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Transition Policy

FBHP Transition Policy

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FBHP Transition Policy

If you were taking a non-formulary drug, or a drug with a Step Therapy or Prior Authorization before joining our plan, FBHP Medicare transition process allows the pharmacist who refills your prescription to provide you with a temporary 30-day supply* of the drug within the first 90 days of your membership in a FBHP plan. Your cost is your plan's appropriate Tier copay and the prescription must be filled at a network pharmacy.

A transition supply allows you time to talk to your doctor about pursuing other options available to you within our formulary. Your plan cannot continue to pay for these medications under the transition policy, even if you have been a member for less than 90 days following your 30-day transition supply.

*A thirty (30) day supply is the maximum transition amount, and could be less if your prescription is written for fewer days.

If you receive a transition supply, you will receive a letter from your plan notifying you that you have received a temporary supply of your prescription drug. Please refer to your Evidence of Coverage for more detailed information on FBHP Medicare Transition Process.

New Members can request a Formulary Exception

As a new Farm Bureau Essential Rx or Select Rx member, you may be taking drugs that are not included on our formulary or are included but your ability to get them is limited. If this applies to you we encourage you to talk with your doctor about switching to appropriate alternative drugs that are included in our formulary. If there are no appropriate alternative drugs covered by our formulary, you or your doctor can request a Formulary Exception.

If your request for a Formulary Exception is approved, you will be able to obtain the drug you are taking for a specified period of time. While you are talking with your doctor to determine your course of action, you may be eligible to receive a temporary or transition supply of the drug anytime during the first 90-days of your membership in our plan.

New members who already take a non-formulary, Step Therapy or Prior Authorization prescription

If you were taking a non-formulary drug or a Step Therapy or Prior Authorization prescription drug before you joined Farm Bureau Essential Rx or Farm Bureau Select Rx, the pharmacist who refills your prescription will be able to provide you with a temporary 30-day supply of your prescription drug during the first 90-days of your membership in our plan. Your cost would be your plan’s Tier cost-sharing amount (copay or coinsurance) and the prescription must be filled at a network pharmacy. A temporary fill allows you time to talk to your doctor about pursuing other formulary alternatives that are covered by your plan.

Transitioning New members who switch to a FBHP plan and reside in a Long Term Care facility

If you were taking a non-formulary drug or a prescription drug with a Step Therapy or a Prior Authorization restriction before you joined FBHP and if you also reside in a Long Term Care facility, the pharmacist who refills your prescription will be able to provide you up to a 102 day supply** of your prescription drug during the first 90-days of your membership in our plan. Your cost would be your plan's Tier cost-sharing amount (copay or coinsurance) and the prescription must be filled at a network pharmacy. This allows you time to talk to your doctor about pursuing other options available to you within our formulary.

**One hundred and two (102) days supply if consistent with the dispensing increment, unless you have a prescription written for fewer days.

When a drug you take is not covered by your plan

Medicare prescription drug plan formularies are not all the same. For that reason, there may be instances when a prescription drug you take is not covered by our formulary. It doesn't mean you need to leave our plan, because you may be able to get coverage for the drug through our Exception process. We can work with your doctor to find a covered alternative drug that your doctor feels is right for your condition.

When you discuss your prescriptions with your doctor, we encourage you to take along your plan's Comprehensive Formulary. If your doctor believes there are no alternative prescription drugs on our formulary that are right for treating your condition, you or your doctor may request a Formulary Exception. If we approve your request for a Formulary Exception, we will begin covering your drug on January 1 of the upcoming plan year.

If you need further assistance with any formulary-related issue or simply have questions about drug coverage in general, please contact Customer Care toll-free at 1-866-643-6924, 8am to 8pm, 5 days a week. TTY users call 711.

Helpful Links


Once enrolled, you’ll have access to more than 67,000 pharmacies. Click here to find a pharmacy.

You may also use a pharmacy that is not in our network. However, if you go to a pharmacy outside the network, you may have to pay more for your prescriptions, and you may have to file a claim to be reimbursed. You will be responsible for payment of any difference between the non-network pharmacy’s charge and the amount the plan allows. 

If you would like to request a printed copy of the pharmacy directory please call 844-368-8738 (TTY 711) Hours: 8am-8pm, 7 days a week.

Medicare beneficiaries with limited incomes may qualify for the Medicare Part D “Extra Help” program. This is also known as the Low Income Subsidy (LIS) program. 

The program was designed to help people with limited incomes pay for prescription drugs. If you qualify for Medicare Part D Extra Help, you will pay less in drug premiums and copayments or coinsurance. You also will be covered during the Coverage Gap (the “Donut Hole”), and you will not have to pay late enrollment penalties. For more information on the LIS Extra Help Program, click here.

Click Here for a 2018 summary of monthly plan premiums for those eligible for extra help.

If you have multiple chronic conditions you may be invited to participate in the Medication Therapy Management Program (MTM). The program is designed for those who have two (2) or more chronic conditions and take a minimum of six (6) different chronic/maintenance medications, or are likely to incur more than $3,697 in annual drug costs. The MTM program offers participants direct access to health care professionals to help them better manage their health and health care expenses. Participation is optional, and you may choose not to participate.

For more about who is eligible for MTM and how the program can help you, click here.


 


Medicare beneficiaries may also enroll in Farm Bureau Essential Rx or Farm Bureau Select Rx through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

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