NORTHROP GRUMMAN GUIDE TO HEALTH NET

NORTHROP GRUMMANGUIDE TO HEALTH NETImportant pharmacy changes effective July 1, 2008

Northrop Grumman Corporation (NGC) has requested benefit design changesto the outpatient prescription drug program that will take effect July 1, 2008.As a Health Net Premier Network EPO plan member, these changes affectyour coverage.

NGC has asked us to give you the details about the changes. We’re providingthis guide now, so that you have plenty of time to understand what’s changingand what to do for continued prescription coverage.

Inside you’ll find:

• Pharmacy Benefit Copayment Overview

• New Generic Substitution Policy

• New Mandatory Mail-order for Maintenance Medications Policy

• Mail-order Q&A

• List of Common Maintenance Medications

Pharmacy guide for Northrop Grumman 1

Pharmacy update

Please read through this guide. If you have any questions, please call Health Net’s dedicatedCustomer Service Contact Center for NGC at 1-800-695-2281. You can also find pharmacycoverage details online at www.healthnet.com/ngc.

2 Pharmacy guide for Northrop Grumman

PHARMACY BENEFIT COPAYMENT OVERVIEW

The outpatient prescription drug benefit that NGC has requested for the Health Net Premier Network EPO,effective July 1, 2008, is as follows:

Retail Pharmacy $5 or 10% – $20 or 10% – $40 or 10% –(up to a 30-day supply) whichever is whichever is whichever is

greater greater greater

Prescriptions by Mail Retail pharmacy Retail pharmacy Retail pharmacy (90-day supply) copay or copay or – copay or

coinsurance – coinsurance – coinsurance –whichever is whichever is whichever is greater greater greater

Annual prescription drug Individual: $1,500 per benefit plan yearout-of-pocket maximum Family: $3,000 per benefit plan year

Mandatory mail order program New provision effective July 1, 20081

for maintenance medications

Generic substitutions New provision effective July 1, 20081

Generic drugs on Health Net

formulary

Brand-namedrugs on

Health Netformulary1

Non-formularydrugs1

Note that the preceding overview provides highlights of benefit information about the NGC Health Plan.Complete details about the plan are contained in the legal plan documents that govern plan operations andadministration. If there is a discrepancy between the information provided above and the provisions of the plan documents, the plan documents will govern.

1Although the prescription drug copayment structure for formulary and non-formulary prescription medications is not changing after July 1, 2008, there are new provisions for mail order prescriptions and generic substitutions. Please refer to the “Generic Substitutions” and “Mandatory Mail-Order forMaintenance Medications” sections in this guide to understand how your out-of-pocket costs may be impacted.


Beginning July 1, 2008, maintenance medicationsmust be filled via Express Scripts, Health Net’sconvenient mail-order service after your third retailfill. A “maintenance medication” is any prescriptiondrug needed to treat a chronic or long-term condition.

With Express Scripts, you can receive up to a three-month (90-day) supply of maintenance medication.

Important: Maintenance prescriptions will not beapproved at a retail pharmacy after the third refill. Youwill have to obtain additional refills from mail order.To avoid refill delays, follow these simple steps:

1. Get a refill now (and no later than June 2008) ifappropriate for your maintenance drug. This willensure you have a supply during the transition tomail-order service.

2. Have your doctor write a 90-day supply for mail-order prior to your third refill of a maintenancemedication.

3. Write your first and last name, member ID number, address, telephone number and the words “Health Net” on the back of theprescription(s).

4. Complete the Health Net mail-order form toestablish your Express Scripts account. We’veincluded a form and pre-paid envelope in thismailing. You can get more forms from our website — www.healthnet.com/ngc or by calling us at 1-800-695-2281.

5. Mail your prescription(s) along with the mail orderform at least two weeks before you’ll need your refill.

Mandatory mail-order for maintenance medications

For your convenience, we’ve included a list ofcommon maintenance medications at the end of this booklet. If you don’t see your medication listedbut take it regularly, please call our Customer Contact Center to find out if it is considered amaintenance medication. Or you can review Health Net’s Maintenance Drug List online atwww.healthnet.com/ngc > My Benefits.

