Call the Farm Bureau Health Plans Member Services number to request a coverage determination (coverage decision). When requesting a formulary or cost-sharing exception, or asking for the plan to cover an additional amount of a drug with a quantity limit or asking for the plan to waive a step therapy requirement, a statement from your doctor supporting your request is required. Usually, the coverage decision will be made within 72 hours after we receive the request or your doctor's supporting statement (if required).
You can request an expedited (fast) coverage decision if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we receive your request or prescribing doctor's supporting statement.
If you are a continuing member in the plan, you may notice that a formulary medication which you are currently taking is either not on the Drug List or its cost-sharing or coverage is limited in the upcoming year. If you are affected by a change in drug coverage you can:
- Work with your doctor (or other prescriber) and ask the plan to make an exception to cover the drug. If we approve your request for a Formulary Exception, our appoval is usually valid until the end of the plan year as long as your doctor continues to prescribe the drug for you and that drug conrinues to be safe and effective for treating your condition.
- Find a different drug that we cover. You can call Customer Service to ask for a list of covered drugs that treat the same medical condition. You should discuss that list with your doctor, who can tell you which drugs may work for you.
In some situations, we will cover a one-time, temporary supply. During the time when you are getting a temporary supply of a drug, you should talk with your doctor to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug.
To initiate a coverage determination request, please contact Farm Bureau Health Plans.
Have the following information ready when you call:
- Member name
- Member date of birth
- Medicare Part D Member ID number
- Name of the medication
- Physician's name
- Physician's phone number
- Physician fax number (if available)
You may also request a coverage decision/exception or prior authorization by logging on to www.optumrx.com and submitting a request. If you are a new user with www.optumrx.com, you will need to register before you can access any tool to assist you. Once you have registered, you will find the Prior Authorization tool under the Health Tools Menu. Once your request has been submitted, we will attempt to contact your doctor to get a supporting statement and/or additional clinical information needed to make a decision.
Note: PDF (Portable Document Format) files can be viewed with Adobe® Reader®. If you don't already have this viewer on your computer, download it free from the Adobe website.
To initiate a request, providers may contact Farm Bureau Health Plans at (866) 643-6924 Monday through Friday, 8am - 8pm or fax toll-free to (800) 527-0531 for Standard Prior Authorization or (800) 784 - 1580 for Specialty Prior Authorization. The plan's decision on your exception request will be provided to you by telephone and/ or mail. In addition, the initiator of the request will be notified by telephone and/ or fax.
To inquire about the status of a coverage decision, contact Farm Bureau Health Plans.
What happens if we deny your request?
If we deny your request, we will send you a written reply explaining the reasons for denial. You have the right to appeal if you are not satisfied with the initial decision. See the "Making an appeal" section for instructions on how to appeal the decision.