pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	mrx_tier_label_list	mrx_tier_benefit_type	mrx_tier_drug_type	mrx_tier_includes	mrx_tier_cstshr_struct_type	mrx_tier_id	mrx_tier_type_id	mrx_tier_locat_rstd	mrx_tier_locat_rsplt	mrx_tier_locat_oon	mrx_tier_locat_mostd	mrx_tier_locat_mosplt	mrx_tier_locat_ltc	mrx_tier_rstd_1m_num	mrx_tier_rstd_2m_num	mrx_tier_rstd_3m_num	mrx_tier_rsplt_1m_num	mrx_tier_rsplt_2m_num	mrx_tier_rsplt_3m_num	mrx_tier_extd_days_yn	mrx_tier_extd_first_fill	mrx_tier_mostd_1m_num	mrx_tier_mostd_2m_num	mrx_tier_mostd_3m_num	mrx_tier_mosplt_1m_num	mrx_tier_mosplt_2m_num	mrx_tier_mosplt_3m_num	mrx_tier_oonp_1m_num	mrx_tier_oonp_othnumn	mrx_tier_ltcp_1m	mrx_tier_rstd_copay_1m	mrx_tier_rstd_copay_2m	mrx_tier_rstd_copay_3m	mrx_tier_rstd_coins_avg_1m	mrx_tier_rstd_coins_1m	mrx_tier_rstd_coins_2m	mrx_tier_rstd_coins_3m	mrx_tier_rsstd_copay_1m	mrx_tier_rsstd_copay_2m	mrx_tier_rsstd_copay_3m	mrx_tier_rsstd_coins_avg_1m	mrx_tier_rsstd_coins_1m	mrx_tier_rsstd_coins_2m	mrx_tier_rsstd_coins_3m	mrx_tier_rspfd_copay_1m	mrx_tier_rspfd_copay_2m	mrx_tier_rspfd_copay_3m	mrx_tier_rspfd_coins_avg_1m	mrx_tier_rspfd_coins_1m	mrx_tier_rspfd_coins_2m	mrx_tier_rspfd_coins_3m	mrx_tier_mostd_copay_1m	mrx_tier_mostd_copay_2m	mrx_tier_mostd_copay_3m	mrx_tier_mostd_coins_1m	mrx_tier_mostd_coins_2m	mrx_tier_mostd_coins_3m	mrx_tier_mosstd_copay_1m	mrx_tier_mosstd_copay_2m	mrx_tier_mosstd_copay_3m	mrx_tier_mosstd_coins_1m	mrx_tier_mosstd_coins_2m	mrx_tier_mosstd_coins_3m	mrx_tier_mospfd_copay_1m	mrx_tier_mospfd_copay_2m	mrx_tier_mospfd_copay_3m	mrx_tier_mospfd_coins_1m	mrx_tier_mospfd_coins_2m	mrx_tier_mospfd_coins_3m	mrx_tier_oonp_copay_1m	mrx_tier_oonp_copay_othnum	mrx_tier_oonp_coins_1m	mrx_tier_oonp_coins_othnum	mrx_tier_ltcp_copay_1m	mrx_tier_ltcp_coins_1m	mrx_tier_rstd_copay_daily	mrx_tier_rsstd_copay_daily	mrx_tier_rspfd_copay_daily	mrx_tier_mostd_copay_daily	mrx_tier_mosstd_copay_daily	mrx_tier_mospfd_copay_daily	mrx_tier_ltcp_copay_daily	mrx_tier_nds_includes	mrx_tier_form_model_desc	mrx_tier_includes_mmp	mrx_tier_nds_includes_mmp	mrx_tier_copay_amt_rstd_mmpmin	mrx_tier_copay_amt_rstd_mmpmax	mrx_tier_copay_amt_oon_mmpmin	mrx_tier_copay_amt_oon_mmpmax	mrx_tier_copay_amt_mstd_mmpmin	mrx_tier_copay_amt_mstd_mmpmax	mrx_tier_copay_amt_ltc_mmpmin	mrx_tier_copay_amt_ltc_mmpmax	mrx_tier_gap_cost_share	mrx_tier_gap_part_drugs	mrx_tier_gap_part_includes
H0022	001	0	1	48	05	H0022_001_0	3	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0022	001	0	1	48	05	H0022_001_0	3	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0022	001	0	1	48	05	H0022_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0028	004	0	1	01	01	H0028_004_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	004	0	1	01	01	H0028_004_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	004	0	1	01	01	H0028_004_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	004	0	1	01	01	H0028_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	004	0	1	01	01	H0028_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	007	0	1	01	01	H0028_007_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	007	0	1	01	01	H0028_007_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	007	0	1	01	01	H0028_007_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	007	0	1	01	01	H0028_007_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	007	0	1	01	01	H0028_007_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	008	1	1	01	01	H0028_008_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	008	1	1	01	01	H0028_008_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	008	1	1	01	01	H0028_008_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	008	1	1	01	01	H0028_008_1	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				68.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	008	1	1	01	01	H0028_008_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	008	2	1	01	01	H0028_008_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	008	2	1	01	01	H0028_008_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	008	2	1	01	01	H0028_008_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	008	2	1	01	01	H0028_008_2	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				68.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	008	2	1	01	01	H0028_008_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	009	0	1	01	01	H0028_009_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	009	0	1	01	01	H0028_009_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	009	0	1	01	01	H0028_009_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	009	0	1	01	01	H0028_009_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0028	009	0	1	01	01	H0028_009_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0029	001	0	1	01	01	H0029_001_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0029	001	0	1	01	01	H0029_001_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	45.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0029	001	0	1	01	01	H0029_001_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0029	001	0	1	01	01	H0029_001_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0029	001	0	1	01	01	H0029_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0029	001	0	1	01	01	H0029_001_0	3	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0029	004	0	1	01	01	H0029_004_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0029	004	0	1	01	01	H0029_004_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	45.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0029	004	0	1	01	01	H0029_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0029	004	0	1	01	01	H0029_004_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0029	004	0	1	01	01	H0029_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0029	004	0	1	01	01	H0029_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	001	0	1	01	01	H0062_001_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	001	0	1	01	01	H0062_001_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	001	0	1	01	01	H0062_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	001	0	1	01	01	H0062_001_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	001	0	1	01	01	H0062_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	001	0	1	01	01	H0062_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	002	0	1	01	01	H0062_002_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	002	0	1	01	01	H0062_002_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	002	0	1	01	01	H0062_002_0	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	002	0	1	01	01	H0062_002_0	3	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	002	0	1	01	01	H0062_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	002	0	1	01	01	H0062_002_0	3	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	003	0	1	01	01	H0062_003_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	003	0	1	01	01	H0062_003_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	003	0	1	01	01	H0062_003_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	37.00	74.00	111.00																			37.00	74.00	111.00																37.00				37.00		1.23			1.23			1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	003	0	1	01	01	H0062_003_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	003	0	1	01	01	H0062_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	003	0	1	01	01	H0062_003_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	004	0	1	01	01	H0062_004_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	1.00	2.00	3.00																			1.00	2.00	3.00																1.00				1.00		0.03			0.03			0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	004	0	1	01	01	H0062_004_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	004	0	1	01	01	H0062_004_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	004	0	1	01	01	H0062_004_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	004	0	1	01	01	H0062_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	004	0	1	01	01	H0062_004_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	005	0	1	01	01	H0062_005_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	005	0	1	01	01	H0062_005_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	005	0	1	01	01	H0062_005_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	005	0	1	01	01	H0062_005_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	005	0	1	01	01	H0062_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0062	005	0	1	01	01	H0062_005_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0088	001	0	1	04	01	H0088_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0088	001	0	1	04	01	H0088_001_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0088	001	0	1	04	01	H0088_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0088	001	0	1	04	01	H0088_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				72.28	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0088	001	0	1	04	01	H0088_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				782.47	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0104	012	0	1	04	01	H0104_012_0	6	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		12.00					4.00		8.00					4.00		8.00																4.00				4.00			0.13	0.13	0.13			0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	012	0	1	04	01	H0104_012_0	6	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					20.00		40.00					20.00		40.00																20.00				20.00			0.66	0.66	0.66			0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	012	0	1	04	01	H0104_012_0	6	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					47.00		94.00					47.00		94.00																47.00				47.00			1.56	1.56	1.56			1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	012	0	1	04	01	H0104_012_0	6	Non-Preferred Brand	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											62.57	50		50				62.57	50		50				50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	012	0	1	04	01	H0104_012_0	6	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	012	0	1	04	01	H0104_012_0	6	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								2.00		6.00					2.00		4.00					2.00		4.00																2.00				2.00			0.06	0.06	0.06			.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	014	0	1	04	01	H0104_014_0	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		12.00					4.00		8.00					4.00		8.00																4.00				4.00			0.13	0.13	0.13			0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	014	0	1	04	01	H0104_014_0	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					20.00		40.00					20.00		40.00																20.00				20.00			0.66	0.66	0.66			0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	014	0	1	04	01	H0104_014_0	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					47.00		94.00					47.00		94.00																47.00				47.00			1.56	1.56	1.56			1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	014	0	1	04	01	H0104_014_0	7	Non-Preferred Brand	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											63.22	50		50				63.22	50		50				50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	014	0	1	04	01	H0104_014_0	7	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	014	0	1	04	01	H0104_014_0	7	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								2.00		6.00					2.00		4.00					2.00		4.00																2.00				2.00			0.06	0.06	0.06			.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	015	0	1	04	01	H0104_015_0	4	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		12.00					4.00		8.00					4.00		8.00																4.00				4.00			0.13	0.13	0.13			0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	015	0	1	04	01	H0104_015_0	4	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								12.00		36.00					12.00		24.00					12.00		24.00																12.00				12.00			0.40	0.40	0.40			0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	015	0	1	04	01	H0104_015_0	4	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					47.00		94.00					47.00		94.00																47.00				47.00			1.56	1.56	1.56			1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	015	0	1	04	01	H0104_015_0	4	Non-Preferred Brand	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											61.04	50		50				61.04	50		50				50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	015	0	1	04	01	H0104_015_0	4	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0104	015	0	1	04	01	H0104_015_0	4	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								2.00		6.00					2.00		4.00					2.00		4.00																2.00				2.00			0.06	0.06	0.06			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0107	003	0	1	04	01	H0107_003_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0107	003	0	1	04	01	H0107_003_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H0107	003	0	1	04	01	H0107_003_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0107	003	0	1	04	01	H0107_003_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H0107	003	0	1	04	01	H0107_003_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0107	003	0	1	04	01	H0107_003_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0107	003	0	1	04	01	H0107_003_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											640.73	25		25				669.99	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0107	004	0	1	04	01	H0107_004_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0107	004	0	1	04	01	H0107_004_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H0107	004	0	1	04	01	H0107_004_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0107	004	0	1	04	01	H0107_004_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H0107	004	0	1	04	01	H0107_004_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0107	004	0	1	04	01	H0107_004_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0107	004	0	1	04	01	H0107_004_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											653.94	25		25				671.50	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0111	001	0	1	04	01	H0111_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0111	001	0	1	04	01	H0111_001_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0111	001	0	1	04	01	H0111_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0111	001	0	1	04	01	H0111_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				58.02	45		45																								45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0111	001	0	1	04	01	H0111_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				567.79	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0111	002	0	1	04	01	H0111_002_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0111	002	0	1	04	01	H0111_002_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0111	002	0	1	04	01	H0111_002_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0111	002	0	1	04	01	H0111_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				57.85	45		45																								45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0111	002	0	1	04	01	H0111_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				749.62	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0137	001	0	1	48	05	H0137_001_0	4	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																						Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs	3	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	4	Preferred Brand Drugs	4	10			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																						Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs	3	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	4	Non-Preferred Brand Drugs	4	10			3	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																						Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs	3	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0148	001	0	1	48	05	H0148_001_0	6	Generic Drugs	4	01			1	1	110		10	100		1	30		90				2	2			90					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	3.35					0.00	3.35			
H0148	001	0	1	48	05	H0148_001_0	6	Brand Drugs	4	10			2	1	110		10	100		1	30		90				2	2			90					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	8.35					0.00	8.35			
H0148	001	0	1	48	05	H0148_001_0	6	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		10			1	30															10	31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H0148	002	0	1	48	05	H0148_002_0	6	Generic Drugs	4	01			1	1	110		10	100		1	30		90				2	2			90					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	3.35					0.00	3.35			
H0148	002	0	1	48	05	H0148_002_0	6	Brand Drugs	4	10			2	1	110		10	100		1	30		90				2	2			90					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	8.35					0.00	8.35			
H0148	002	0	1	48	05	H0148_002_0	6	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		10			1	30															10	31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H0150	024	1	1	01	01	H0150_024_1	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00	12.00	6.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0150	024	1	1	01	01	H0150_024_1	4	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00	12.00	6.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0150	024	1	1	01	01	H0150_024_1	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	12.00					7.00	14.00	7.00					12.00	24.00	12.00																12.00				12.00			0.40	0.23	0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0150	024	1	1	01	01	H0150_024_1	4	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	12.00					7.00	14.00	7.00					12.00	24.00	12.00																12.00				12.00			0.40	0.23	0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0150	024	1	1	01	01	H0150_024_1	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	135.00																45.00				45.00			1.50	1.33	1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0150	024	1	1	01	01	H0150_024_1	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											69.07	50	50	50				66.15	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0150	024	1	1	01	01	H0150_024_1	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											340.90	29						346.07	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0150	024	2	1	01	01	H0150_024_2	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00	12.00	6.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0150	024	2	1	01	01	H0150_024_2	4	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00	12.00	6.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0150	024	2	1	01	01	H0150_024_2	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	12.00					7.00	14.00	7.00					12.00	24.00	12.00																12.00				12.00			0.40	0.23	0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0150	024	2	1	01	01	H0150_024_2	4	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	12.00					7.00	14.00	7.00					12.00	24.00	12.00																12.00				12.00			0.40	0.23	0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0150	024	2	1	01	01	H0150_024_2	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	135.00																45.00				45.00			1.50	1.33	1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0150	024	2	1	01	01	H0150_024_2	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											69.07	50	50	50				66.15	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0150	024	2	1	01	01	H0150_024_2	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											340.90	29						346.07	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	011	0	1	01	01	H0154_011_0	10	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	011	0	1	01	01	H0154_011_0	10	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0154	011	0	1	01	01	H0154_011_0	10	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					12.00	24.00	36.00											12.00	24.00	36.00				10.00	20.00	24.00				12.00				12.00			0.40	0.40		0.40	0.33	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	011	0	1	01	01	H0154_011_0	10	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				39.50	78.50	94.00				47.00				47.00			1.57	1.57		1.57	1.32	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	011	0	1	01	01	H0154_011_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											68.17	50	50	50				68.17	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	011	0	1	01	01	H0154_011_0	10	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	012	0	1	01	01	H0154_012_0	10	Preferred Generic	3	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	012	0	1	01	01	H0154_012_0	10	Generic	3	01	1	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	012	0	1	01	01	H0154_012_0	10	Preferred Brand	3	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	012	0	1	01	01	H0154_012_0	10	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	012	0	1	01	01	H0154_012_0	10	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	014	0	1	01	01	H0154_014_0	11	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	014	0	1	01	01	H0154_014_0	11	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					12.00	24.00	36.00											12.00	24.00	36.00				10.00	20.00	24.00				12.00				12.00			0.40	0.40		0.40	0.33	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	014	0	1	01	01	H0154_014_0	11	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				39.50	78.50	94.00				47.00				47.00			1.57	1.57		1.57	1.32	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	014	0	1	01	01	H0154_014_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											59.15	50	50	50				59.15	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	014	0	1	01	01	H0154_014_0	11	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	015	1	1	01	01	H0154_015_1	11	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	015	1	1	01	01	H0154_015_1	11	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					15.00	30.00	45.00											15.00	30.00	45.00				12.50	25.00	30.00				15.00				15.00			0.50	0.50		0.50	0.42	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	015	1	1	01	01	H0154_015_1	11	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				39.50	78.50	94.00				47.00				47.00			1.57	1.57		1.57	1.32	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	015	1	1	01	01	H0154_015_1	11	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											79.40	50	50	50				79.40	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	015	1	1	01	01	H0154_015_1	11	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	29						1.00	29																							29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	015	2	1	01	01	H0154_015_2	11	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	015	2	1	01	01	H0154_015_2	11	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					15.00	30.00	45.00											15.00	30.00	45.00				12.50	25.00	30.00				15.00				15.00			0.50	0.50		0.50	0.42	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	015	2	1	01	01	H0154_015_2	11	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				39.50	78.50	94.00				47.00				47.00			1.57	1.57		1.57	1.32	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	015	2	1	01	01	H0154_015_2	11	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											79.40	50	50	50				79.40	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0154	015	2	1	01	01	H0154_015_2	11	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	29						1.00	29																							29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0192	001	0	1	48	05	H0192_001_0	4	Generic Drugs	4	01			1	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0192	001	0	1	48	05	H0192_001_0	4	Brand Drugs	4	10			2	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0192	001	0	1	48	05	H0192_001_0	4	Non-Medicare Rx/OTC Drugs	4	10			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0281	001	0	1	48	05	H0281_001_0	3	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0281	001	0	1	48	05	H0281_001_0	3	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0281	001	0	1	48	05	H0281_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0294	002	0	1	04	01	H0294_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	002	0	1	04	01	H0294_002_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	002	0	1	04	01	H0294_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	002	0	1	04	01	H0294_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	002	0	1	04	01	H0294_002_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1123.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	004	0	1	04	01	H0294_004_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	004	0	1	04	01	H0294_004_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	004	0	1	04	01	H0294_004_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	004	0	1	04	01	H0294_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	004	0	1	04	01	H0294_004_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				553.