IMPORTANT! If you are an existing

Health Net Member andhave filled a maintenance

medication at least 3 timesprior to July 1, 2008 youmust use mail order for

future refills.


At the request of NGC, the Health Net Premier Network EPO plan also has a newpolicy for generic substitutions effective July 1, 2008.

If a brand-name drug (formulary or non-formulary) is requested when a genericequivalent is available, you pay:

• the applicable brand co-pay; plus

• the price difference between the brand and generic drug.

This policy applies whether the prescribing doctor notes “Dispense As Written,” “Do Not Substitute” or similar words, or you request a brand-name drug.

By using generic drugs, you save money. For example, let’s say you need a formularydrug that retails for $22.47 as generic and $85.50 for the brand-name. You pay:

• $5 for the generic; or

• $83.03 for the brand-name. Your cost equation is: $20 (brand copay) + $63.03[($85.50-$22.47)] for a total of $83.03 — more than 16 times the cost for thegeneric.

The good news is that generic drugs are as safe as brand-name drugs. All generic drugmanufacturing and marketing must be conducted in strict compliance with theguidelines established by the U.S. Food and Drug Administration (FDA). No prescriptiondrug may be sold without FDA approval.

You can find out what generic drugs are on the Health Net formulary by going to our website at www.healthnet.com/ngc. Choose “Recommended Drug List” from theleft-hand navigation bar. We also recommend that you talk to your doctor about thelower-cost alternatives that will be just as effective for you.

GENERIC SUBSTITUTIONS


Mail-order Q & A

Q What drugs can I order through the mail-order program?

A You must use the mail-order program for allmaintenance medication prescriptions. Amaintenance medication is a prescription drugtaken continuously to manage chronic or long-term conditions where the person respondspositively to drug treatment and dosageadjustments are either no longer required ormade infrequently.

Q Do I have to use Express Scripts for mymaintenance medications?

A Yes. Maintenance medications must be filled viamail-order beginning July 1, 2008. Maintenancemedications filled at a retail pharmacy won’t beapproved after three refills, and you’ll beresponsible for the full cost.

If you are a current Health Net Member andhave filled a maintenance medication at least3 times prior to July 1, 2008 you must usemail-order for future refills.

Q What can I do to ensure efficient servicethrough the mail-order program?

A To ensure fast, efficient service please follow the following tips:

1. For current prescriptions: Send onlymaintenance drug prescriptions to mail-order that you have been using for a period of time and will continue to use for a longperiod of time.

Make sure your name, member ID, and thewords “Health Net” are clearly written on theprescription, and that the prescription iswritten for a 90-day supply.

2. For new prescriptions for maintenancedrugs: Ask your physician to write twoprescriptions; the first for a 30-day supplythat you should fill though a retail pharmacy.

The second should be written for a 90-daysupply if your doctor deems this isappropriate. Once you obtain the first scriptyou can mail your second prescription to themail-order vendor before your third refill. The mail service will send your secondprescription as soon as it is eligible forrefilling. (Follow this step each time you have a new prescription.)

Remember — after 3 refills you are required touse mail-order under this plan.

3. Include the Health Net mail-order form withyour prescription. Be sure to complete allsections including those titled, “allergies” and“medical conditions.”

4. Include the correct copayment orcoinsurance. You can pay by check, moneyorder, VISA, MasterCard, Discover orAmerican Express. If paying by credit card,please provide the number, expiration dateand verification code.

5. Allow at least 14 days for delivery.

(continued on next page)

get on-line access at www.express-scripts.com


Q Is there a number I can call to reach Express Scripts?

A Yes. The number to call is 1-866-265-9455 (en Espanol, 1-866-265-9456). You may use thisnumber to order refills, check on the status ofyour order, or ask general mail-order questions.You may also call Customer Service to obtainmail-order envelopes or order forms.

Questions about benefits, eligibility or what iscovered under the pharmacy benefit should bedirected to Health Net at 1-800-695-2281.

Q Can I refill by phone or online?

A Yes. Both options are available with ExpressScripts.

• Telephone: Call 1-866-265-9455 (en Espanol, 1-866-265-9456) and have your credit card handy.

