Q1GROUP LLC | Q1Medicare.com - a non-government resource for the Medicare community
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

Search Criteria
PDP     MAPD
Scroll down to see formulary results.

Farm Bureau Essential Rx (PDP) (S2668-005-0)
Tier 1 (314)
Tier 2 (1510)
Tier 3 (297)
Tier 4 (859)
Tier 5 (890)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2019 Medicare Part D Plan Formulary Information
Farm Bureau Essential Rx (PDP) (S2668-005-0)
Benefit Details           
The Farm Bureau Essential Rx (PDP) (S2668-005-0)
Formulary Drugs Starting with the Letter B

in CMS PDP Region 12 which includes: AL TN
Plan Monthly Premium: $59.10 Deductible: $415 Qualifies for LIS: No
Drugs Starting with Letter B

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Bacitracin 500 unit/gm Eye Ointment   2 Generic $9.00$27.00None
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT   2 Generic $9.00$27.00None
BACLOFEN 10 MG TABLET   2 Generic $9.00$27.00None
BACLOFEN 20 MG TABLET   2 Generic $9.00$27.00None
BACLOFEN 5 MG TABLET   2 Generic $9.00$27.00None
BACTROBAN NASAL 2% OINTMENT   4 Non-Preferred Drug 45%45%None
BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT)   4 Non-Preferred Drug 45%45%None
BALVERSA 3 MG TABLET   5 Specialty Tier 25%25%P
BALVERSA 4 MG TABLET   5 Specialty Tier 25%25%P
BALVERSA 5 MG TABLET   5 Specialty Tier 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK   2 Generic $9.00$27.00None
Banzel 200mg/1   5 Specialty Tier 25%25%None
Banzel 40mg/mL   5 Specialty Tier 25%25%None
BANZEL TABLET 400MG   5 Specialty Tier 25%25%None
BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE   5 Specialty Tier 25%25%Q:600
/30Days
BAXDELA 300 MG VIAL   5 Specialty Tier 25%25%None
BAXDELA 450 MG TABLET   5 Specialty Tier 25%25%None
BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL   3 Preferred Brand $40.00$120.00None
BELSOMRA 10 MG TABLET   3 Preferred Brand $40.00$120.00Q:30
/30Days
BELSOMRA 15 MG TABLET   3 Preferred Brand $40.00$120.00Q:30
/30Days
BELSOMRA 20 MG TABLET   3 Preferred Brand $40.00$120.00Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BELSOMRA 5 MG TABLET   3 Preferred Brand $40.00$120.00Q:30
/30Days
BENAZEPRIL HCL 10 MG TABLET   1 Preferred Generic $4.00$12.00None
BENAZEPRIL HCL 20 MG TABLET   1 Preferred Generic $4.00$12.00None
BENAZEPRIL HCL 40 MG TABLET   1 Preferred Generic $4.00$12.00None
BENAZEPRIL HCL 5 MG TABLET   1 Preferred Generic $4.00$12.00None
BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT)   1 Preferred Generic $4.00$12.00None
BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT)   1 Preferred Generic $4.00$12.00None
BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT)   1 Preferred Generic $4.00$12.00None
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT)   1 Preferred Generic $4.00$12.00None
BENLYSTA 200 MG/ML AUTOINJECT   5 Specialty Tier 25%25%P
BENLYSTA 200 MG/ML SYRINGE   5 Specialty Tier 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BENZNIDAZOLE 100 MG TABLET   3 Preferred Brand $40.00$120.00None