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	010	0	1	04	01	H0294_010_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	010	0	1	04	01	H0294_010_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	010	0	1	04	01	H0294_010_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	010	0	1	04	01	H0294_010_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	010	0	1	04	01	H0294_010_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				926.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	011	0	1	04	01	H0294_011_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	011	0	1	04	01	H0294_011_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	011	0	1	04	01	H0294_011_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	011	0	1	04	01	H0294_011_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	011	0	1	04	01	H0294_011_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				538.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	012	0	1	04	01	H0294_012_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	012	0	1	04	01	H0294_012_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	012	0	1	04	01	H0294_012_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	012	0	1	04	01	H0294_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0294	012	0	1	04	01	H0294_012_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				628.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0302	001	0	1	01	01	H0302_001_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	001	0	1	01	01	H0302_001_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	001	0	1	01	01	H0302_001_0	8	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					120.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	001	0	1	01	01	H0302_001_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	001	0	1	01	01	H0302_001_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					31																																					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	006	0	1	01	01	H0302_006_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	006	0	1	01	01	H0302_006_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					45.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	006	0	1	01	01	H0302_006_0	8	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	006	0	1	01	01	H0302_006_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	006	0	1	01	01	H0302_006_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					29																																					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	008	0	1	01	01	H0302_008_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	008	0	1	01	01	H0302_008_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					45.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	008	0	1	01	01	H0302_008_0	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	008	0	1	01	01	H0302_008_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0302	008	0	1	01	01	H0302_008_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					29																																					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0332	002	0	1	01	01	H0332_002_0	6	Preferred Generic	4	01	1	2	1	1		110	01			1				30		90	1	2							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0332	002	0	1	01	01	H0332_002_0	6	Preferred Generic	4	01	1	2	1	3		110	01			1				30		90	1	2							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H0332	002	0	1	01	01	H0332_002_0	6	Generic	4	01	1	2	2	1		110	01			1				30		90	1	2							30		31								20.00		60.00					17.00		42.50																							20.00				20.00			0.67	0.57				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0332	002	0	1	01	01	H0332_002_0	6	Preferred Brand	4	10	1	2	3	1		110	01			1				30		90	1	2							30		31								45.00		135.00					40.00		100.00																							45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0332	002	0	1	01	01	H0332_002_0	6	Non-Preferred Brand	4	10	1	2	4	1		110	01			1				30		90	1	2							30		31								70.00		210.00					60.00		150.00																							70.00				70.00			2.33	2.00				2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0332	002	0	1	01	01	H0332_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31												32							32																							32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0332	004	0	1	02	01	H0332_004_0	5	Preferred Generic	4	01	1	2	1	1		110	01			1				30		90	1	2							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0332	004	0	1	02	01	H0332_004_0	5	Preferred Generic	4	01	1	2	1	3		110	01			1				30		90	1	2							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H0332	004	0	1	02	01	H0332_004_0	5	Generic	4	01	1	2	2	1		110	01			1				30		90	1	2							30		31								20.00		60.00					17.00		42.50																							20.00				20.00			0.67	0.57				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0332	004	0	1	02	01	H0332_004_0	5	Preferred Brand	4	10	1	2	3	1		110	01			1				30		90	1	2							30		31								45.00		135.00					40.00		100.00																							45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0332	004	0	1	02	01	H0332_004_0	5	Non-Preferred Brand	4	10	1	2	4	1		110	01			1				30		90	1	2							30		31								70.00		210.00					60.00		150.00																							70.00				70.00			2.33	2.00				2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0332	004	0	1	02	01	H0332_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31												32							32																							32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0336	001	0	1	48	05	H0336_001_0	5	Generic Drugs	4	01			1	1	110		01	110		1	30		90				2	2	30		90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0336	001	0	1	48	05	H0336_001_0	5	Brand Drugs	4	10			2	1	110		01	110		1	30		90				2	2	30		90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0336	001	0	1	48	05	H0336_001_0	5	Non-Medicare Rx Drugs	4	11			3	1	110		01	110		1	30		90				1	2	30		90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0336	001	0	1	48	05	H0336_001_0	5	Non-Medicare OTC Drugs	4	11			4	1	110		01	110		1	30		90				1	2	30		90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0351	038	0	1	01	01	H0351_038_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	12.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	038	0	1	01	01	H0351_038_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	42.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	038	0	1	01	01	H0351_038_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	038	0	1	01	01	H0351_038_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	038	0	1	01	01	H0351_038_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	038	0	1	01	01	H0351_038_0	5	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	041	0	1	01	01	H0351_041_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	041	0	1	01	01	H0351_041_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	33.00																17.00				17.00			0.57	0.40	0.40			0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	041	0	1	01	01	H0351_041_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	041	0	1	01	01	H0351_041_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	041	0	1	01	01	H0351_041_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	041	0	1	01	01	H0351_041_0	4	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	042	0	1	01	01	H0351_042_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	12.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	042	0	1	01	01	H0351_042_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	42.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	042	0	1	01	01	H0351_042_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	042	0	1	01	01	H0351_042_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	042	0	1	01	01	H0351_042_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	042	0	1	01	01	H0351_042_0	4	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	1	1	01	01	H0351_043_1	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	1	1	01	01	H0351_043_1	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	42.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	1	1	01	01	H0351_043_1	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	1	1	01	01	H0351_043_1	5	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	1	1	01	01	H0351_043_1	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	1	1	01	01	H0351_043_1	5	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	4	1	01	01	H0351_043_4	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	4	1	01	01	H0351_043_4	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	42.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	4	1	01	01	H0351_043_4	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	4	1	01	01	H0351_043_4	5	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	4	1	01	01	H0351_043_4	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	043	4	1	01	01	H0351_043_4	5	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	1	1	01	01	H0351_044_1	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	1	1	01	01	H0351_044_1	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	42.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	1	1	01	01	H0351_044_1	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	1	1	01	01	H0351_044_1	4	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	1	1	01	01	H0351_044_1	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	1	1	01	01	H0351_044_1	4	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	2	1	01	01	H0351_044_2	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	2	1	01	01	H0351_044_2	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	42.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	2	1	01	01	H0351_044_2	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	2	1	01	01	H0351_044_2	6	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	2	1	01	01	H0351_044_2	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	2	1	01	01	H0351_044_2	6	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	3	1	01	01	H0351_044_3	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	3	1	01	01	H0351_044_3	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	42.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	3	1	01	01	H0351_044_3	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	3	1	01	01	H0351_044_3	4	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	3	1	01	01	H0351_044_3	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	044	3	1	01	01	H0351_044_3	4	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	1	1	01	01	H0351_049_1	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	12.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	1	1	01	01	H0351_049_1	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	42.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	1	1	01	01	H0351_049_1	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	1	1	01	01	H0351_049_1	5	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	1	1	01	01	H0351_049_1	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	1	1	01	01	H0351_049_1	5	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	2	1	01	01	H0351_049_2	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	12.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	2	1	01	01	H0351_049_2	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	42.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	2	1	01	01	H0351_049_2	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	2	1	01	01	H0351_049_2	5	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	2	1	01	01	H0351_049_2	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0351	049	2	1	01	01	H0351_049_2	5	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0354	001	0	1	01	01	H0354_001_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	5.00					7.00	14.00	21.00																7.00				7.00			0.23	0.07	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	001	0	1	01	01	H0354_001_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	25.00					15.00	30.00	45.00																15.00				15.00			0.50	0.33	0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	001	0	1	01	01	H0354_001_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	001	0	1	01	01	H0354_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	300.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	001	0	1	01	01	H0354_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											585.61	29						393.44	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	024	0	1	01	01	H0354_024_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	5.00					7.00	14.00	21.00																7.00				7.00			0.23	0.07	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	024	0	1	01	01	H0354_024_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	25.00					15.00	30.00	45.00																15.00				15.00			0.50	0.33	0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	024	0	1	01	01	H0354_024_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	024	0	1	01	01	H0354_024_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	300.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	024	0	1	01	01	H0354_024_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											963.95	33						606.61	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	027	0	1	01	01	H0354_027_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	5.00					7.00	14.00	21.00																7.00				7.00			0.23	0.07	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	027	0	1	01	01	H0354_027_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	25.00					15.00	30.00	45.00																15.00				15.00			0.50	0.33	0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	027	0	1	01	01	H0354_027_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	027	0	1	01	01	H0354_027_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	300.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0354	027	0	1	01	01	H0354_027_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											518.42	29						320.85	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	001	0	1	01	01	H0432_001_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	001	0	1	01	01	H0432_001_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	001	0	1	01	01	H0432_001_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	001	0	1	01	01	H0432_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	001	0	1	01	01	H0432_001_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				773.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	002	0	1	01	01	H0432_002_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	002	0	1	01	01	H0432_002_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	002	0	1	01	01	H0432_002_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	002	0	1	01	01	H0432_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	002	0	1	01	01	H0432_002_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				790.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	003	0	1	01	01	H0432_003_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	003	0	1	01	01	H0432_003_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	003	0	1	01	01	H0432_003_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	003	0	1	01	01	H0432_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	003	0	1	01	01	H0432_003_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				780.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	004	0	1	01	01	H0432_004_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	004	0	1	01	01	H0432_004_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	004	0	1	01	01	H0432_004_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	004	0	1	01	01	H0432_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	004	0	1	01	01	H0432_004_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				790.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	005	0	1	01	01	H0432_005_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	005	0	1	01	01	H0432_005_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	005	0	1	01	01	H0432_005_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	005	0	1	01	01	H0432_005_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	005	0	1	01	01	H0432_005_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				780.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	006	0	1	01	01	H0432_006_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	006	0	1	01	01	H0432_006_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	006	0	1	01	01	H0432_006_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	006	0	1	01	01	H0432_006_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	006	0	1	01	01	H0432_006_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				790.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	007	0	1	01	01	H0432_007_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	007	0	1	01	01	H0432_007_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	007	0	1	01	01	H0432_007_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	007	0	1	01	01	H0432_007_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	007	0	1	01	01	H0432_007_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				780.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	008	0	1	01	01	H0432_008_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	008	0	1	01	01	H0432_008_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	008	0	1	01	01	H0432_008_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	008	0	1	01	01	H0432_008_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0432	008	0	1	01	01	H0432_008_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				790.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0439	003	1	1	01	01	H0439_003_1	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					10.00	20.00	20.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0439	003	1	1	01	01	H0439_003_1	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	38.00					12.00	24.00	24.00					19.00	38.00	38.00																19.00				19.00			0.63	0.40	0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0439	003	1	1	01	01	H0439_003_1	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0439	003	1	1	01	01	H0439_003_1	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											66.92	50	50	50				61.33	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0439	003	1	1	01	01	H0439_003_1	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											357.55	27						335.17	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0439	003	2	1	01	01	H0439_003_2	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					10.00	20.00	20.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0439	003	2	1	01	01	H0439_003_2	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	38.00					12.00	24.00	24.00					19.00	38.00	38.00																19.00				19.00			0.63	0.40	0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0439	003	2	1	01	01	H0439_003_2	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0439	003	2	1	01	01	H0439_003_2	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											66.92	50	50	50				61.33	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0439	003	2	1	01	01	H0439_003_2	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											357.55	27						335.17	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0480	001	0	1	48	05	H0480_001_0	5	Generic Drugs	4	01			1	1	110		01	100		1	30		90				2	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0480	001	0	1	48	05	H0480_001_0	5	Brand Drugs	4	10			2	1	110		01	100		1	30		90				2	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0480	001	0	1	48	05	H0480_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01	100		1	30		90				1	1			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0490	004	0	1	01	01	H0490_004_0	5	Preferred Generic	3	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0490	004	0	1	01	01	H0490_004_0	5	Generic	3	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0490	004	0	1	01	01	H0490_004_0	5	Preferred Brand	3	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	41.00	82.00	123.00																			41.00	82.00	123.00																41.00				41.00		1.32			1.32			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0490	004	0	1	01	01	H0490_004_0	5	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				63.31	38	38	38																		38	38	38															38			38									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0490	004	0	1	01	01	H0490_004_0	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0504	015	0	1	01	01	H0504_015_0	3	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	015	0	1	01	01	H0504_015_0	3	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier											1		
H0504	015	0	1	01	01	H0504_015_0	3	Generic	4	11	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	36.00					5.00	10.00	7.50							7.50																12.00				12.00			0.40	0.17				0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	015	0	1	01	01	H0504_015_0	3	Generic	4	11	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	36.00					5.00	10.00	7.50							7.50																12.00				12.00			0.40	0.17				0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier											1		
H0504	015	0	1	01	01	H0504_015_0	3	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	015	0	1	01	01	H0504_015_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	015	0	1	01	01	H0504_015_0	3	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											99.80	30	30	30				99.80	30	30	30						30															30			30								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	015	0	1	01	01	H0504_015_0	3	Specialty Tier	4	11	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	017	0	1	01	01	H0504_017_0	3	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	017	0	1	01	01	H0504_017_0	3	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier											1		
H0504	017	0	1	01	01	H0504_017_0	3	Generic	4	11	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	017	0	1	01	01	H0504_017_0	3	Generic	4	11	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier											1		
H0504	017	0	1	01	01	H0504_017_0	3	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	017	0	1	01	01	H0504_017_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	017	0	1	01	01	H0504_017_0	3	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											99.52	33	33	33				99.52	33	33	33						33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	017	0	1	01	01	H0504_017_0	3	Specialty Tier	4	11	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	021	0	1	01	01	H0504_021_0	3	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	4.50							4.50																8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	021	0	1	01	01	H0504_021_0	3	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	4.50							4.50																8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier											1		
H0504	021	0	1	01	01	H0504_021_0	3	Generic	4	11	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	021	0	1	01	01	H0504_021_0	3	Generic	4	11	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier											1		
H0504	021	0	1	01	01	H0504_021_0	3	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	021	0	1	01	01	H0504_021_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	021	0	1	01	01	H0504_021_0	3	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											98.11	31	31	31				98.11	31	31	31						31															31			31								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	021	0	1	01	01	H0504_021_0	3	Specialty Tier	4	11	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H0504	026	0	1	01	01	H0504_026_0	4	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	4.50							4.50																8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	026	0	1	01	01	H0504_026_0	4	Generic	4	11	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	026	0	1	01	01	H0504_026_0	4	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	026	0	1	01	01	H0504_026_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	026	0	1	01	01	H0504_026_0	4	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											97.78	29	29	29				97.78	29	29	29						29															29			29								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	026	0	1	01	01	H0504_026_0	4	Specialty Tier	4	11	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	028	0	1	01	01	H0504_028_0	4	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	4.50							4.50																8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	028	0	1	01	01	H0504_028_0	4	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	4.50							4.50																8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier											1		
