Farm Bureau Select Rx (PDP) Formulary



Below is the 2023 Formulary, or prescription drug list, from Farm Bureau Select Rx (PDP) by Members Health Insurance Company. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a In Alabama, Tennessee. plan that covers your prescriptions. It also helps you compare costs among Medicare Part D and Medicare Advantage plans available to you. You’ll want to make sure the medicines you are currently taking are covered under any plans you are considering enrolling in.

This Farm Bureau Select Rx (PDP)(S2668-006) plan has a $0 drug deductible. The Initial Coverage Limit (ICL) for this plan is $4660. The Initial Coverage Period is the period after the Deductible has been met but before the Coverage Gap phase. Once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will enter the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will be required to pay 25% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. You can see if this plan offers coverage in the "donut hole" by clicking the "Coverage Gap" link above the chart.

In 2023 if you have spent $7400 in expenditures you enter the Catastrophic Phase. During the Catastrophic Period you will begin to receive significant coverage. Members Health Insurance Company will begin paying approximately 95% of your covered medication expenses. You can see if this plan covers your drugs in the Catastrophic Phase by clicking the "Catastrophic" link above the chart.



Plan Overview

Plan Name:Farm Bureau Select Rx (PDP)
Plan ID: S2668-006
Formulary
Provider: Members Health Insurance Company
Plan Year:2023
Premium:$97.20
Deductible:$0
Initial Coverage Limit:$4660
Coverage Area:Alabama, Tennessee
Similar Plan:S2668-005


Change Table Options:

Drugs Starting Letter:
Coverage Phase:

*Tip Click the Drug name to Compare Coverage and Retail Cost for Every Plan In Your Area
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Drug
Name⇅
Tier
Level
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/Days
Prior Auth
Y/N
Step
Therapy
Famciclovir
3$42$47NANN
Famotidine
2$9$20NANN
Fanapt
445%50%NA8/180NY
Farxiga
3$42$47NANN
Fasenra
533%33%NAYN
Febuxostat
445%50%NANN
Felbamate
445%50%NANN
Felodipine
2$9$20NANN
Femynor
3$42$47NANN
Fenofibrate
2$9$20NANN
Fentanyl
445%50%NANN
Fentanyl Citrate
533%33%NAYN
Fentanyl Transdermal
445%50%NANN
Fetzima
445%50%NA30/30NY
Finacea Foam
445%50%NA50/30NN
Firmagon
533%33%NA4/365YN
Flac Otic Oil
445%50%NANN
Flecainide Acetate
2$9$20NANN
Flovent
3$42$47NA24/30NN
Fluconazole
3$42$47NANN
Flucytosine
533%33%NANN
Fludrocortisone Acetate
2$9$20NANN
Fluocinolone Acetonide
445%50%NANN
Fluocinonide
3$42$47NANN
Fluorometholone
445%50%NANN
Fluorouracil
445%50%NANN
Fluoxetine
1$1$15NANN
Fluphenazine Decanoate
445%50%NANN
Fluphenazine Hydrochloride
445%50%NANN
Flurbiprofen
3$42$47NANN
Flurbiprofen Sodium
2$9$20NANN
Fluticasone Propionate
3$42$47NANN
Fluticasone Propionate And Salmeterol
2$9$20NA60/30NN
Fluvoxamine Maleate
2$9$20NANN
Fml Forte
445%50%NANN
Fondaparinux Sodium
533%33%NA28/90NN
Formoterol Fumarate
445%50%NA120/30YN
Forteo
533%33%NAYN
Fosamprenavir Calcium
533%33%NANN
Fosinopril Sodium
2$9$20NANN
Fosinopril Sodium And Hydrochlorothiazide
2$9$20NANN
Fotivda
533%33%NAYN
Furosemide
3$42$47NANN
Fuzeon
533%33%NANN
Fycompa
533%33%NANN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for S2668-006

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1. Pre-Deductable: Before you reach the plans deductible of $0. Some plans offer select Pre-deductible drug Coverage
2. Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit of $4660
3. Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $7400 in 2023.
4. Catastrophic: Anything over $7400 you will receive a significant increase in coverage.

Definitions:

Premium: A monthly flat fee that varies by plan.
Deductible: The amount you must pay each year for your prescriptions before your plan begins to pay its share of your covered drugs. The max in 2022 is $320. Some plans have a $0 Deductible.
Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less.
Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. That means the plan will only cover the drug up to a designated quantity or amount. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered.
Prior Authorization: Certain Drugs require you or your doctor to get prior authorization to be covered. Usually just an additional form. If you dont get approval, the plan may not cover the drug.
Does the Deduct Apply: Some drugs do not require that the deductible is met before you receive coverage.
Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. 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.
Cost Preferred: Your Cost for the Drug at the Providers In-Network Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Non-Preferred: Your Cost for the Prescription Drug at a Non-Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. As a Percent of the total drug cost or a flat rate.


What if a drug I need is not listed?

Please check the formulary for different brand and generic names. If you still cannot locate your drugs, your plan may not offer coverage. Talk to your doctor first about changing your prescription to a drug on your plan's formulary. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances.

Last updated on
Source:CMS Formulary Data Q4 2022
Source:NDC Directory by FDA.gov

**We make every attempt to keep our information accurate. But please check with the plan providers to verify all information.

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