BENZNIDAZOLE 12.5 MG TABLET   3 Preferred Brand $40.00$120.00None
BENZTROPINE MES 0.5 MG Tablet [Cogentin]   2 Generic $9.00$27.00None
BENZTROPINE MES 1 MG TABLET [Cogentin]   2 Generic $9.00$27.00None
BENZTROPINE MES 2 MG TABLET [Cogentin]   2 Generic $9.00$27.00None
BERINERT 500 UNIT KIT   5 Specialty Tier 25%25%P
BESER 0.05% LOTION [Cutivate]   4 Non-Preferred Drug 45%45%None
BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR   4 Non-Preferred Drug 45%45%None
Betamethasone Dipropionate 0.64mg/g / 45 g TUBE   2 Generic $9.00$27.00None
BETAMETHASONE DP 0.05% LOT   2 Generic $9.00$27.00None
Betamethasone DP 0.05% ointment   2 Generic $9.00$27.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BETAMETHASONE DP AUG 0.05% CRM   2 Generic $9.00$27.00None
BETAMETHASONE DP AUG 0.05% GEL   2 Generic $9.00$27.00None
BETAMETHASONE DP AUG 0.05% LOT   2 Generic $9.00$27.00None
BETAMETHASONE DP AUG 0.05% OIN   2 Generic $9.00$27.00None
BETAMETHASONE VA 0.1% CREAM   2 Generic $9.00$27.00None
BETAMETHASONE VALERATE 0.1% LOTION   2 Generic $9.00$27.00None
BETAMETHASONE VALERATE 0.12% FOAM   4 Non-Preferred Drug 45%45%None
BETAMETHASONE VALERATE OINTMENT USP   2 Generic $9.00$27.00None
BETASERON 0.3 MG KIT   5 Specialty Tier 25%25%P Q:15
/30Days
BETAXOLOL 10 MG TABLET   2 Generic $9.00$27.00None
BETAXOLOL 20 MG TABLET   2 Generic $9.00$27.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Betaxolol 5 MG/ML Ophthalmic Solution   2 Generic $9.00$27.00None
BETHANECHOL 10 MG TABLET   2 Generic $9.00$27.00None
BETHANECHOL 25 MG TABLET   2 Generic $9.00$27.00None
BETHANECHOL 5 MG TABLET   2 Generic $9.00$27.00None
BETHANECHOL 50 MG TABLET   2 Generic $9.00$27.00None
BETHKIS 300 MG/4 ML AMPULE   5 Specialty Tier 25%25%P
BETIMOL 0.25% EYE DROPS   4 Non-Preferred Drug 45%45%None
BETIMOL 0.5% EYE DROPS   4 Non-Preferred Drug 45%45%None
BEXAROTENE 75 MG CAPSULE [Targretin]   5 Specialty Tier 25%25%P
BEXSERO PREFILLED SYRINGE   3 Preferred Brand $40.00$120.00None
BICALUTAMIDE 50 MG TABLET   2 Generic $9.00$27.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BICILL LA PFS 600MU 1ML PED   4 Non-Preferred Drug 45%45%None
BICILLIN C-R 1.2MM UNITS SYR 2ML x 10   4 Non-Preferred Drug 45%45%None
BICILLIN C-R 900/300 SYRINGE 2ML x 10   4 Non-Preferred Drug 45%45%None
BICILLIN LA PFS 1200MU 2ML   4 Non-Preferred Drug 45%45%None
BICILLIN LA. 600000UNIT/ML 1ML   4 Non-Preferred Drug 45%45%None
BIKTARVY 50-200-25 MG TABLET   5 Specialty Tier 25%25%Q:30
/30Days
BIMATOPROST 0.03% EYE DROPS [Lumigan]   2 Generic $9.00$27.00Q:5
/30Days
BINOSTO 70 MG TABLET EFF   4 Non-Preferred Drug 45%45%Q:4
/28Days
BISOPROLOL FUMARATE 10 MG TAB   2 Generic $9.00$27.00None
BISOPROLOL FUMARATE 5 MG TAB   2 Generic $9.00$27.00None
BISOPROLOL-HCTZ 10-6.25 MG TAB   1 Preferred Generic $4.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BISOPROLOL-HCTZ 2.5-6.25 MG TB   1 Preferred Generic $4.00$12.00None