H0504	028	0	1	01	01	H0504_028_0	4	Generic	4	11	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	028	0	1	01	01	H0504_028_0	4	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	028	0	1	01	01	H0504_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	028	0	1	01	01	H0504_028_0	4	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											99.24	33	33	33				99.24	33	33	33						33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	028	0	1	01	01	H0504_028_0	4	Specialty Tier	4	11	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	029	0	1	01	01	H0504_029_0	4	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					5.00	10.00	7.50							7.50																10.00				10.00			0.33	0.17				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	029	0	1	01	01	H0504_029_0	4	Generic	4	11	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	029	0	1	01	01	H0504_029_0	4	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	029	0	1	01	01	H0504_029_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	029	0	1	01	01	H0504_029_0	4	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											99.97	30	30	30				99.97	30	30	30						30															30			30								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	029	0	1	01	01	H0504_029_0	4	Specialty Tier	4	11	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	031	0	1	01	01	H0504_031_0	4	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					5.00	10.00	7.50							7.50																10.00				10.00			0.33	0.17				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	031	0	1	01	01	H0504_031_0	4	Generic	4	11	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					12.00	24.00	18.00							18.00																20.00				20.00			0.67	0.40				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	031	0	1	01	01	H0504_031_0	4	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	031	0	1	01	01	H0504_031_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	031	0	1	01	01	H0504_031_0	4	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											97.94	27	27	27				97.94	27	27	27						27															27			27								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	031	0	1	01	01	H0504_031_0	4	Specialty Tier	4	11	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	037	0	1	01	01	H0504_037_0	4	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	4.50							4.50																8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	037	0	1	01	01	H0504_037_0	4	Generic	4	11	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					12.00	24.00	18.00							18.00																20.00				20.00			0.67	0.40				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	037	0	1	01	01	H0504_037_0	4	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	037	0	1	01	01	H0504_037_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	037	0	1	01	01	H0504_037_0	4	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											82.71	30	30	30				82.71	30	30	30						30															30			30								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	037	0	1	01	01	H0504_037_0	4	Specialty Tier	4	11	1	1	6	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	038	0	1	01	01	H0504_038_0	4	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					5.00	10.00	7.50							7.50																10.00				10.00			0.33	0.17				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	038	0	1	01	01	H0504_038_0	4	Generic	4	11	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					15.00	30.00	22.50							22.50																20.00				20.00			0.67	0.50				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	038	0	1	01	01	H0504_038_0	4	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	038	0	1	01	01	H0504_038_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	038	0	1	01	01	H0504_038_0	4	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											84.49	33	33	33				84.49	33	33	33						33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	038	0	1	01	01	H0504_038_0	4	Specialty Tier	4	11	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	039	0	1	01	01	H0504_039_0	5	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					5.00	10.00	7.50							7.50																10.00				10.00			0.33	0.17				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	039	0	1	01	01	H0504_039_0	5	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					5.00	10.00	7.50							7.50																10.00				10.00			0.33	0.17				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier											1		
H0504	039	0	1	01	01	H0504_039_0	5	Generic	4	11	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					15.00	30.00	22.50							22.50																20.00				20.00			0.67	0.50				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	039	0	1	01	01	H0504_039_0	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	039	0	1	01	01	H0504_039_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	039	0	1	01	01	H0504_039_0	5	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											89.34	33	33	33				89.34	33	33	33						33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0504	039	0	1	01	01	H0504_039_0	5	Specialty Tier	4	11	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
H0523	002	0	1	01	01	H0523_002_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	002	0	1	01	01	H0523_002_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	002	0	1	01	01	H0523_002_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	002	0	1	01	01	H0523_002_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	002	0	1	01	01	H0523_002_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	002	0	1	01	01	H0523_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	002	0	1	01	01	H0523_002_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	022	0	1	01	01	H0523_022_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	022	0	1	01	01	H0523_022_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	022	0	1	01	01	H0523_022_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	022	0	1	01	01	H0523_022_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	022	0	1	01	01	H0523_022_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	022	0	1	01	01	H0523_022_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	022	0	1	01	01	H0523_022_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	031	0	1	01	01	H0523_031_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	031	0	1	01	01	H0523_031_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	031	0	1	01	01	H0523_031_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	031	0	1	01	01	H0523_031_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	031	0	1	01	01	H0523_031_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	031	0	1	01	01	H0523_031_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	031	0	1	01	01	H0523_031_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	052	0	1	01	01	H0523_052_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	052	0	1	01	01	H0523_052_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	052	0	1	01	01	H0523_052_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	052	0	1	01	01	H0523_052_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	052	0	1	01	01	H0523_052_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	052	0	1	01	01	H0523_052_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	052	0	1	01	01	H0523_052_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	060	0	1	01	01	H0523_060_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	060	0	1	01	01	H0523_060_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	060	0	1	01	01	H0523_060_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	060	0	1	01	01	H0523_060_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	060	0	1	01	01	H0523_060_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	060	0	1	01	01	H0523_060_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	060	0	1	01	01	H0523_060_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	061	0	1	01	01	H0523_061_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	061	0	1	01	01	H0523_061_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	061	0	1	01	01	H0523_061_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	061	0	1	01	01	H0523_061_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	061	0	1	01	01	H0523_061_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	061	0	1	01	01	H0523_061_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	061	0	1	01	01	H0523_061_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	063	0	1	01	01	H0523_063_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	063	0	1	01	01	H0523_063_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	063	0	1	01	01	H0523_063_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	063	0	1	01	01	H0523_063_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0523	063	0	1	01	01	H0523_063_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	063	0	1	01	01	H0523_063_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0523	063	0	1	01	01	H0523_063_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0524	002	0	2	01	01	H0524_002_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	002	0	2	01	01	H0524_002_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	002	0	2	01	01	H0524_002_0	8	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	002	0	2	01	01	H0524_002_0	8	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	002	0	2	01	01	H0524_002_0	8	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	002	0	2	01	01	H0524_002_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	002	0	2	01	01	H0524_002_0	8	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2306.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	002	0	2	01	01	H0524_002_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	002	0	2	01	01	H0524_002_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	003	0	1	01	01	H0524_003_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	003	0	1	01	01	H0524_003_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	003	0	1	01	01	H0524_003_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	003	0	1	01	01	H0524_003_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	003	0	1	01	01	H0524_003_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	003	0	1	01	01	H0524_003_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	003	0	1	01	01	H0524_003_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2041.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	003	0	1	01	01	H0524_003_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	003	0	1	01	01	H0524_003_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	008	0	1	01	01	H0524_008_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	008	0	1	01	01	H0524_008_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	008	0	1	01	01	H0524_008_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	008	0	1	01	01	H0524_008_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	008	0	1	01	01	H0524_008_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	008	0	1	01	01	H0524_008_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	008	0	1	01	01	H0524_008_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2598.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	008	0	1	01	01	H0524_008_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	008	0	1	01	01	H0524_008_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	010	0	2	01	01	H0524_010_0	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	010	0	2	01	01	H0524_010_0	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	010	0	2	01	01	H0524_010_0	7	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	010	0	2	01	01	H0524_010_0	7	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	010	0	2	01	01	H0524_010_0	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	010	0	2	01	01	H0524_010_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	010	0	2	01	01	H0524_010_0	7	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2308.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	010	0	2	01	01	H0524_010_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	010	0	2	01	01	H0524_010_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	013	0	1	01	01	H0524_013_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	013	0	1	01	01	H0524_013_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	013	0	1	01	01	H0524_013_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	16.00		48.00																			16.00		32.00																16.00				16.00		0.53			0.53			0.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	013	0	1	01	01	H0524_013_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	16.00		48.00																			16.00		32.00																16.00				16.00		0.53			0.53			0.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	013	0	1	01	01	H0524_013_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	013	0	1	01	01	H0524_013_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	013	0	1	01	01	H0524_013_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2205.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	013	0	1	01	01	H0524_013_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	013	0	1	01	01	H0524_013_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	015	0	1	01	01	H0524_015_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	015	0	1	01	01	H0524_015_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	015	0	1	01	01	H0524_015_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	015	0	1	01	01	H0524_015_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	015	0	1	01	01	H0524_015_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	015	0	1	01	01	H0524_015_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	015	0	1	01	01	H0524_015_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2035.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	015	0	1	01	01	H0524_015_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	015	0	1	01	01	H0524_015_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	029	0	1	01	01	H0524_029_0	5	Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.26			0.26			0.25	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	029	0	1	01	01	H0524_029_0	5	Generic	3	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	17.00		51.00																			17.00		34.00																17.00				17.00		0.56			0.56			0.54	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	029	0	1	01	01	H0524_029_0	5	Preferred Brand	3	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	029	0	1	01	01	H0524_029_0	5	Non-Preferred Brand	3	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	029	0	1	01	01	H0524_029_0	5	Specialty Tier	3	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1789.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	029	0	1	01	01	H0524_029_0	5	Vaccines	3	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	031	0	1	01	01	H0524_031_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	031	0	1	01	01	H0524_031_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	031	0	1	01	01	H0524_031_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	031	0	1	01	01	H0524_031_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	031	0	1	01	01	H0524_031_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	031	0	1	01	01	H0524_031_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	031	0	1	01	01	H0524_031_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2114.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	031	0	1	01	01	H0524_031_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	031	0	1	01	01	H0524_031_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	032	0	1	01	01	H0524_032_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	032	0	1	01	01	H0524_032_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	032	0	1	01	01	H0524_032_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	032	0	1	01	01	H0524_032_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	032	0	1	01	01	H0524_032_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	032	0	1	01	01	H0524_032_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	032	0	1	01	01	H0524_032_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2271.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	032	0	1	01	01	H0524_032_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	032	0	1	01	01	H0524_032_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	033	0	1	01	01	H0524_033_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	033	0	1	01	01	H0524_033_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	033	0	1	01	01	H0524_033_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	033	0	1	01	01	H0524_033_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	033	0	1	01	01	H0524_033_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	033	0	1	01	01	H0524_033_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	033	0	1	01	01	H0524_033_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2184.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	033	0	1	01	01	H0524_033_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	033	0	1	01	01	H0524_033_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	034	0	1	01	01	H0524_034_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	034	0	1	01	01	H0524_034_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	034	0	1	01	01	H0524_034_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	034	0	1	01	01	H0524_034_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	034	0	1	01	01	H0524_034_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	034	0	1	01	01	H0524_034_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	034	0	1	01	01	H0524_034_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1852.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	034	0	1	01	01	H0524_034_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	034	0	1	01	01	H0524_034_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	035	0	1	01	01	H0524_035_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	035	0	1	01	01	H0524_035_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	035	0	1	01	01	H0524_035_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	035	0	1	01	01	H0524_035_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	035	0	1	01	01	H0524_035_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	035	0	1	01	01	H0524_035_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	035	0	1	01	01	H0524_035_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2219.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	035	0	1	01	01	H0524_035_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	035	0	1	01	01	H0524_035_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	036	0	1	01	01	H0524_036_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	036	0	1	01	01	H0524_036_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	036	0	1	01	01	H0524_036_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	036	0	1	01	01	H0524_036_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	036	0	1	01	01	H0524_036_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	036	0	1	01	01	H0524_036_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	036	0	1	01	01	H0524_036_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				6676.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	036	0	1	01	01	H0524_036_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	036	0	1	01	01	H0524_036_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	037	0	1	01	01	H0524_037_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	037	0	1	01	01	H0524_037_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	037	0	1	01	01	H0524_037_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	037	0	1	01	01	H0524_037_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	037	0	1	01	01	H0524_037_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	037	0	1	01	01	H0524_037_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	037	0	1	01	01	H0524_037_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1953.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	037	0	1	01	01	H0524_037_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	037	0	1	01	01	H0524_037_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	038	0	1	01	01	H0524_038_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	038	0	1	01	01	H0524_038_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	038	0	1	01	01	H0524_038_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	038	0	1	01	01	H0524_038_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	038	0	1	01	01	H0524_038_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	038	0	1	01	01	H0524_038_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	038	0	1	01	01	H0524_038_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1905.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	038	0	1	01	01	H0524_038_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	038	0	1	01	01	H0524_038_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	039	0	1	01	01	H0524_039_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	039	0	1	01	01	H0524_039_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	039	0	1	01	01	H0524_039_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	039	0	1	01	01	H0524_039_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	039	0	1	01	01	H0524_039_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	039	0	1	01	01	H0524_039_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	039	0	1	01	01	H0524_039_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2378.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	039	0	1	01	01	H0524_039_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	039	0	1	01	01	H0524_039_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	040	0	1	01	01	H0524_040_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	040	0	1	01	01	H0524_040_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	040	0	1	01	01	H0524_040_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	040	0	1	01	01	H0524_040_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	040	0	1	01	01	H0524_040_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	040	0	1	01	01	H0524_040_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	040	0	1	01	01	H0524_040_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2091.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	040	0	1	01	01	H0524_040_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	040	0	1	01	01	H0524_040_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	041	0	1	01	01	H0524_041_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	041	0	1	01	01	H0524_041_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	041	0	1	01	01	H0524_041_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	041	0	1	01	01	H0524_041_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	041	0	1	01	01	H0524_041_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	041	0	1	01	01	H0524_041_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	041	0	1	01	01	H0524_041_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2100.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	041	0	1	01	01	H0524_041_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	041	0	1	01	01	H0524_041_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	042	0	1	01	01	H0524_042_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	042	0	1	01	01	H0524_042_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	042	0	1	01	01	H0524_042_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	042	0	1	01	01	H0524_042_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	042	0	1	01	01	H0524_042_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	042	0	1	01	01	H0524_042_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	042	0	1	01	01	H0524_042_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1511.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	042	0	1	01	01	H0524_042_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	042	0	1	01	01	H0524_042_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	043	0	1	01	01	H0524_043_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	043	0	1	01	01	H0524_043_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	043	0	1	01	01	H0524_043_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	043	0	1	01	01	H0524_043_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	043	0	1	01	01	H0524_043_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	043	0	1	01	01	H0524_043_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	043	0	1	01	01	H0524_043_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1946.