Farm Bureau Essential Rx is a prescription drug plan approved by Medicare. This plan offers a large network of pharmacies, which have contracted with the plan to provide your covered prescription drugs at negotiated prices. Generally, the plan does not cover prescription drugs purchased at an out-of-network pharmacy.
Farm Bureau Essential Rx has a $505 deductible you are responsible for before you reach the initial coverage state. The monthly premium for Farm Bureau Essential Rx is $85.40.
Initial Coverage Stage
You reach this stage after you have met your annual deductible of $505. You will pay the following copayments or coinsurance when using a Network Pharmacy.
|Tier 1 – Preferred Generic
|Tier 2 – Generic
|Tier 3 – Preferred Brand
|Tier 4 – Non-Preferred Brand
|50% of drug cost
|50% of drug cost
|Tier 5 – Specialty
|25% of drug cost
|25% of drug cost
When using the Plan’s Mail Order Pharmacy, your copayments and coinsurance will be the same as Network Pharmacy copayments and coinsurance.
When using a network Long Term Care Pharmacy, the Network Pharmacy copayments and coinsurance apply to a 31-day supply.
When using a network Home Infusion Pharmacy, the Network Pharmacy copayments and coinsurance apply to a 30-day supply.
Coverage Gap Stage
This stage begins when your drug costs total $4,660.
Medicare’s Coverage Gap Discount Program provides 70% manufacturer discounts on brand name drugs.
During the Coverage Gap:
- You pay 25% of the cost of the drug and the Plan pays 5% for brand name drugs; and
- You pay 25% of the cost of the drug and the Plan pays 75% for generic drugs.
This stage begins when your out-of-pocket costs reach $7,400.
During the Catastrophic Stage your share of the cost of covered drugs will be either copayment or coinsurance, whichever is the larger amount:
- 5% of the cost of the drug; or
- $4.15 for generic drugs and $10.35 for all other drugs.
The following plan documents will help you find more information about Farm Bureau Select Rx. All documents are PDF (Portable Document Format) and can be viewed with Adobe Reader. If you don’t already have this viewer on your computer, download it free from the Adobe website.
|Summary of Benefits (PDF)
|The Summary of Benefits provides an overview of the plan benefits.
|Annual Notice of Change (PDF)
|The Annual Notice of Change is a notice sent to all members in September each year to explain the changes effective in the next plan year.
|Enrollment Form (PDF)
|If you would like to enroll for one of our plans, you can complete the Enrollment Form and mail it to us.
|Evidence of Coverage (PDF)
|The Evidence of Coverage explains your plan benefits, your rights and responsibilities, and provides you with important contact information.
|Pharmacy Directory (PDF)
|The Pharmacy Directory provides you with a list of network pharmacies and their locations.
|Comprehensive Formulary (PDF)
|The Comprehensive Formulary is the list of drugs covered by this plan. The formulary also tells you if a drug is restricted.
|Prior Authorization Criteria (PDF)
|The Prior Authorization Criteria explains what is needed to review certain drugs that require prior authorization.
|Step Therapy Criteria (PDF)
|The Step Therapy Criteria explains what is needed to review certain drugs that require step therapy.
|Quantity Limits Criteria (PDF)
|The Quantity Limits Criteria explains what is needed to review certain drugs with quantity limits.
|CMS Star Ratings (PDF)
|The Medicare program uses a 5 star system to rate all prescription drug plans based on quality and performance.