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Farm Bureau Health Plans

Education & Resources

Farm Bureau Select Rx 2020 Farm Bureau Essential Rx 2020 How Medicare Works Formulary Medication Therapy Management (MTM) How to Appoint a Representative Quality Assurance Programs Documents & Forms
Part D Coverage Stages Transition Policy Coverage Determinations Appeals Enrollment/Disenrollment Filing a Grievance Fraud, Waste & Abuse Premium Payment Terms & Conditions Medicare's Extra Help Program

Medicare.gov Resources

Medicare.gov Medicare Complaint Form Medicare Prescription Drug Coverage Determinations Best Available Evidence for Low-Income Subsidy

Formulary (Prescription Drug List)

A formulary is a list of covered prescription drugs and includes both generic and brand drugs.  The Farm Bureau Health Plans formulary was developed by a team of doctors and pharmacists, and meets requirements set by Medicare. 

The formulary will indicate what tier each drug is in and will indicate if there are any restrictions and/or limitations for each drug.

Each drug on the formulary is in one of following five cost-sharing tiers:
Type
Description
Tier 1
Preferred Generic
Includes lower-cost, commonly used generic drugs.
Tier 2
Generic
Includes many generic drugs.
Tier 3
Preferred Brand
Includes many common brand name drugs, called preferred brands and some higher-cost generic drugs.
Tier 4
Non-Preferred Brand
Includes non-preferred generic and non-preferred brand name drugs. In addition, Part D eligible Compounded Medications are covered in Tier 4.
Tier 5
Specialty Tier
Includes unique and/or very high-cost drugs.

2020 Farm Bureau Select Rx Formulary 

2020 Farm Bureau Essential Formulary

Are there restrictions on my medications?

For certain prescription drugs, special rules restrict how and when the plan covers them. A team of doctors and pharmacists developed the drug list and rules to help ensure safe, effective, and affordable drug use.   

If there is a restriction for your drug, it usually means that you (or your doctor) will have to use the coverage determination process to ask us to cover the drug.


Getting plan approval in advance

For certain drugs, you or your provider need to get approval from the plan before we will agree to cover the drug for you. This is called “prior authorization” (PA). Sometimes the requirement for getting approval in advance helps guide appropriate use of certain drugs. If you do not get this approval, your drug might not be covered by the plan.


Trying a different drug first

This requirement encourages you to try less costly but just as effective drugs before the plan covers another drug. For example, if Drug A and Drug B treat the same medical condition, the plan may require you to try Drug A first. If Drug A does not work for you, the plan will then cover Drug B. This requirement to try a different drug first is called “step therapy” (ST).

Quantity Limits (QL)

For certain drugs, we limit the amount of the drug that you can have by limiting how much of a drug you can get each time you fill your prescription. For example, if it is normally considered safe to take only one pill per day for a certain drug, we may limit coverage for your prescription to no more than one pill per day.


Medicare Part B or Medicare Part D Coverage Determination (B/D)

Depending on how a drug is used, it may be covered by either Medicare Part B (doctor and outpatient health care) or Medicare Part D (prescription drugs). Your doctor may need to provide the plan with more information about how this drug will be used to make sure it's correctly covered by Medicare.

NOTE: If you do not get approval from the plan for a drug with a restriction or limit before using it, you may be responsible for paying the full cost of the drug.

Types of Drugs Not Covered

Medicare excludes certain prescription drugs from coverage.  If you get a drug that is excluded by Medicare, you will be responsible for the full cost of the drug.  Drugs generally not covered by Medicare prescription drug plans include, but are not limited to,:

  • Drugs covered by Medicare Part A and/or Part B.
  • Drugs purchased outside of the U.S. and its territories.
  • Off-label use of a drug.
  • Over-the-counter drugs.
  • Drugs used for cosmetic purposes or to promote hair growth.
  • Drugs used to treat sexual or erectile dysfunction.

Review the Evidence of Coverage for a list of drug types not covered by Medicare prescription drug plans.