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	043	0	1	01	01	H0524_043_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	043	0	1	01	01	H0524_043_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	046	0	1	01	01	H0524_046_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	046	0	1	01	01	H0524_046_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	046	0	1	01	01	H0524_046_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	046	0	1	01	01	H0524_046_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	046	0	1	01	01	H0524_046_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	046	0	1	01	01	H0524_046_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	046	0	1	01	01	H0524_046_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2190.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	046	0	1	01	01	H0524_046_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	046	0	1	01	01	H0524_046_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	051	0	1	01	01	H0524_051_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	051	0	1	01	01	H0524_051_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	051	0	1	01	01	H0524_051_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	051	0	1	01	01	H0524_051_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0524	051	0	1	01	01	H0524_051_0	6	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	051	0	1	01	01	H0524_051_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	051	0	1	01	01	H0524_051_0	6	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2263.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	051	0	1	01	01	H0524_051_0	6	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0524	051	0	1	01	01	H0524_051_0	6	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0543	001	0	1	01	01	H0543_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	001	0	1	01	01	H0543_001_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						20.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	001	0	1	01	01	H0543_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	001	0	1	01	01	H0543_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	001	0	1	01	01	H0543_001_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				778.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	004	0	1	01	01	H0543_004_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	004	0	1	01	01	H0543_004_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	004	0	1	01	01	H0543_004_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	004	0	1	01	01	H0543_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	004	0	1	01	01	H0543_004_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				775.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	007	0	1	01	01	H0543_007_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	007	0	1	01	01	H0543_007_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		.33						.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	007	0	1	01	01	H0543_007_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	007	0	1	01	01	H0543_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	007	0	1	01	01	H0543_007_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				692.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	013	0	1	01	01	H0543_013_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	013	0	1	01	01	H0543_013_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		.33						.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	013	0	1	01	01	H0543_013_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	013	0	1	01	01	H0543_013_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	013	0	1	01	01	H0543_013_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				704.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	019	0	1	01	01	H0543_019_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	15.00		45.00																											45.00						0.00				15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	019	0	1	01	01	H0543_019_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	20.00		60.00																											60.00						0.00				20.00				20.00		0.66						0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	019	0	1	01	01	H0543_019_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	019	0	1	01	01	H0543_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	019	0	1	01	01	H0543_019_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				965.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	022	0	1	01	01	H0543_022_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	022	0	1	01	01	H0543_022_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	022	0	1	01	01	H0543_022_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	022	0	1	01	01	H0543_022_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	022	0	1	01	01	H0543_022_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				775.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	028	0	1	01	01	H0543_028_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	028	0	1	01	01	H0543_028_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	028	0	1	01	01	H0543_028_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	028	0	1	01	01	H0543_028_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	028	0	1	01	01	H0543_028_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				617.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	029	0	1	01	01	H0543_029_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	029	0	1	01	01	H0543_029_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	029	0	1	01	01	H0543_029_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	029	0	1	01	01	H0543_029_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	029	0	1	01	01	H0543_029_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				478.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	032	0	1	01	01	H0543_032_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	032	0	1	01	01	H0543_032_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	032	0	1	01	01	H0543_032_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	032	0	1	01	01	H0543_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	032	0	1	01	01	H0543_032_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				693.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	035	0	1	01	01	H0543_035_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	035	0	1	01	01	H0543_035_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	035	0	1	01	01	H0543_035_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	035	0	1	01	01	H0543_035_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	035	0	1	01	01	H0543_035_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				527.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	036	0	1	01	01	H0543_036_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	036	0	1	01	01	H0543_036_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	036	0	1	01	01	H0543_036_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	036	0	1	01	01	H0543_036_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	036	0	1	01	01	H0543_036_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				727.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	060	0	1	01	01	H0543_060_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	060	0	1	01	01	H0543_060_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	060	0	1	01	01	H0543_060_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	060	0	1	01	01	H0543_060_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	060	0	1	01	01	H0543_060_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				610.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	070	0	1	01	01	H0543_070_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	070	0	1	01	01	H0543_070_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	070	0	1	01	01	H0543_070_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	070	0	1	01	01	H0543_070_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	070	0	1	01	01	H0543_070_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				796.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	086	0	1	01	01	H0543_086_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	086	0	1	01	01	H0543_086_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	086	0	1	01	01	H0543_086_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	086	0	1	01	01	H0543_086_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	086	0	1	01	01	H0543_086_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				623.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	089	0	1	01	01	H0543_089_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	089	0	1	01	01	H0543_089_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	089	0	1	01	01	H0543_089_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	089	0	1	01	01	H0543_089_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	089	0	1	01	01	H0543_089_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				667.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	138	0	1	01	01	H0543_138_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	138	0	1	01	01	H0543_138_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0543	138	0	1	01	01	H0543_138_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	138	0	1	01	01	H0543_138_0	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0543	138	0	1	01	01	H0543_138_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	138	0	1	01	01	H0543_138_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	138	0	1	01	01	H0543_138_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				798.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	140	0	1	01	01	H0543_140_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	140	0	1	01	01	H0543_140_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	140	0	1	01	01	H0543_140_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	140	0	1	01	01	H0543_140_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	140	0	1	01	01	H0543_140_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				657.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	144	0	1	01	01	H0543_144_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	144	0	1	01	01	H0543_144_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0543	144	0	1	01	01	H0543_144_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	144	0	1	01	01	H0543_144_0	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0543	144	0	1	01	01	H0543_144_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	144	0	1	01	01	H0543_144_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	144	0	1	01	01	H0543_144_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				823.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	145	0	1	01	01	H0543_145_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	145	0	1	01	01	H0543_145_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	145	0	1	01	01	H0543_145_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	145	0	1	01	01	H0543_145_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	145	0	1	01	01	H0543_145_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				762.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	146	0	1	01	01	H0543_146_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	146	0	1	01	01	H0543_146_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	146	0	1	01	01	H0543_146_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	146	0	1	01	01	H0543_146_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	146	0	1	01	01	H0543_146_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				853.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	147	0	1	01	01	H0543_147_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	147	0	1	01	01	H0543_147_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	147	0	1	01	01	H0543_147_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	147	0	1	01	01	H0543_147_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	147	0	1	01	01	H0543_147_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				639.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	148	0	1	01	01	H0543_148_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	148	0	1	01	01	H0543_148_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	148	0	1	01	01	H0543_148_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	148	0	1	01	01	H0543_148_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	148	0	1	01	01	H0543_148_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				835.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	151	0	1	01	01	H0543_151_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	151	0	1	01	01	H0543_151_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						20.00				10.00				10.00		.33						.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	151	0	1	01	01	H0543_151_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	151	0	1	01	01	H0543_151_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	151	0	1	01	01	H0543_151_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				780.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	152	0	1	01	01	H0543_152_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	152	0	1	01	01	H0543_152_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	152	0	1	01	01	H0543_152_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	152	0	1	01	01	H0543_152_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	152	0	1	01	01	H0543_152_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				831.00	32		32																										32						32			32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	158	0	1	01	01	H0543_158_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	158	0	1	01	01	H0543_158_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	158	0	1	01	01	H0543_158_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	158	0	1	01	01	H0543_158_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	158	0	1	01	01	H0543_158_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				617.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	163	0	1	01	01	H0543_163_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	163	0	1	01	01	H0543_163_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	163	0	1	01	01	H0543_163_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	163	0	1	01	01	H0543_163_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	163	0	1	01	01	H0543_163_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				795.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	164	0	1	01	01	H0543_164_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	164	0	1	01	01	H0543_164_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0543	164	0	1	01	01	H0543_164_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	164	0	1	01	01	H0543_164_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H0543	164	0	1	01	01	H0543_164_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	164	0	1	01	01	H0543_164_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	164	0	1	01	01	H0543_164_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				776.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	165	0	1	01	01	H0543_165_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	165	0	1	01	01	H0543_165_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0543	165	0	1	01	01	H0543_165_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	165	0	1	01	01	H0543_165_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H0543	165	0	1	01	01	H0543_165_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	165	0	1	01	01	H0543_165_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	165	0	1	01	01	H0543_165_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				770.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	166	0	1	01	01	H0543_166_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	166	0	1	01	01	H0543_166_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0543	166	0	1	01	01	H0543_166_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	166	0	1	01	01	H0543_166_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H0543	166	0	1	01	01	H0543_166_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	166	0	1	01	01	H0543_166_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	166	0	1	01	01	H0543_166_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				689.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	167	0	1	01	01	H0543_167_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	167	0	1	01	01	H0543_167_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	167	0	1	01	01	H0543_167_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	167	0	1	01	01	H0543_167_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0543	167	0	1	01	01	H0543_167_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				732.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	002	0	1	01	01	H0544_002_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	002	0	1	01	01	H0544_002_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	002	0	1	01	01	H0544_002_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					19.00																9.50				9.50		0.32						0.31		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	002	0	1	01	01	H0544_002_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					19.00																9.50				9.50		0.32						0.31		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	002	0	1	01	01	H0544_002_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					75.00																37.50				37.50		1.25						1.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	002	0	1	01	01	H0544_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	002	0	1	01	01	H0544_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	002	0	1	01	01	H0544_002_0	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	002	0	1	01	01	H0544_002_0	5	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	003	0	1	01	01	H0544_003_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	003	0	1	01	01	H0544_003_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	003	0	1	01	01	H0544_003_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	003	0	1	01	01	H0544_003_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	003	0	1	01	01	H0544_003_0	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				2.91	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	003	0	1	01	01	H0544_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				3.33	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	003	0	1	01	01	H0544_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				2.40	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	003	0	1	01	01	H0544_003_0	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	003	0	1	01	01	H0544_003_0	5	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	004	0	1	01	01	H0544_004_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	004	0	1	01	01	H0544_004_0	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	004	0	1	01	01	H0544_004_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		.25						.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	004	0	1	01	01	H0544_004_0	7	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		.25						.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	004	0	1	01	01	H0544_004_0	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					75.00																37.50				37.50		1.25						1.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	004	0	1	01	01	H0544_004_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	004	0	1	01	01	H0544_004_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	004	0	1	01	01	H0544_004_0	7	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	004	0	1	01	01	H0544_004_0	7	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	005	0	1	01	01	H0544_005_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	005	0	1	01	01	H0544_005_0	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	005	0	1	01	01	H0544_005_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					19.00																9.50				9.50		0.32						0.31		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	005	0	1	01	01	H0544_005_0	7	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					19.00																9.50				9.50		0.32						0.31		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	005	0	1	01	01	H0544_005_0	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					75.00																37.50				37.50		1.25						1.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	005	0	1	01	01	H0544_005_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	005	0	1	01	01	H0544_005_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	005	0	1	01	01	H0544_005_0	7	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	005	0	1	01	01	H0544_005_0	7	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	007	0	1	01	01	H0544_007_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	007	0	1	01	01	H0544_007_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.50		43.50																					29.00																14.50				14.50		0.48						0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	007	0	1	01	01	H0544_007_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	007	0	1	01	01	H0544_007_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					190.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	007	0	1	01	01	H0544_007_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	007	0	1	01	01	H0544_007_0	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	008	0	1	01	01	H0544_008_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	008	0	1	01	01	H0544_008_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	008	0	1	01	01	H0544_008_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	008	0	1	01	01	H0544_008_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	008	0	1	01	01	H0544_008_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	008	0	1	01	01	H0544_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	008	0	1	01	01	H0544_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	008	0	1	01	01	H0544_008_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	008	0	1	01	01	H0544_008_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	010	0	1	01	01	H0544_010_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	010	0	1	01	01	H0544_010_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	010	0	1	01	01	H0544_010_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	010	0	1	01	01	H0544_010_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	010	0	1	01	01	H0544_010_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	010	0	1	01	01	H0544_010_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	010	0	1	01	01	H0544_010_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	010	0	1	01	01	H0544_010_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	010	0	1	01	01	H0544_010_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	012	0	1	01	01	H0544_012_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	012	0	1	01	01	H0544_012_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	012	0	1	01	01	H0544_012_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	012	0	1	01	01	H0544_012_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	012	0	1	01	01	H0544_012_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	012	0	1	01	01	H0544_012_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	012	0	1	01	01	H0544_012_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	012	0	1	01	01	H0544_012_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	012	0	1	01	01	H0544_012_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	013	0	1	01	01	H0544_013_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	013	0	1	01	01	H0544_013_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	013	0	1	01	01	H0544_013_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		.25						.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	013	0	1	01	01	H0544_013_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		.25						.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	013	0	1	01	01	H0544_013_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					75.00																37.50				37.50		1.25						1.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	013	0	1	01	01	H0544_013_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	013	0	1	01	01	H0544_013_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	013	0	1	01	01	H0544_013_0	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	013	0	1	01	01	H0544_013_0	5	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	014	0	1	01	01	H0544_014_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	014	0	1	01	01	H0544_014_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	014	0	1	01	01	H0544_014_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		.25						.