• Online: Go to www.express-scripts.com, click on “Activate your account” and registerfor access to the website.

Note that Express Scripts pharmacists can onlyfill refills authorized by your physician.

Q How will I know if there is a problem with my prescription?

A Express Scripts will call you. If no one is home, they will leave a message for you to call“Express Scripts”. They will not leave any other information to ensure your privacy. You must call Express Scripts at 1-866-265-9455within 48 hours or they will return yourprescription unfilled.


Common maintenance medicationsWhat follows is a list of common maintenance medications. This list may not be complete. Drugs are subject tochange based on Medi-Span, a third party pharmacy database vendor. Drugs may be added or removed at anytime.

If you don’t see your medication listed but take it regularly, please call our Customer Contact Center to find out if it is considered a maintenance medication. Or you can review Health Net’s Maintenance Drug List online atwww.healthnet.com/ngc > My Benefits.

ACTONEL Risedronate sodium 2

ACTOS Pioglitazone 2

ADDERALL XR Amphetamine salt combo 3

ALLOPURINOL ZYLOPRIM 1

ALTACE Ramipril 1

AMIODARONE HCL PACERONE; CORDARONE 1

AMLODIPINE BESYLATE NORVASC 1

AMLODIPINE BESYLATE-BENAZEPRIL LOTREL 1

AMPHETAMINE SALT COMBO ADDERALL 3

ARICEPT Donepezil hydrochloride 2

ARIMIDEX Anastrozole 2

ARMOUR THYROID Thyroid, Dessicated 1

ASACOL Mesalamine 2

ATENOLOL TENORMIN 1

AVANDIA Rosiglitazone 2

AVODART Dutasteride 3

BACLOFEN Lioresal 1

BENAZEPRIL HCL LOTENSIN 1

BENAZEPRIL HCL-HCTZ LOTENSIN HCT 1

BENICAR Olmesartan Medoxomil 2

BENICAR HCT Olmesartan Medoxomil / 2Hydrochlorothiazide

BONIVA Ibandronate sodium 3

CAPTOPRIL CAPOTEN 1

CARBAMAZEPINE TEGRETOL 1

CARBIDOPA-LEVODOPA SINEMET SR 1

CARTIA XT Diltiazem HCl Coated Beads Cap SR 124HR

CARVEDILOL COREG 1

CELEBREX Celecoxib 3

CLONAZEPAM KLONOPIN 1

CLONIDINE HCL CATAPRES 1

CONCERTA METHYLPHENIDATE ER 2

COZAAR Losartan potassium 3

brand name generic name tier


CRESTOR Rosuvastatin calcium 3

CYTOMEL Liothyronine 2

DEPAKOTE Divalproex Sodium 2

DEPAKOTE ER Divalproex sodium tab SR 24 hr 2

DETROL LA Tolterodine tartrate cap SR 24hr 2

DICLOFENAC SODIUM VOLTAREN 1

DIGITEK Digoxin 1

DIGOXIN LANOXIN 1

DILTIAZEM ER DILACOR; CARDIZEM SR 1

DILT-XR Diltiazem hcl cap SR 24hr 1

DIOVAN Valsartan 2

DIOVAN HCT Valsartan / Hydrochlorothiazide 2

DOXAZOSIN MESYLATE CARDURA 1

ENALAPRIL MALEATE VASOTEC 1

ESTRADIOL ESTRACE 1

ETODOLAC LODINE 1

EVISTA Raloxifene 2

FELODIPINE ER PLENDIL 1

FINASTERIDE PROSCAR 1

FLOMAX Tamsulosin 2

FOLIC ACID Folic Acid 1

FOSAMAX Alendronate Sodium 1

FOSAMAX PLUS D Alendronate sodium-cholecalciferol 2

FOSINOPRIL SODIUM MONOPRIL 1

FUROSEMIDE LASIX 1

GABAPENTIN NEURONTIN 1

