If your plan has a deductible, this stage begins when you fill your first prescription of the year. During this stage, you pay the full cost of your prescription drugs.
2021 Farm Bureau Select Rx Deductible - $0
2021 Farm Bureau Essential Rx Deductible - $445
Initial Coverage Stage
If your plan does not have a deductible, you start in the Initial Coverage Stage. If your plan has a deductible, you enter the Initial Coverage Stage once your deductible is met.
During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost. Depending on the Tier Level of your prescription drug, you will pay either a set co-payment or coinsurance.
You stay in this stage until your total drug costs for the year total $4,130. Total drug costs are your payments plus the plan’s payments.
Coverage Gap Stage
During the Coverage Gap Stage, the Medicare Coverage Gap discount program provides 70% manufacturer discounts on brand name drugs. This discount is automatically applied at the pharmacy. The plan also provides some coverage for generic drugs during this stage.
Brand Name Drugs:
You pay 25% (plus a portion of the dispensing fee) and the plan pays the remaining 5%.
You pay 25% of the price and the plan pays 75%.
You stay in the Coverage Gap Stage until your year-to-date out-of-pocket costs reach $6,550. The out-of-pocket costs do not include what the plan has paid for your prescription drugs.
Once your out-of-pocket costs reach $6,550, you enter the Catastrophic Stage. During this stage, the plan will pay most of the costs for your prescription drugs for the rest of the calendar year.
Your share of the cost for a covered drug will be either coinsurance or co-payment, whichever is the larger amount:
- 5% of the cost of the drug; or
- $3.70 for generic drugs and $9.20 for all other drugs.