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	014	0	1	01	01	H0544_014_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		.25						.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	014	0	1	01	01	H0544_014_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					75.00																37.50				37.50		1.25						1.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	014	0	1	01	01	H0544_014_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	014	0	1	01	01	H0544_014_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	014	0	1	01	01	H0544_014_0	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	014	0	1	01	01	H0544_014_0	5	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	015	0	1	01	01	H0544_015_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	015	0	1	01	01	H0544_015_0	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	015	0	1	01	01	H0544_015_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		.25						.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	015	0	1	01	01	H0544_015_0	7	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		.25						.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	015	0	1	01	01	H0544_015_0	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					75.00																37.50				37.50		1.25						1.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	015	0	1	01	01	H0544_015_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	015	0	1	01	01	H0544_015_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	015	0	1	01	01	H0544_015_0	7	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	015	0	1	01	01	H0544_015_0	7	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	019	0	1	01	01	H0544_019_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	019	0	1	01	01	H0544_019_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	019	0	1	01	01	H0544_019_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	019	0	1	01	01	H0544_019_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	019	0	1	01	01	H0544_019_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	019	0	1	01	01	H0544_019_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	019	0	1	01	01	H0544_019_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	019	0	1	01	01	H0544_019_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	019	0	1	01	01	H0544_019_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	020	0	1	01	01	H0544_020_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	020	0	1	01	01	H0544_020_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	020	0	1	01	01	H0544_020_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	020	0	1	01	01	H0544_020_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	020	0	1	01	01	H0544_020_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	020	0	1	01	01	H0544_020_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	020	0	1	01	01	H0544_020_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	020	0	1	01	01	H0544_020_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	020	0	1	01	01	H0544_020_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	021	0	1	01	01	H0544_021_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		15.00							10.00																10.00				10.00			0.33	0.17				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	021	0	1	01	01	H0544_021_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								17.50		52.50					12.50		37.50							25.00																17.50				17.50			0.58	0.42				0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	021	0	1	01	01	H0544_021_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	021	0	1	01	01	H0544_021_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					90.00		270.00							180.00																95.00				95.00			3.17	3.00				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	021	0	1	01	01	H0544_021_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	021	0	1	01	01	H0544_021_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					10.00		30.00							20.00																10.00				10.00			0.33	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	024	0	1	01	01	H0544_024_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	024	0	1	01	01	H0544_024_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	024	0	1	01	01	H0544_024_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			.42	.25				.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	024	0	1	01	01	H0544_024_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			.42	.25				.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	024	0	1	01	01	H0544_024_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	024	0	1	01	01	H0544_024_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	024	0	1	01	01	H0544_024_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	024	0	1	01	01	H0544_024_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	024	0	1	01	01	H0544_024_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	025	0	1	01	01	H0544_025_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	025	0	1	01	01	H0544_025_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	025	0	1	01	01	H0544_025_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			.42	.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	025	0	1	01	01	H0544_025_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			.42	.25				.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	025	0	1	01	01	H0544_025_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	025	0	1	01	01	H0544_025_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	025	0	1	01	01	H0544_025_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	025	0	1	01	01	H0544_025_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	025	0	1	01	01	H0544_025_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	027	0	1	01	01	H0544_027_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	027	0	1	01	01	H0544_027_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	027	0	1	01	01	H0544_027_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	027	0	1	01	01	H0544_027_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	027	0	1	01	01	H0544_027_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	027	0	1	01	01	H0544_027_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	027	0	1	01	01	H0544_027_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	027	0	1	01	01	H0544_027_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	027	0	1	01	01	H0544_027_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	031	0	1	01	01	H0544_031_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	031	0	1	01	01	H0544_031_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	031	0	1	01	01	H0544_031_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	031	0	1	01	01	H0544_031_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	031	0	1	01	01	H0544_031_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	031	0	1	01	01	H0544_031_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	031	0	1	01	01	H0544_031_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	031	0	1	01	01	H0544_031_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	031	0	1	01	01	H0544_031_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	032	0	1	01	01	H0544_032_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	032	0	1	01	01	H0544_032_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	032	0	1	01	01	H0544_032_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	032	0	1	01	01	H0544_032_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	032	0	1	01	01	H0544_032_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	032	0	1	01	01	H0544_032_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	032	0	1	01	01	H0544_032_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	032	0	1	01	01	H0544_032_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	032	0	1	01	01	H0544_032_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	036	0	1	01	01	H0544_036_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	036	0	1	01	01	H0544_036_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	036	0	1	01	01	H0544_036_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	036	0	1	01	01	H0544_036_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	036	0	1	01	01	H0544_036_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	036	0	1	01	01	H0544_036_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	036	0	1	01	01	H0544_036_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	036	0	1	01	01	H0544_036_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	036	0	1	01	01	H0544_036_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	037	0	1	01	01	H0544_037_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	037	0	1	01	01	H0544_037_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	037	0	1	01	01	H0544_037_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	037	0	1	01	01	H0544_037_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	037	0	1	01	01	H0544_037_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	037	0	1	01	01	H0544_037_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	037	0	1	01	01	H0544_037_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	037	0	1	01	01	H0544_037_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	037	0	1	01	01	H0544_037_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	038	0	1	01	01	H0544_038_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	038	0	1	01	01	H0544_038_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	038	0	1	01	01	H0544_038_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	038	0	1	01	01	H0544_038_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	038	0	1	01	01	H0544_038_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	038	0	1	01	01	H0544_038_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	038	0	1	01	01	H0544_038_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	038	0	1	01	01	H0544_038_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	038	0	1	01	01	H0544_038_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	041	0	1	01	01	H0544_041_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	041	0	1	01	01	H0544_041_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	041	0	1	01	01	H0544_041_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	041	0	1	01	01	H0544_041_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	041	0	1	01	01	H0544_041_0	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				2.91	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	041	0	1	01	01	H0544_041_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				3.33	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	041	0	1	01	01	H0544_041_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				2.40	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	041	0	1	01	01	H0544_041_0	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	041	0	1	01	01	H0544_041_0	5	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	050	0	1	01	01	H0544_050_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	050	0	1	01	01	H0544_050_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	050	0	1	01	01	H0544_050_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		0.25						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	050	0	1	01	01	H0544_050_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		0.25						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	050	0	1	01	01	H0544_050_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	050	0	1	01	01	H0544_050_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	050	0	1	01	01	H0544_050_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	050	0	1	01	01	H0544_050_0	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	050	0	1	01	01	H0544_050_0	5	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H0544	052	0	1	01	01	H0544_052_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	052	0	1	01	01	H0544_052_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	052	0	1	01	01	H0544_052_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	052	0	1	01	01	H0544_052_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	052	0	1	01	01	H0544_052_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	052	0	1	01	01	H0544_052_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	053	0	1	01	01	H0544_053_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	053	0	1	01	01	H0544_053_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	053	0	1	01	01	H0544_053_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					13.00	26.00	39.00					13.00	39.00	39.00																13.00				13.00			0.43	0.43	0.43			0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	053	0	1	01	01	H0544_053_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	053	0	1	01	01	H0544_053_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	053	0	1	01	01	H0544_053_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	054	0	1	01	01	H0544_054_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	054	0	1	01	01	H0544_054_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	054	0	1	01	01	H0544_054_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					18.00	36.00	54.00					18.00	54.00	54.00																18.00				18.00			0.60	0.60	0.60			0.53		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	054	0	1	01	01	H0544_054_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	054	0	1	01	01	H0544_054_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	054	0	1	01	01	H0544_054_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	054	0	1	01	01	H0544_054_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	054	0	1	01	01	H0544_054_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	055	0	1	01	01	H0544_055_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	055	0	1	01	01	H0544_055_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	055	0	1	01	01	H0544_055_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					19.00	38.00	57.00					19.00	57.00	57.00																19.00				19.00			0.63	0.63	0.63			0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	055	0	1	01	01	H0544_055_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	055	0	1	01	01	H0544_055_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	055	0	1	01	01	H0544_055_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	056	0	1	01	01	H0544_056_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	056	0	1	01	01	H0544_056_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	056	0	1	01	01	H0544_056_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	056	0	1	01	01	H0544_056_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	056	0	1	01	01	H0544_056_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	056	0	1	01	01	H0544_056_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	056	0	1	01	01	H0544_056_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	057	0	1	01	01	H0544_057_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	057	0	1	01	01	H0544_057_0	6	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	057	0	1	01	01	H0544_057_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	057	0	1	01	01	H0544_057_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	057	0	1	01	01	H0544_057_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	057	0	1	01	01	H0544_057_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	058	0	1	01	01	H0544_058_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	058	0	1	01	01	H0544_058_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	058	0	1	01	01	H0544_058_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	058	0	1	01	01	H0544_058_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	058	0	1	01	01	H0544_058_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	058	0	1	01	01	H0544_058_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	059	0	1	01	01	H0544_059_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	059	0	1	01	01	H0544_059_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	059	0	1	01	01	H0544_059_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	059	0	1	01	01	H0544_059_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	059	0	1	01	01	H0544_059_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	059	0	1	01	01	H0544_059_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	060	3	1	01	01	H0544_060_3	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00	21.00	21.00																12.00				12.00			0.40	0.23	0.23			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	3	1	01	01	H0544_060_3	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	3	1	01	01	H0544_060_3	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	3	1	01	01	H0544_060_3	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	3	1	01	01	H0544_060_3	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	3	1	01	01	H0544_060_3	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	3	1	01	01	H0544_060_3	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	060	4	1	01	01	H0544_060_4	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00	21.00	21.00																12.00				12.00			0.40	0.23	0.23			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	4	1	01	01	H0544_060_4	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	4	1	01	01	H0544_060_4	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	4	1	01	01	H0544_060_4	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	4	1	01	01	H0544_060_4	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	4	1	01	01	H0544_060_4	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	060	4	1	01	01	H0544_060_4	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	061	0	1	01	01	H0544_061_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00	21.00	21.00																12.00				12.00			0.40	0.23	0.23			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	061	0	1	01	01	H0544_061_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	061	0	1	01	01	H0544_061_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	061	0	1	01	01	H0544_061_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	061	0	1	01	01	H0544_061_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	061	0	1	01	01	H0544_061_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	061	0	1	01	01	H0544_061_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	062	0	1	01	01	H0544_062_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	062	0	1	01	01	H0544_062_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	062	0	1	01	01	H0544_062_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	062	0	1	01	01	H0544_062_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	062	0	1	01	01	H0544_062_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	062	0	1	01	01	H0544_062_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	063	0	1	01	01	H0544_063_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	063	0	1	01	01	H0544_063_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	063	0	1	01	01	H0544_063_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	063	0	1	01	01	H0544_063_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	063	0	1	01	01	H0544_063_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	063	0	1	01	01	H0544_063_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	063	0	1	01	01	H0544_063_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	064	0	1	01	01	H0544_064_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	064	0	1	01	01	H0544_064_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	064	0	1	01	01	H0544_064_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	064	0	1	01	01	H0544_064_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	064	0	1	01	01	H0544_064_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	064	0	1	01	01	H0544_064_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	064	0	1	01	01	H0544_064_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	065	0	1	01	01	H0544_065_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	065	0	1	01	01	H0544_065_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00	21.00	21.00																12.00				12.00			0.40	0.23	0.23			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	065	0	1	01	01	H0544_065_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	065	0	1	01	01	H0544_065_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	065	0	1	01	01	H0544_065_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	065	0	1	01	01	H0544_065_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	065	0	1	01	01	H0544_065_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0544	066	0	1	01	01	H0544_066_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	066	0	1	01	01	H0544_066_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	066	0	1	01	01	H0544_066_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	066	0	1	01	01	H0544_066_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	066	0	1	01	01	H0544_066_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	066	0	1	01	01	H0544_066_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	067	0	1	01	01	H0544_067_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	067	0	1	01	01	H0544_067_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	067	0	1	01	01	H0544_067_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	067	0	1	01	01	H0544_067_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	067	0	1	01	01	H0544_067_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	067	0	1	01	01	H0544_067_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	069	0	1	01	01	H0544_069_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	069	0	1	01	01	H0544_069_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	069	0	1	01	01	H0544_069_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	069	0	1	01	01	H0544_069_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	069	0	1	01	01	H0544_069_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	069	0	1	01	01	H0544_069_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	070	0	1	01	01	H0544_070_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	070	0	1	01	01	H0544_070_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	070	0	1	01	01	H0544_070_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	070	0	1	01	01	H0544_070_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	070	0	1	01	01	H0544_070_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	070	0	1	01	01	H0544_070_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	071	0	1	01	01	H0544_071_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	071	0	1	01	01	H0544_071_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	071	0	1	01	01	H0544_071_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					19.00	38.00	57.00					19.00	57.00	57.00																19.00				19.00			0.63	0.63	0.63			0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	071	0	1	01	01	H0544_071_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	071	0	1	01	01	H0544_071_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	071	0	1	01	01	H0544_071_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	072	0	1	01	01	H0544_072_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	072	0	1	01	01	H0544_072_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0544	072	0	1	01	01	H0544_072_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	072	0	1	01	01	H0544_072_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	072	0	1	01	01	H0544_072_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	072	0	1	01	01	H0544_072_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0544	074	0	1	01	01	H0544_074_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	074	0	1	01	01	H0544_074_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	074	0	1	01	01	H0544_074_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	074	0	1	01	01	H0544_074_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	074	0	1	01	01	H0544_074_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	074	0	1	01	01	H0544_074_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0544	074	0	1	01	01	H0544_074_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0545	001	0	1	01	01	H0545_001_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	1			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	001	0	1	01	01	H0545_001_0	7	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	1			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	001	0	1	01	01	H0545_001_0	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	001	0	1	01	01	H0545_001_0	7	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		90				2	1			90				30		31				72.92	25		25																				25															25			25								3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	001	0	1	01	01	H0545_001_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				596.68	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	001	0	1	01	01	H0545_001_0	7	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				2	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	012	0	1	01	01	H0545_012_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	012	0	1	01	01	H0545_012_0	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0545	012	0	1	01	01	H0545_012_0	7	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	1			90				30		31	9.00		27.00																					27.00																9.00				9.00		0.30						0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	012	0	1	01	01	H0545_012_0	7	Generic	4	01	3	2	2	3	110		01	100		1	30		90				2	1			90				30		31	9.00		27.00																					27.00																9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		3