GEMFIBROZIL LOPID 1

GLIMEPIRIDE AMARYL 1

GLIPIZIDE GLUCOTROL 1

GLIPIZIDE ER GLUCOTROL XL 1

GLYBURIDE MICRONASE 1

GLYBURIDE-METFORMIN HCL GLUCOVANCE 1

HUMALOG Insulin lispro (human) 2

HUMULIN N Insulin isophane (human) 2

HYDROCHLOROTHIAZIDE ESIDREX 1

IBUPROFEN MOTRIN 1

INDOMETHACIN INDOCIN 1

ISOSORBIDE MONONITRATE ISMO 1

JANUVIA Sitagliptin Phosphate 2

KEPPRA Levetiracetam 2

KLOR-CON Potassium Cl 1

KLOR-CON 10 Potassium Cl 1

KLOR-CON M20 Potassium Cl 1



LABETALOL HCL TRANDATE 1

LAMICTAL Lamotrigine 2

LANTUS Insulin glargine 2

LEVOTHROID Levothyroxine 1

LEVOTHYROXINE SODIUM SYNTHROID; LEVOTHROID 1

LEVOXYL Levothyroxine 1

LIPITOR Atorvastatin 3

LISINOPRIL ZESTRIL; PRINIVIL 1

LISINOPRIL-HCTZ ZESTORETIC; PRINIZIDE 1

LOTREL Amlodipine Besylate-Benazepril 1

LOVASTATIN MEVACOR 1

LYRICA Pregabalin 3

MEDROXYPROGESTERONE ACETATE AMEN; PROVERA 1

MELOXICAM MOBIC 1

METFORMIN HCL GLUCOPHAGE 1

METFORMIN HCL ER GLUCOPHAGE ER 1

METOPROLOL SUCCINATE TOPROL XL 1

METOPROLOL TARTRATE LOPRESSOR 1

NABUMETONE RELAFEN 1

NAMENDA Memantine 3

NAPROXEN NAPROSYN 1

NIASPAN Niacin SR 2

NIFEDIAC CC Nifedipine ER 1

NIFEDICAL XL PROCARDIA XL 1

NIFEDIPINE ER ADALAT CC; PROCARDIA XL 1

OXYBUTYNIN CHLORIDE DITROPAN 1

PHENYTOIN SODIUM EXTENDED DILANTIN 1

PLAVIX Clopidogrel bisulfate 2

POTASSIUM CHLORIDE KLOR-CON; MICRO-K 1

PRAVASTATIN SODIUM PRAVACHOL 1

PREMARIN Estrogens, conjugated 2

PREMPRO Conjugated Estrogen- 2Medroxyprogesterone

PROPRANOLOL HCL INDERAL 1

QUINAPRIL HCL ACCUPRIL 1

REQUIP Ropinirole hydrochloride 2

SIMVASTATIN ZOCOR 1

SINGULAIR Montelukast 2

SPIRONOLACTONE ALDACTONE 1

STRATTERA Atomoxetine 3

SYNTHROID Levothyroxine 1

TAMOXIFEN CITRATE NOLVADEX 1

TERAZOSIN HCL HYTRIN 1



TOPAMAX Topiramate 2

TOPROL XL Metoprolol succinate 1

TRIAMTERENE-HCTZ DYAZIDE; MAXZIDE 1

TRICOR Fenofibrate 1

VERAPAMIL HCL CALAN 1

VIVELLE-DOT Estradiol patch 2

VYTORIN Ezetimibe-simvastatin 2

ZETIA Ezetimibe 3


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CA47741 (3/08) Health Net of California, Inc. is a subsidiary of Health Net, Inc. Health Net® is a registered service mark of Health Net, Inc. All rights reserved.

We’re here for youPlease let us know if you have questions. Our team of friendly, knowledgeable customer service staff isstanding by to answer your questions and help youget the most from your health plan benefits.

1-800-695-2281

Telecommunications Device for the Hearing and Speech Impaired:1-800-995-0852

We’re open 8:00 a.m. to 6 p.m., Monday through Friday. Or visit us online anytime atwww.healthnet.com/ngc.

Health NetPost Office Box 9103Van Nuys, California 91409-9103

Health Net of CaliforniaPost Office Box 9103Van Nuys, CA 91409-9103V. RuelasCA 900-02-07

Documents

NORTHROP GRUMMAN GUIDE TO HEALTH NET