BISOPROLOL-HCTZ 5-6.25 MG TAB   1 Preferred Generic $4.00$12.00None
BIVIGAM LIQUID 10% VIAL   5 Specialty Tier 25%25%P
BLEPHAMIDE 10-0.2% EYE OINT   4 Non-Preferred Drug 45%45%None
BLEPHAMIDE EYE DROPS   4 Non-Preferred Drug 45%45%None
BLISOVI 24 FE TABLET   2 Generic $9.00$27.00None
BLISOVI FE 1.5-30 TABLET   2 Generic $9.00$27.00None
BOOSTRIX TDAP VACCINE SYRINGE   3 Preferred Brand $40.00$120.00None
BOOSTRIX TDAP VACCINE VIAL   3 Preferred Brand $40.00$120.00None
BOSENTAN 125 MG TABLET [Tracleer]   5 Specialty Tier 25%25%P Q:60
/30Days
BOSENTAN 62.5 MG TABLET [Tracleer]   5 Specialty Tier 25%25%P Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BOSULIF 100 MG TABLET   5 Specialty Tier 25%25%P
BOSULIF 400 MG TABLET   5 Specialty Tier 25%25%P
BOSULIF 500 MG TABLET   5 Specialty Tier 25%25%P
BRAFTOVI 50 MG CAPSULE   5 Specialty Tier 25%25%P
BRAFTOVI 75 MG CAPSULE   5 Specialty Tier 25%25%P
BREO ELLIPTA 100-25 MCG INH   3 Preferred Brand $40.00$120.00Q:60
/30Days
BREO ELLIPTA 200-25 MCG INH   3 Preferred Brand $40.00$120.00Q:60
/30Days
BRIELLYN TABLET   2 Generic $9.00$27.00None
BRILINTA 60 MG TABLET   4 Non-Preferred Drug 45%45%None
BRILINTA 90mg/1 60 TABLET BOTTLE   4 Non-Preferred Drug 45%45%None
BRIMONIDINE 0.2% EYE DROP   2 Generic $9.00$27.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BRIMONIDINE TARTRATE 0.15% DRP   2 Generic $9.00$27.00None
BRIVIACT 10 MG TABLET   5 Specialty Tier 25%25%None
BRIVIACT 10 MG/ML ORAL SOLN   5 Specialty Tier 25%25%None
BRIVIACT 100 MG TABLET   5 Specialty Tier 25%25%None
BRIVIACT 25 MG TABLET   5 Specialty Tier 25%25%None
BRIVIACT 50 MG TABLET   5 Specialty Tier 25%25%None
BRIVIACT 75 MG TABLET   5 Specialty Tier 25%25%None
BROMFENAC SODIUM 0.09% EYE DROPS [Xibrom]   2 Generic $9.00$27.00None
BROMOCRIPTINE 2.5 MG TABLET [Parlodel]   4 Non-Preferred Drug 45%45%None
BROMOCRIPTINE MESYLATE 5MG CAPSULE [Parlodel]   4 Non-Preferred Drug 45%45%None
BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort]   4 Non-Preferred Drug 45%45%P Q:120
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort]   4 Non-Preferred Drug 45%45%P Q:120
/30Days
BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort]   4 Non-Preferred Drug 45%45%P Q:120
/30Days
BUDESONIDE EC 3 MG CAPSULE CAPDR - ER [Entocort EC]   5 Specialty Tier 25%25%None
BUDESONIDE ER 9 MG TABLET DR - ER [UCERIS]   5 Specialty Tier 25%25%None
BUMETANIDE 0.25MG/ML VIAL   2 Generic $9.00$27.00None
BUMETANIDE 0.5 MG TABLET   2 Generic $9.00$27.00None
BUMETANIDE 1 MG TABLET   2 Generic $9.00$27.00None
BUMETANIDE 2 MG TABLET   2 Generic $9.00$27.00None
BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone]   4 Non-Preferred Drug 45%45%Q:60
/30Days
BUPRENORP-NALOX 2-0.5 MG SL FILM [Suboxone]   4 Non-Preferred Drug 45%45%Q:360
/30Days
BUPRENORP-NALOX 4-1 MG SL FILM [Suboxone]   4 Non-Preferred Drug 45%45%Q:180
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUPRENORP-NALOX 8-2 MG SL FILM [Suboxone]   2 Generic $9.00$27.00Q:90
/30Days