H0545	012	0	1	01	01	H0545_012_0	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	1			90				30		31	37.00		111.00																					111.00																37.00				37.00		1.23						1.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	012	0	1	01	01	H0545_012_0	7	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		90				2	1			90				30		31				53.87	30		30																				30															30			30								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	012	0	1	01	01	H0545_012_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				515.43	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	012	0	1	01	01	H0545_012_0	7	Select Care Drugs	4	11	1	2	6	1	110		01	110		1	30		90				2	1	30		90				30		31	10.00		30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0545	012	0	1	01	01	H0545_012_0	7	Select Care Drugs	4	11	1	2	6	3	110		01	110		1	30		90				2	1	30		90				30		31	10.00		30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0562	009	0	1	01	01	H0562_009_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	009	0	1	01	01	H0562_009_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	009	0	1	01	01	H0562_009_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	009	0	1	01	01	H0562_009_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	009	0	1	01	01	H0562_009_0	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	009	0	1	01	01	H0562_009_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	012	0	1	01	01	H0562_012_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	012	0	1	01	01	H0562_012_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	24.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	012	0	1	01	01	H0562_012_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	012	0	1	01	01	H0562_012_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	012	0	1	01	01	H0562_012_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	012	0	1	01	01	H0562_012_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	039	0	1	01	01	H0562_039_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	14.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	039	0	1	01	01	H0562_039_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					12.00	24.00	36.00											19.00	38.00	57.00				12.00	24.00	24.00				19.00				19.00			0.63	0.40		0.63	0.40	0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	039	0	1	01	01	H0562_039_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	039	0	1	01	01	H0562_039_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	039	0	1	01	01	H0562_039_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	039	0	1	01	01	H0562_039_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	055	0	1	01	01	H0562_055_0	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	055	0	1	01	01	H0562_055_0	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	055	0	1	01	01	H0562_055_0	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	055	0	1	01	01	H0562_055_0	4	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	055	0	1	01	01	H0562_055_0	4	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					30	30	30																		30	30	30															30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	055	0	1	01	01	H0562_055_0	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	068	0	1	01	01	H0562_068_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	068	0	1	01	01	H0562_068_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	068	0	1	01	01	H0562_068_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	068	0	1	01	01	H0562_068_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	068	0	1	01	01	H0562_068_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	068	0	1	01	01	H0562_068_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	079	0	1	01	01	H0562_079_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	079	0	1	01	01	H0562_079_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	079	0	1	01	01	H0562_079_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	079	0	1	01	01	H0562_079_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	079	0	1	01	01	H0562_079_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	079	0	1	01	01	H0562_079_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	084	0	1	01	01	H0562_084_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	084	0	1	01	01	H0562_084_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					13.00	26.00	39.00											18.00	36.00	54.00				13.00	26.00	26.00				18.00				18.00			0.60	0.43		0.60	0.43	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	084	0	1	01	01	H0562_084_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	084	0	1	01	01	H0562_084_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	084	0	1	01	01	H0562_084_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	084	0	1	01	01	H0562_084_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	090	0	1	01	01	H0562_090_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	090	0	1	01	01	H0562_090_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	090	0	1	01	01	H0562_090_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	090	0	1	01	01	H0562_090_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	090	0	1	01	01	H0562_090_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	090	0	1	01	01	H0562_090_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	092	0	1	01	01	H0562_092_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	092	0	1	01	01	H0562_092_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	092	0	1	01	01	H0562_092_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	092	0	1	01	01	H0562_092_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	092	0	1	01	01	H0562_092_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	092	0	1	01	01	H0562_092_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	092	0	1	01	01	H0562_092_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	092	0	1	01	01	H0562_092_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	092	0	1	01	01	H0562_092_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	095	0	1	01	01	H0562_095_0	4	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	095	0	1	01	01	H0562_095_0	4	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	095	0	1	01	01	H0562_095_0	4	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	095	0	1	01	01	H0562_095_0	4	Non-Preferred Brand	3	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	095	0	1	01	01	H0562_095_0	4	Specialty Tier	3	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												28	28	28					28	28	28										28	28	28				28	28	28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	095	0	1	01	01	H0562_095_0	4	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	097	0	1	01	01	H0562_097_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					5.00	10.00	15.00											8.00	16.00	24.00				5.00	10.00	10.00				8.00				8.00			0.27	0.17		0.27	0.17	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	097	0	1	01	01	H0562_097_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					12.00	24.00	36.00											15.00	30.00	45.00				12.00	24.00	24.00				15.00				15.00			0.50	0.40		0.50	0.40	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	097	0	1	01	01	H0562_097_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	097	0	1	01	01	H0562_097_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	097	0	1	01	01	H0562_097_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	097	0	1	01	01	H0562_097_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	1	1	01	01	H0562_100_1	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	1	1	01	01	H0562_100_1	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	100	1	1	01	01	H0562_100_1	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	1	1	01	01	H0562_100_1	5	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	100	1	1	01	01	H0562_100_1	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	1	1	01	01	H0562_100_1	5	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	1	1	01	01	H0562_100_1	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	1	1	01	01	H0562_100_1	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	1	1	01	01	H0562_100_1	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	100	2	1	01	01	H0562_100_2	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	2	1	01	01	H0562_100_2	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	100	2	1	01	01	H0562_100_2	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	2	1	01	01	H0562_100_2	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	100	2	1	01	01	H0562_100_2	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	2	1	01	01	H0562_100_2	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	2	1	01	01	H0562_100_2	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	2	1	01	01	H0562_100_2	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	100	2	1	01	01	H0562_100_2	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	101	1	1	01	01	H0562_101_1	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	1	1	01	01	H0562_101_1	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	101	1	1	01	01	H0562_101_1	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	1	1	01	01	H0562_101_1	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	101	1	1	01	01	H0562_101_1	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	1	1	01	01	H0562_101_1	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	1	1	01	01	H0562_101_1	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	1	1	01	01	H0562_101_1	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	1	1	01	01	H0562_101_1	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	101	2	1	01	01	H0562_101_2	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	2	1	01	01	H0562_101_2	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	101	2	1	01	01	H0562_101_2	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	2	1	01	01	H0562_101_2	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	101	2	1	01	01	H0562_101_2	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	2	1	01	01	H0562_101_2	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	2	1	01	01	H0562_101_2	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	2	1	01	01	H0562_101_2	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	101	2	1	01	01	H0562_101_2	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0562	103	0	1	01	01	H0562_103_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	24.00											13.00	26.00	39.00				8.00	16.00	16.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	103	0	1	01	01	H0562_103_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	103	0	1	01	01	H0562_103_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	103	0	1	01	01	H0562_103_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	103	0	1	01	01	H0562_103_0	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	103	0	1	01	01	H0562_103_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	1	1	01	01	H0562_110_1	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	1	1	01	01	H0562_110_1	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	1	1	01	01	H0562_110_1	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	1	1	01	01	H0562_110_1	4	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	1	1	01	01	H0562_110_1	4	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					29	29	29																		29	29	29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	1	1	01	01	H0562_110_1	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	2	1	01	01	H0562_110_2	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	2	1	01	01	H0562_110_2	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	2	1	01	01	H0562_110_2	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	2	1	01	01	H0562_110_2	4	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	2	1	01	01	H0562_110_2	4	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					29	29	29																		29	29	29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	2	1	01	01	H0562_110_2	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	3	1	01	01	H0562_110_3	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	3	1	01	01	H0562_110_3	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	3	1	01	01	H0562_110_3	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	3	1	01	01	H0562_110_3	4	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	3	1	01	01	H0562_110_3	4	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					29	29	29																		29	29	29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	110	3	1	01	01	H0562_110_3	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	1	1	01	01	H0562_111_1	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	1	1	01	01	H0562_111_1	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	1	1	01	01	H0562_111_1	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	1	1	01	01	H0562_111_1	4	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	1	1	01	01	H0562_111_1	4	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					28	28	28																		28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	1	1	01	01	H0562_111_1	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	2	1	01	01	H0562_111_2	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	2	1	01	01	H0562_111_2	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	2	1	01	01	H0562_111_2	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	2	1	01	01	H0562_111_2	4	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	2	1	01	01	H0562_111_2	4	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					28	28	28																		28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	2	1	01	01	H0562_111_2	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	3	1	01	01	H0562_111_3	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	3	1	01	01	H0562_111_3	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	3	1	01	01	H0562_111_3	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	3	1	01	01	H0562_111_3	4	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	3	1	01	01	H0562_111_3	4	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					28	28	28																		28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	111	3	1	01	01	H0562_111_3	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	112	0	1	01	01	H0562_112_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	112	0	1	01	01	H0562_112_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	10.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	112	0	1	01	01	H0562_112_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	112	0	1	01	01	H0562_112_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	112	0	1	01	01	H0562_112_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	112	0	1	01	01	H0562_112_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	113	0	1	01	01	H0562_113_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	113	0	1	01	01	H0562_113_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	113	0	1	01	01	H0562_113_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	113	0	1	01	01	H0562_113_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	113	0	1	01	01	H0562_113_0	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	113	0	1	01	01	H0562_113_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	114	0	1	01	01	H0562_114_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	114	0	1	01	01	H0562_114_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	24.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	114	0	1	01	01	H0562_114_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	114	0	1	01	01	H0562_114_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	114	0	1	01	01	H0562_114_0	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0562	114	0	1	01	01	H0562_114_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0571	001	0	1	01	01	H0571_001_0	8	Preferred Generic	4	01	1	2	1	1		111	10	100		1				30	60	90	1	2			90					14	31								3.00	6.00	9.00					3.00	6.00	6.00							6.00																	3.00			3.00			0.10	0.10				0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0571	001	0	1	01	01	H0571_001_0	8	Generic	4	01	1	2	2	1		111	10	100		1				30	60	90	1	2			90					14	31								7.00	14.00	21.00					7.00	14.00	14.00							14.00																	7.00			7.00			0.23	0.23				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0571	001	0	1	01	01	H0571_001_0	8	Preferred Brand	4	11	1	2	3	1		111	10	100		1				30	60	90	1	2			90					14	31								40.00	80.00	120.00					40.00	80.00	80.00							80.00																	40.00			40.00			1.33	1.33				1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0571	001	0	1	01	01	H0571_001_0	8	Non-Preferred Brand	4	11	1	2	4	1		111	10	100		1				30	60	90	1	2			90					14	31								60.00	120.00	180.00					60.00	120.00	120.00							120.00																	60.00			60.00			2.00	2.00				1.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0571	001	0	1	01	01	H0571_001_0	8	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							14	31												30							30						30																		30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0609	002	0	1	01	01	H0609_002_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	002	0	1	01	01	H0609_002_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	002	0	1	01	01	H0609_002_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	002	0	1	01	01	H0609_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	002	0	1	01	01	H0609_002_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				559.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	007	0	1	01	01	H0609_007_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	007	0	1	01	01	H0609_007_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	007	0	1	01	01	H0609_007_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	007	0	1	01	01	H0609_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	007	0	1	01	01	H0609_007_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				558.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	012	0	1	01	01	H0609_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	012	0	1	01	01	H0609_012_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	012	0	1	01	01	H0609_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	012	0	1	01	01	H0609_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	012	0	1	01	01	H0609_012_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				569.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	020	0	1	01	01	H0609_020_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	020	0	1	01	01	H0609_020_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	020	0	1	01	01	H0609_020_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	020	0	1	01	01	H0609_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	020	0	1	01	01	H0609_020_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				601.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	025	0	1	01	01	H0609_025_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	025	0	1	01	01	H0609_025_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	025	0	1	01	01	H0609_025_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	025	0	1	01	01	H0609_025_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	025	0	1	01	01	H0609_025_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				827.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	026	0	1	01	01	H0609_026_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	026	0	1	01	01	H0609_026_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	026	0	1	01	01	H0609_026_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	026	0	1	01	01	H0609_026_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	026	0	1	01	01	H0609_026_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				612.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	027	0	1	01	01	H0609_027_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						2.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	027	0	1	01	01	H0609_027_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						16.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	027	0	1	01	01	H0609_027_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	027	0	1	01	01	H0609_027_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	027	0	1	01	01	H0609_027_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				783.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	028	0	1	01	01	H0609_028_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				1	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	028	0	1	01	01	H0609_028_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				1	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0609	028	0	1	01	01	H0609_028_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		100				1	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	028	0	1	01	01	H0609_028_0	3	Generic	4	01	1	2	2	3	110		01		100	1	30		100				1	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H0609	028	0	1	01	01	H0609_028_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				1	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	028	0	1	01	01	H0609_028_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				1	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0609	028	0	1	01	01	H0609_028_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		100				1	2						100	30		31				1016.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0630	013	0	1	01	01	H0630_013_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	9.00		27.00																			9.00		18.00																9.00				9.00		0.30			0.30			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	013	0	1	01	01	H0630_013_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	9.00		27.00																			9.00		18.00																9.00				9.00		0.30			0.30			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	013	0	1	01	01	H0630_013_0	8	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	013	0	1	01	01	H0630_013_0	8	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	013	0	1	01	01	H0630_013_0	8	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	013	0	1	01	01	H0630_013_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	013	0	1	01	01	H0630_013_0	8	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1857.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	013	0	1	01	01	H0630_013_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	013	0	1	01	01	H0630_013_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	015	0	1	01	01	H0630_015_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.26			0.26			0.25	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	015	0	1	01	01	H0630_015_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.26			0.26			0.25	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	015	0	1	01	01	H0630_015_0	8	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	17.00		51.00																			17.00		34.00																17.00				17.00		0.56			0.56			0.54	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	015	0	1	01	01	H0630_015_0	8	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	17.00		51.00																			17.00		34.00																17.00				17.00		0.56			0.56			0.54	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	015	0	1	01	01	H0630_015_0	8	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	015	0	1	01	01	H0630_015_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	015	0	1	01	01	H0630_015_0	8	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1787.