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 Adobe Reader for free from the Adobe website.
Farm Bureau Select Rx 2024 Coverage
Farm Bureau Select 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. There are certain pharmacies that have agreed to special pricing, known as Preferred Cost-Sharing Pharmacies. Your copayment and coinsurance will be lower when you use a Preferred Cost-Sharing Pharmacy. Generally, the plan does not cover prescription drugs purchased at an out-of-network pharmacy.
Farm Bureau Select Rx includes two Preferred Cost-Sharing Pharmacies: Kroger and Walmart.
Farm Bureau Select Rx does not have a deductible and coverage begins with the initial coverage phase. The monthly premium for Farm Bureau Select Rx is $76.70.
Preferred Cost-Sharing Pharmacy
You will pay the following copayments or coinsurance when using a Network Pharmacy.
30-Day Supply |
100-Day Supply |
|
Tier 1 - Preferred Generic |
$1 |
$3 |
Tier 2 - Generic |
$9 |
$27 |
Tier 3 - Preferred Brand |
$42 |
$126 |
Tier 4 - Non-Preferred Brand |
45% of drug cost |
45% of drug cost |
Tier 5 - Specialty |
33% of drug cost |
Not covered |
Network Pharmacy (Standard Cost-Sharing)
30-Day Supply |
100-Day Supply |
|
Tier 1 - Preferred Generic |
$15 |
$45 |
Tier 2 - Generic |
$20 |
$60 |
Tier 3 - Preferred Brand |
$47 |
$141 |
Tier 4 - Non-Preferred Brand |
50% of drug cost |
50% of drug cost |
Tier 5 - Specialty |
33% of drug cost |
Not covered |
You pay copays or coinsurance and the plan pays the difference until the total cost of drugs paid by both you and the plan reaches $5,030.
This stage begins when your drug costs total $5,030.
You pay 25% coinsurance for generic drugs and 25% coinsurance for brand drugs during this stage. You move into the Catastrophic Stage once you and others on your behalf have spent $8,000 on your drug costs.
This stage begins when your out-of-pocket costs reach $8,000.
Once you and others on your behalf have spent $8,000 in drug costs, the plan pays the full cost of your covered Part D drugs and you pay nothing.
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.
The Comprehensive Formulary is the list of drugs covered by this plan. The formulary also tells you if a drug is restricted.
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.