BUPRENORPHIN-NALOXON 2-0.5 MG SL [Suboxone]   3 Preferred Brand $40.00$120.00Q:360
/30Days
BUPRENORPHIN-NALOXON 8-2 MG SL [Suboxone]   3 Preferred Brand $40.00$120.00Q:90
/30Days
BUPRENORPHINE 2 MG TABLET Subligual [Subutex]   2 Generic $9.00$27.00None
BUPRENORPHINE 8 MG TABLET Subligual [Subutex]   2 Generic $9.00$27.00None
BUPROPION HCL 100 MG TABLET   2 Generic $9.00$27.00None
BUPROPION HCL 75 MG TABLET   2 Generic $9.00$27.00None
BUPROPION HCL SR 100 MG TABLET   2 Generic $9.00$27.00Q:90
/30Days
BUPROPION HCL SR 150 MG TABLET   2 Generic $9.00$27.00Q:60
/30Days
BUPROPION HCL SR 150 MG TABLET   2 Generic $9.00$27.00Q:90
/30Days
BUPROPION HCL SR 200 MG TABLET   2 Generic $9.00$27.00Q:90
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUPROPION HCL XL 150 MG TABLET   2 Generic $9.00$27.00Q:90
/30Days
BUPROPION HCL XL 300 MG TABLET   2 Generic $9.00$27.00Q:30
/30Days
BUSPIRONE HCL 15 MG TABLET   2 Generic $9.00$27.00None
BUSPIRONE HCL 30 MG TABLET   2 Generic $9.00$27.00None
BUSPIRONE HCL 5 MG TABLET   2 Generic $9.00$27.00None
BUSPIRONE HCL 7.5 MG TABLET   2 Generic $9.00$27.00None
BUSPIRONE HYDROCHLORIDE 10 MG TABLETS   2 Generic $9.00$27.00None
BUTALBITAL-ACETAMINOPHN 50-300 Capsule   4 Non-Preferred Drug 45%45%P
BUTALBITAL-ASA-CAFFEINE CAPSULE   4 Non-Preferred Drug 45%45%P
BUTALBITAL/ACETAMINOPHEN 325; 50mg/1; mg/1 100 TABLET BOTTLE   4 Non-Preferred Drug 45%45%P
BUTALBITAL/ACETAMINOPHEN 50-300 tab   4 Non-Preferred Drug 45%45%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUTORPHANOL 10MG/ML SPRAY   2 Generic $9.00$27.00None
BYDUREON 2 MG PEN INJECT   4 Non-Preferred Drug 45%45%S Q:4
/28Days
BYDUREON BCISE 2 MG AUTOINJECT   4 Non-Preferred Drug 45%45%S Q:3
/28Days
Bystolic 10mg/1 30 TABLET BOTTLE   3 Preferred Brand $40.00$120.00None
Bystolic 2.5mg/1 30 TABLET BOTTLE   3 Preferred Brand $40.00$120.00None
BYSTOLIC 20 MG TABLET   3 Preferred Brand $40.00$120.00None
Bystolic 5mg 30 TABLET BOTTLE   3 Preferred Brand $40.00$120.00None

Chart Legend:

Below are a few notes to help you understand the above 2019 Medicare Part D Farm Bureau Essential Rx (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region). The plan name is followed by the plan type (PDP, HMO, HMO-POS, PPO, PFFS, etc.)

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $415 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have five (5) tiers 1=Preferred Generics, 2=Generics, 3=Preferred Brands, 4=Non-preferred Brands, 5=Specialty Drugs. *Some Part D plans exclude one or more drug tiers from the deductible. If the drug tier field above is followed by * (example: 2*), then this drug tier is excluded from the plan’s deductible.
    • Tier Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $3820) at a "Preferred" network pharmacy. In most cases, the "Preferred" network pharmacy cost-sharing is lower than the standard (non-preferred) network pharmacy cost-sharing.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2019 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.