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	015	0	1	01	01	H0630_015_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	015	0	1	01	01	H0630_015_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	016	0	1	01	01	H0630_016_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	016	0	1	01	01	H0630_016_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	016	0	1	01	01	H0630_016_0	8	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.38	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	016	0	1	01	01	H0630_016_0	8	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.38	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	016	0	1	01	01	H0630_016_0	8	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	016	0	1	01	01	H0630_016_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	016	0	1	01	01	H0630_016_0	8	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1839.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	016	0	1	01	01	H0630_016_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	016	0	1	01	01	H0630_016_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	017	0	1	01	01	H0630_017_0	10	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		5.00																7.00				7.00		0.23			0.23			0.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	017	0	1	01	01	H0630_017_0	10	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		5.00																7.00				7.00		0.23			0.23			0.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	017	0	1	01	01	H0630_017_0	10	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	017	0	1	01	01	H0630_017_0	10	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	017	0	1	01	01	H0630_017_0	10	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	017	0	1	01	01	H0630_017_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	017	0	1	01	01	H0630_017_0	10	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1820.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	017	0	1	01	01	H0630_017_0	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	017	0	1	01	01	H0630_017_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	018	0	1	01	01	H0630_018_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	6.00		18.00																			6.00		5.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	018	0	1	01	01	H0630_018_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	6.00		18.00																			6.00		5.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	018	0	1	01	01	H0630_018_0	8	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	018	0	1	01	01	H0630_018_0	8	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	018	0	1	01	01	H0630_018_0	8	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	018	0	1	01	01	H0630_018_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	018	0	1	01	01	H0630_018_0	8	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1886.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	018	0	1	01	01	H0630_018_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	018	0	1	01	01	H0630_018_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	020	0	1	01	01	H0630_020_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	9.00		27.00																			9.00		18.00																9.00				9.00		0.30			0.30			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	020	0	1	01	01	H0630_020_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	9.00		27.00																			9.00		18.00																9.00				9.00		0.30			0.30			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	020	0	1	01	01	H0630_020_0	8	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	020	0	1	01	01	H0630_020_0	8	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	020	0	1	01	01	H0630_020_0	8	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	020	0	1	01	01	H0630_020_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	020	0	1	01	01	H0630_020_0	8	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				2301.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	020	0	1	01	01	H0630_020_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	020	0	1	01	01	H0630_020_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	021	0	1	01	01	H0630_021_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.26			0.26			0.25	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	021	0	1	01	01	H0630_021_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.26			0.26			0.25	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	021	0	1	01	01	H0630_021_0	8	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	17.00		51.00																			17.00		34.00																17.00				17.00		0.56			0.56			0.54	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	021	0	1	01	01	H0630_021_0	8	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	17.00		51.00																			17.00		34.00																17.00				17.00		0.56			0.56			0.54	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0630	021	0	1	01	01	H0630_021_0	8	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	021	0	1	01	01	H0630_021_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	021	0	1	01	01	H0630_021_0	8	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1806.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	021	0	1	01	01	H0630_021_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H0630	021	0	1	01	01	H0630_021_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H0710	006	0	1	04	01	H0710_006_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	006	0	1	04	01	H0710_006_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	006	0	1	04	01	H0710_006_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	006	0	1	04	01	H0710_006_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	006	0	1	04	01	H0710_006_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1126.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	008	0	1	04	01	H0710_008_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	008	0	1	04	01	H0710_008_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	008	0	1	04	01	H0710_008_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	008	0	1	04	01	H0710_008_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	008	0	1	04	01	H0710_008_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1138.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	009	0	1	04	01	H0710_009_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	009	0	1	04	01	H0710_009_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	009	0	1	04	01	H0710_009_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	009	0	1	04	01	H0710_009_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	009	0	1	04	01	H0710_009_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				994.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	012	0	1	04	01	H0710_012_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	012	0	1	04	01	H0710_012_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	012	0	1	04	01	H0710_012_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	012	0	1	04	01	H0710_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	012	0	1	04	01	H0710_012_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1122.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	018	0	1	04	01	H0710_018_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	018	0	1	04	01	H0710_018_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	018	0	1	04	01	H0710_018_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	018	0	1	04	01	H0710_018_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	018	0	1	04	01	H0710_018_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1004.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	030	0	1	04	01	H0710_030_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	030	0	1	04	01	H0710_030_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	030	0	1	04	01	H0710_030_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	030	0	1	04	01	H0710_030_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	030	0	1	04	01	H0710_030_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				998.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	037	0	1	04	01	H0710_037_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	037	0	1	04	01	H0710_037_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	037	0	1	04	01	H0710_037_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	037	0	1	04	01	H0710_037_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0710	037	0	1	04	01	H0710_037_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				998.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	005	0	1	01	01	H0712_005_0	2	Preferred Generic	2	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	005	0	1	01	01	H0712_005_0	2	Generic	2	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	005	0	1	01	01	H0712_005_0	2	Preferred Brand	2	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	005	0	1	01	01	H0712_005_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.14	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	005	0	1	01	01	H0712_005_0	2	Specialty Tier	2	11	1	1	5	1	010		01		010	1	30											30			30		31				484.00	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	019	0	1	01	01	H0712_019_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	019	0	1	01	01	H0712_019_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	019	0	1	01	01	H0712_019_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	019	0	1	01	01	H0712_019_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				72.49	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	019	0	1	01	01	H0712_019_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				583.63	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	020	0	1	02	01	H0712_020_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	020	0	1	02	01	H0712_020_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	19.00		57.00																									19.00		57.00				19.00		47.50				19.00				19.00		0.63				0.63	0.63	0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	020	0	1	02	01	H0712_020_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	020	0	1	02	01	H0712_020_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.09	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	020	0	1	02	01	H0712_020_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				467.96	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	021	0	1	01	01	H0712_021_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	021	0	1	01	01	H0712_021_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		42.50				17.00				17.00		0.57				0.57	0.57	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	021	0	1	01	01	H0712_021_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	021	0	1	01	01	H0712_021_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				73.59	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	021	0	1	01	01	H0712_021_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				590.58	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	022	0	1	01	01	H0712_022_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	022	0	1	01	01	H0712_022_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	022	0	1	01	01	H0712_022_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	022	0	1	01	01	H0712_022_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				54.03	45		45																								45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	022	0	1	01	01	H0712_022_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				765.28	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	023	0	1	01	01	H0712_023_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	023	0	1	01	01	H0712_023_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	023	0	1	01	01	H0712_023_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	023	0	1	01	01	H0712_023_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				54.14	45		45																								45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	023	0	1	01	01	H0712_023_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				579.67	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	024	0	1	01	01	H0712_024_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	024	0	1	01	01	H0712_024_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	024	0	1	01	01	H0712_024_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	024	0	1	01	01	H0712_024_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				54.14	45		45																								45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	024	0	1	01	01	H0712_024_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				579.67	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	025	0	1	01	01	H0712_025_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	025	0	1	01	01	H0712_025_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	025	0	1	01	01	H0712_025_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	025	0	1	01	01	H0712_025_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				74.93	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0712	025	0	1	01	01	H0712_025_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				528.39	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0724	001	0	1	01	01	H0724_001_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0724	001	0	1	01	01	H0724_001_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	27.00																14.00				14.00			0.47	0.30	0.30			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0724	001	0	1	01	01	H0724_001_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0724	001	0	1	01	01	H0724_001_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0724	001	0	1	01	01	H0724_001_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0724	001	0	1	01	01	H0724_001_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0724	002	0	1	01	01	H0724_002_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0724	002	0	1	01	01	H0724_002_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	27.00																14.00				14.00			0.47	0.30	0.30			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0724	002	0	1	01	01	H0724_002_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0724	002	0	1	01	01	H0724_002_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0724	002	0	1	01	01	H0724_002_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0724	002	0	1	01	01	H0724_002_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0735	001	0	1	04	01	H0735_001_0	10	Preferred Generic	4	01	1	2	1	1	110		10	110		1	30		90				1	2	30		90					29	31	6.00		18.00																			6.00		12.00																	6.00			6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0735	001	0	1	04	01	H0735_001_0	10	Generic	4	01	1	2	2	1	110		10	110		1	30		90				1	2	30		90					29	31	15.00		45.00																			15.00		30.00																	15.00			15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0735	001	0	1	04	01	H0735_001_0	10	Preferred Brand	4	10	1	2	3	1	110		10	110		1	30		90				1	2	30		90					29	31	45.00		135.00																			45.00		90.00																	45.00			45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0735	001	0	1	04	01	H0735_001_0	10	Non-Preferred Drug	4	11	1	2	4	1	110		10	110		1	30		90				1	2	30		90					29	31	90.00		270.00																			90.00		180.00																	90.00			90.00		3.00			3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0735	001	0	1	04	01	H0735_001_0	10	Specialty Tier	4	11	1	1	5	1	110		10	110		1	30		90				1	2	30		90					29	31				571.71	27		27																		27		27																27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0735	002	0	1	04	01	H0735_002_0	9	Preferred Generic	4	01	1	2	1	1	110		10	110		1	30		90				1	2	30		90					29	31	6.00		18.00																			6.00		12.00																	6.00			6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0735	002	0	1	04	01	H0735_002_0	9	Generic	4	01	1	2	2	1	110		10	110		1	30		90				1	2	30		90					29	31	12.00		36.00																			12.00		24.00																	12.00			12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0735	002	0	1	04	01	H0735_002_0	9	Preferred Brand	4	10	1	2	3	1	110		10	110		1	30		90				1	2	30		90					29	31	40.00		120.00																			40.00		80.00																	40.00			40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0735	002	0	1	04	01	H0735_002_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		10	110		1	30		90				1	2	30		90					29	31	80.00		240.00																			80.00		160.00																	80.00			80.00		2.67			2.67			2.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0735	002	0	1	04	01	H0735_002_0	9	Specialty Tier	4	11	1	1	5	1	110		10	110		1	30		90				1	2	30		90					29	31				620.30	28		28																		28		28																28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	030	0	1	01	01	H0755_030_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	030	0	1	01	01	H0755_030_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	030	0	1	01	01	H0755_030_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	030	0	1	01	01	H0755_030_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	030	0	1	01	01	H0755_030_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				759.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	031	0	1	01	01	H0755_031_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	031	0	1	01	01	H0755_031_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	031	0	1	01	01	H0755_031_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	031	0	1	01	01	H0755_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	031	0	1	01	01	H0755_031_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				746.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	033	0	1	01	01	H0755_033_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	033	0	1	01	01	H0755_033_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	033	0	1	01	01	H0755_033_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	033	0	1	01	01	H0755_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	033	0	1	01	01	H0755_033_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				624.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	034	0	1	01	01	H0755_034_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	034	0	1	01	01	H0755_034_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	034	0	1	01	01	H0755_034_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	034	0	1	01	01	H0755_034_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	034	0	1	01	01	H0755_034_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				732.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	035	0	1	01	01	H0755_035_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	035	0	1	01	01	H0755_035_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	035	0	1	01	01	H0755_035_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	035	0	1	01	01	H0755_035_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	035	0	1	01	01	H0755_035_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				798.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	036	0	1	01	01	H0755_036_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	036	0	1	01	01	H0755_036_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	036	0	1	01	01	H0755_036_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	036	0	1	01	01	H0755_036_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	036	0	1	01	01	H0755_036_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				871.00	32		32																										32						32			32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	038	0	1	01	01	H0755_038_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	038	0	1	01	01	H0755_038_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	038	0	1	01	01	H0755_038_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	038	0	1	01	01	H0755_038_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0755	038	0	1	01	01	H0755_038_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				769.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0811	001	0	1	49	05	H0811_001_0	3	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0811	001	0	1	49	05	H0811_001_0	3	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0811	001	0	1	49	05	H0811_001_0	3	Non-Medicare Rx Drugs	4	11			3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0811	001	0	1	49	05	H0811_001_0	3	Non-Medicare OTC Drugs	4	11			4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0838	020	0	1	01	01	H0838_020_0	12	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	020	0	1	01	01	H0838_020_0	12	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				8.25	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	020	0	1	01	01	H0838_020_0	12	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				81.65	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	020	0	1	01	01	H0838_020_0	12	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				43.29	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	020	0	1	01	01	H0838_020_0	12	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	020	0	1	01	01	H0838_020_0	12	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	024	0	1	01	01	H0838_024_0	13	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	024	0	1	01	01	H0838_024_0	13	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	024	0	1	01	01	H0838_024_0	13	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				69.28	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	024	0	1	01	01	H0838_024_0	13	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				39.37	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	024	0	1	01	01	H0838_024_0	13	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	024	0	1	01	01	H0838_024_0	13	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	025	0	1	01	01	H0838_025_0	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	025	0	1	01	01	H0838_025_0	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0838	025	0	1	01	01	H0838_025_0	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	025	0	1	01	01	H0838_025_0	13	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	025	0	1	01	01	H0838_025_0	13	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					225.00																75.00				75.00		2.50						2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	025	0	1	01	01	H0838_025_0	13	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	025	0	1	01	01	H0838_025_0	13	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	025	0	1	01	01	H0838_025_0	13	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0838	026	0	1	01	01	H0838_026_0	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	026	0	1	01	01	H0838_026_0	9	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0838	026	0	1	01	01	H0838_026_0	9	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	026	0	1	01	01	H0838_026_0	9	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	026	0	1	01	01	H0838_026_0	9	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					225.00																75.00				75.00		2.50						2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	026	0	1	01	01	H0838_026_0	9	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	026	0	1	01	01	H0838_026_0	9	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	027	0	1	01	01	H0838_027_0	8	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	027	0	1	01	01	H0838_027_0	8	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				5.92	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	027	0	1	01	01	H0838_027_0	8	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				80.11	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	027	0	1	01	01	H0838_027_0	8	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				45.81	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	027	0	1	01	01	H0838_027_0	8	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	027	0	1	01	01	H0838_027_0	8	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	028	0	1	01	01	H0838_028_0	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	028	0	1	01	01	H0838_028_0	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0838	028	0	1	01	01	H0838_028_0	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	028	0	1	01	01	H0838_028_0	13	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	028	0	1	01	01	H0838_028_0	13	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					225.00																75.00				75.00		2.50						2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	028	0	1	01	01	H0838_028_0	13	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	028	0	1	01	01	H0838_028_0	13	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	028	0	1	01	01	H0838_028_0	13	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0838	029	0	1	01	01	H0838_029_0	13	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	029	0	1	01	01	H0838_029_0	13	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				5.75	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	029	0	1	01	01	H0838_029_0	13	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				65.37	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	029	0	1	