispensing fee. The amount paid by the member and the manufacturer dicounted amount count towards the member's out-of-pocket cost. The amount paid by the plan (5%) does not count towards the member's out-of-pocket cost.

Once the member's out-of pocket costs reach $5,100, they move to the Catastrophic Coverage Stage.

Catastrophic Coverage Stage

A member enters the Catastrophic Coverage Stage after $5,100 out-of-pocket costs are reached (excluding premiums). Through the end of the year, member pays the greater of: Generic drugs - $3.40 copay or a 5% coinsurance; Brand name drugs - $8.50 copay or a 5% co-insurance. On January 1 each year, the five drug payment stages start over.

Footnotes

  • Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy, such as when you have a medical emergency or when your drug is not in stock at a network pharmacy.
  • You are not required to use Farm Bureau Select Rx mail order to obtain a 90-day supply of your maintenance medication. New prescriptions for Select 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 Select Rx anytime at (855) 540-4744 (TTY 711) 8am to 8pm, 7 days a week.
  • Farm Bureau Select Rx is an affiliate of Members Health Insurance.
  • Copays & coinsurance apply to all tiers during the initial coverage phase and do not apply during the coverage gap. Different copays or coinsurance apply during the catastrophic stage.

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.

$99.00 $1,188.00

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)
Pharmacy Directory (PDF)
Prescription Drug Coverage Comprehensive Formulary (PDF)
Prior Authorization Critieria (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.