Welcome to Northrop Grumman - Benefits Online
Welcome to Northrop Grumman - Benefits Online
Welcome to Northrop Grumman - Benefits Online
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Prescription Drug Coverage in the PPO<br />
and EPOs<br />
Your cost varies depending on the type of prescription drug you purchase<br />
Type of Drug<br />
Generic<br />
Network Retail Pharmacy<br />
(30-day supply)<br />
$5 copay or 10% coinsurance,<br />
whichever is greater<br />
Preferred Brand $20 copay or 10%<br />
coinsurance, whichever is<br />
greater<br />
Brand $40 copay or 10%<br />
coinsurance, whichever is<br />
greater<br />
Mail Service Pharmacy<br />
(up <strong>to</strong> 90-day supply)<br />
$5 copay or 10%<br />
coinsurance, whichever<br />
is greater<br />
$20 copay or 10%<br />
coinsurance, whichever<br />
is greater<br />
$40 copay or 10%<br />
coinsurance, whichever<br />
is greater<br />
In the PPO, you can go <strong>to</strong> a non-network pharmacy and pay 50% of the eligible cost. (Non-network<br />
coverage is not available in the EPOs.)<br />
The annual out-of-pocket maximum for prescription drugs is:<br />
• In the PPO – $2,000/individual and $4,000/family<br />
• In the EPOs – $1,500/individual and $3,000/family<br />
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