01	01	H0838_029_0	13	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				34.69	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	029	0	1	01	01	H0838_029_0	13	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	029	0	1	01	01	H0838_029_0	13	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	032	0	1	01	01	H0838_032_0	14	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0838	032	0	1	01	01	H0838_032_0	14	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0838	032	0	1	01	01	H0838_032_0	14	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0838	032	0	1	01	01	H0838_032_0	14	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0838	032	0	1	01	01	H0838_032_0	14	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0838	032	0	1	01	01	H0838_032_0	14	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0838	032	0	1	01	01	H0838_032_0	14	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H0838	032	0	1	01	01	H0838_032_0	14	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H0838	033	0	1	01	01	H0838_033_0	13	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	033	0	1	01	01	H0838_033_0	13	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				6.67	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	033	0	1	01	01	H0838_033_0	13	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				70.55	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	033	0	1	01	01	H0838_033_0	13	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				41.49	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	033	0	1	01	01	H0838_033_0	13	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	033	0	1	01	01	H0838_033_0	13	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	035	0	1	01	01	H0838_035_0	15	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	035	0	1	01	01	H0838_035_0	15	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0838	035	0	1	01	01	H0838_035_0	15	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	035	0	1	01	01	H0838_035_0	15	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	035	0	1	01	01	H0838_035_0	15	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					225.00																75.00				75.00		2.50						2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	035	0	1	01	01	H0838_035_0	15	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	035	0	1	01	01	H0838_035_0	15	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	036	0	1	01	01	H0838_036_0	15	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	036	0	1	01	01	H0838_036_0	15	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				6.47	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	036	0	1	01	01	H0838_036_0	15	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				75.89	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	036	0	1	01	01	H0838_036_0	15	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				44.78	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	036	0	1	01	01	H0838_036_0	15	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	036	0	1	01	01	H0838_036_0	15	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	037	0	1	01	01	H0838_037_0	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	037	0	1	01	01	H0838_037_0	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0838	037	0	1	01	01	H0838_037_0	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	037	0	1	01	01	H0838_037_0	13	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	037	0	1	01	01	H0838_037_0	13	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	037	0	1	01	01	H0838_037_0	13	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	037	0	1	01	01	H0838_037_0	13	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0838	037	0	1	01	01	H0838_037_0	13	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H0904	004	0	1	01	01	H0904_004_0	9	Preferred Generic	4	01	1	2	1	1	110		01	010		1	30		90				1	1	30						30		31	5.00		5.00																			5.00																		5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	004	0	1	01	01	H0904_004_0	9	Generic	4	01	1	2	2	1	110		01	010		1	30		90				1	1	30						30		31	10.00		10.00																			10.00																		10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	004	0	1	01	01	H0904_004_0	9	Preferred Brand	4	10	1	2	3	1	110		01	010		1	30		90				1	1	30						30		31	40.00		40.00																			40.00																		40.00				40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	004	0	1	01	01	H0904_004_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		01	010		1	30		90				1	1	30						30		31	60.00		60.00																			60.00																		60.00				60.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	004	0	1	01	01	H0904_004_0	9	Specialty Tier	4	11	1	1	5	1	110		01	010		1	30		90				1	1	30						30		31				596.00	33		33																		33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	005	0	1	01	01	H0904_005_0	8	Preferred Generic	4	01	1	2	1	1	110		01	010		1	30		90				1	1	30						30		31	2.00		2.00																			2.00																		2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	005	0	1	01	01	H0904_005_0	8	Generic	4	01	1	2	2	1	110		01	010		1	30		90				1	1	30						30		31	8.00		8.00																			8.00																		8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	005	0	1	01	01	H0904_005_0	8	Preferred Brand	4	10	1	2	3	1	110		01	010		1	30		90				1	1	30						30		31	35.00		35.00																			35.00																		35.00				35.00		1.17			1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	005	0	1	01	01	H0904_005_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	010		1	30		90				1	1	30						30		31	60.00		60.00																			60.00																		60.00				60.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	005	0	1	01	01	H0904_005_0	8	Specialty Tier	4	11	1	1	5	1	110		01	010		1	30		90				1	1	30						30		31				596.00	33		33																		33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	006	0	1	01	01	H0904_006_0	8	Preferred Generic	4	01	1	2	1	1	110		01	010		1	30		90				1	1	30						30		31	5.00		5.00																			5.00																		5.00				5.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	006	0	1	01	01	H0904_006_0	8	Generic	4	01	1	2	2	1	110		01	010		1	30		90				1	1	30						30		31	10.00		10.00																			10.00																		10.00				10.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	006	0	1	01	01	H0904_006_0	8	Preferred Brand	4	10	1	2	3	1	110		01	010		1	30		90				1	1	30						30		31	40.00		40.00																			40.00																		40.00				40.00		1.17			1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	006	0	1	01	01	H0904_006_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	010		1	30		90				1	1	30						30		31	60.00		60.00																			60.00																		60.00				60.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0904	006	0	1	01	01	H0904_006_0	8	Specialty Tier	4	11	1	1	5	1	110		01	010		1	30		90				1	1	30						30		31				596.00	33		33																		33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H0908	001	0	1	01	01	H0908_001_0	6	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0908	001	0	1	01	01	H0908_001_0	6	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0908	001	0	1	01	01	H0908_001_0	6	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0908	001	0	1	01	01	H0908_001_0	6	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0908	001	0	1	01	01	H0908_001_0	6	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0908	001	0	1	01	01	H0908_001_0	6	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H0913	002	0	1	01	01	H0913_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	002	0	1	01	01	H0913_002_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	002	0	1	01	01	H0913_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	002	0	1	01	01	H0913_002_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				75.81	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	002	0	1	01	01	H0913_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				578.94	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	012	0	1	01	01	H0913_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	012	0	1	01	01	H0913_012_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	012	0	1	01	01	H0913_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	012	0	1	01	01	H0913_012_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				71.76	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	012	0	1	01	01	H0913_012_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				646.23	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	013	0	1	01	01	H0913_013_0	2	Preferred Generic	2	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	013	0	1	01	01	H0913_013_0	2	Generic	2	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	013	0	1	01	01	H0913_013_0	2	Preferred Brand	2	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	013	0	1	01	01	H0913_013_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.45	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0913	013	0	1	01	01	H0913_013_0	2	Specialty Tier	2	11	1	1	5	1	010		01		010	1	30											30			30		31				446.45	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H0927	001	0	1	48	05	H0927_001_0	7	Generic Drugs	4	11			1	1	110		01	100		1	30		90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0927	001	0	1	48	05	H0927_001_0	7	Brand Drugs	4	11			2	1	110		01	100		1	30		90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0927	001	0	1	48	05	H0927_001_0	7	Non-Medicare OTC Drugs	4	11			3	1	110		01	100		1	30		90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1016	001	0	1	01	01	H1016_001_0	15	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1016	001	0	1	01	01	H1016_001_0	15	Preferred Generic	4	11	3	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1016	001	0	1	01	01	H1016_001_0	15	Generic	4	11	3	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1016	001	0	1	01	01	H1016_001_0	15	Generic	4	11	3	2	2	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1016	001	0	1	01	01	H1016_001_0	15	Preferred Brand	4	11	3	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	100.00																									40.00	80.00	120.00				40.00	80.00	100.00				40.00				40.00		1.33				1.33	1.33	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1016	001	0	1	01	01	H1016_001_0	15	Non-Preferred Drug	4	11	3	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	75.00	150.00	187.50																									75.00	150.00	225.00				75.00	150.00	187.50				75.00				75.00		2.50				2.50	2.50	2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1016	001	0	1	01	01	H1016_001_0	15	Specialty Tier	4	11	3	1	5	1	010		01			1	30														30		31				696.39	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1016	021	0	1	01	01	H1016_021_0	14	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1016	021	0	1	01	01	H1016_021_0	14	Preferred Generic	4	11	3	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1016	021	0	1	01	01	H1016_021_0	14	Generic	4	11	3	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	7.00	14.00	17.50																									7.00	14.00	21.00				7.00	14.00	17.50				7.00				7.00		0.23				0.23	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1016	021	0	1	01	01	H1016_021_0	14	Generic	4	11	3	2	2	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	7.00	14.00	17.50																									7.00	14.00	21.00				7.00	14.00	17.50				7.00				7.00		0.23				0.23	0.23	0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1016	021	0	1	01	01	H1016_021_0	14	Preferred Brand	4	11	3	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	100.00																									40.00	80.00	120.00				40.00	80.00	100.00				40.00				40.00		1.33				1.33	1.33	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1016	021	0	1	01	01	H1016_021_0	14	Non-Preferred Drug	4	11	3	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	75.00	150.00	187.50																									75.00	150.00	225.00				75.00	150.00	187.50				75.00				75.00		2.50				2.50	2.50	2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1016	021	0	1	01	01	H1016_021_0	14	Specialty Tier	4	11	3	1	5	1	010		01			1	30														30		31				696.39	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	001	0	1	01	01	H1019_001_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	001	0	1	01	01	H1019_001_0	2	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1019	001	0	1	01	01	H1019_001_0	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	001	0	1	01	01	H1019_001_0	2	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1019	001	0	1	01	01	H1019_001_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					20.00		60.00											47.00		141.00				20.00		50.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	001	0	1	01	01	H1019_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	001	0	1	01	01	H1019_001_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	006	0	1	01	01	H1019_006_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	006	0	1	01	01	H1019_006_0	2	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1019	006	0	1	01	01	H1019_006_0	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	006	0	1	01	01	H1019_006_0	2	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1019	006	0	1	01	01	H1019_006_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	006	0	1	01	01	H1019_006_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								36.00		108.00					35.00		105.00											36.00		108.00				35.00		95.00				36.00				36.00			1.20	1.17		1.20	1.17	1.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	006	0	1	01	01	H1019_006_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	023	0	1	01	01	H1019_023_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	023	0	1	01	01	H1019_023_0	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	023	0	1	01	01	H1019_023_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	023	0	1	01	01	H1019_023_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	023	0	1	01	01	H1019_023_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	024	0	1	01	01	H1019_024_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	024	0	1	01	01	H1019_024_0	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	024	0	1	01	01	H1019_024_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	024	0	1	01	01	H1019_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	024	0	1	01	01	H1019_024_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	026	0	1	01	01	H1019_026_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	026	0	1	01	01	H1019_026_0	5	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	026	0	1	01	01	H1019_026_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	026	0	1	01	01	H1019_026_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	026	0	1	01	01	H1019_026_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	028	0	1	01	01	H1019_028_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	028	0	1	01	01	H1019_028_0	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	028	0	1	01	01	H1019_028_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	028	0	1	01	01	H1019_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	028	0	1	01	01	H1019_028_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	043	0	1	01	01	H1019_043_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	043	0	1	01	01	H1019_043_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	043	0	1	01	01	H1019_043_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		80.00				47.00				47.00			1.57	1		1.57	1	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	043	0	1	01	01	H1019_043_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	043	0	1	01	01	H1019_043_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	054	0	1	01	01	H1019_054_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	054	0	1	01	01	H1019_054_0	2	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1019	054	0	1	01	01	H1019_054_0	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	054	0	1	01	01	H1019_054_0	2	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1019	054	0	1	01	01	H1019_054_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					10.00		30.00											47.00		141.00				10.00		20.00				47.00				47.00			1.57	0.33		1.57	0.33	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	054	0	1	01	01	H1019_054_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					55.00		165.00											100.00		300.00				55.00		155.00				100.00				100.00			3.33	1.83		3.33	1.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	054	0	1	01	01	H1019_054_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	057	0	1	01	01	H1019_057_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	057	0	1	01	01	H1019_057_0	2	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1019	057	0	1	01	01	H1019_057_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	057	0	1	01	01	H1019_057_0	2	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1019	057	0	1	01	01	H1019_057_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		80.00				47.00				47.00			1.57	1		1.57	1	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	057	0	1	01	01	H1019_057_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	057	0	1	01	01	H1019_057_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	060	0	1	01	01	H1019_060_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	060	0	1	01	01	H1019_060_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	060	0	1	01	01	H1019_060_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	060	0	1	01	01	H1019_060_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	060	0	1	01	01	H1019_060_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	065	0	1	01	01	H1019_065_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	065	0	1	01	01	H1019_065_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	065	0	1	01	01	H1019_065_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	065	0	1	01	01	H1019_065_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	065	0	1	01	01	H1019_065_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	069	0	1	01	01	H1019_069_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	069	0	1	01	01	H1019_069_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	069	0	1	01	01	H1019_069_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	069	0	1	01	01	H1019_069_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	069	0	1	01	01	H1019_069_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	073	0	1	01	01	H1019_073_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	073	0	1	01	01	H1019_073_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	073	0	1	01	01	H1019_073_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	073	0	1	01	01	H1019_073_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	073	0	1	01	01	H1019_073_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	076	0	1	01	01	H1019_076_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	076	0	1	01	01	H1019_076_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	076	0	1	01	01	H1019_076_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	076	0	1	01	01	H1019_076_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	076	0	1	01	01	H1019_076_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	077	0	1	01	01	H1019_077_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	077	0	1	01	01	H1019_077_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	077	0	1	01	01	H1019_077_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	077	0	1	01	01	H1019_077_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	077	0	1	01	01	H1019_077_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	079	0	1	01	01	H1019_079_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	079	0	1	01	01	H1019_079_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	079	0	1	01	01	H1019_079_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	079	0	1	01	01	H1019_079_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	079	0	1	01	01	H1019_079_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	081	0	1	01	01	H1019_081_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	081	0	1	01	01	H1019_081_0	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	081	0	1	01	01	H1019_081_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	081	0	1	01	01	H1019_081_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	081	0	1	01	01	H1019_081_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	083	0	1	01	01	H1019_083_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	083	0	1	01	01	H1019_083_0	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	083	0	1	01	01	H1019_083_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	083	0	1	01	01	H1019_083_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	083	0	1	01	01	H1019_083_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	085	0	1	01	01	H1019_085_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	085	0	1	01	01	H1019_085_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	085	0	1	01	01	H1019_085_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	085	0	1	01	01	H1019_085_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	085	0	1	01	01	H1019_085_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	089	0	1	01	01	H1019_089_0	3	Preferred Generic	4	11	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.00	25		25				1.00	24		24										25		25				24		24			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	089	0	1	01	01	H1019_089_0	3	Generic	4	11	3	1	2	1		110	01		110	1				30		90	2	2				30		90	30		31											6.00	25		25				5.00	24		24										25		25				24		24			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	089	0	1	01	01	H1019_089_0	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	25		25				34.00	24		24										25		25				24		24			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	089	0	1	01	01	H1019_089_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	25		25				38.00	24		24										25		25				24		24			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	089	0	1	01	01	H1019_089_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	090	0	1	01	01	H1019_090_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	090	0	1	01	01	H1019_090_0	5	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	090	0	1	01	01	H1019_090_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	090	0	1	01	01	H1019_090_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	090	0	1	01	01	H1019_090_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	091	0	1	01	01	H1019_091_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	091	0	1	01	01	H1019_091_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	091	0	1	01	01	H1019_091_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	091	0	1	01	01	H1019_091_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	091	0	1	01	01	H1019_091_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	092	0	1	01	01	H1019_092_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	092	0	1	01	01	H1019_092_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	092	0	1	01	01	H1019_092_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	092	0	1	01	01	H1019_092_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	092	0	1	01	01	H1019_092_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	094	0	1	01	01	H1019_094_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	094	0	1	01	01	H1019_094_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	094	0	1	01	01	H1019_094_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	094	0	1	01	01	H1019_094_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1019	094	0	1	01	01	H1019_094_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1026	001	0	1	01	01	H1026_001_0	10	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	001	0	1	01	01	H1026_001_0	10	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	001	0	1	01	01	H1026_001_0	10	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					5.00		15.00					5.00		15.00																15.00				5.00			0.48	0.16	0.16			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	001	0	1	01	01	H1026_001_0	10	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					5.00		15.00					5.00		15.00																15.00				5.00			0.48	0.16	0.16			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	001	0	1	01	01	H1026_001_0	10	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	001	0	1	01	01	H1026_001_0	10	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	001	0	1	01	01	H1026_001_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											582.02	33						582.02	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	001	0	1	01	01	H1026_001_0	10	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	001	0	1	01	01	H1026_001_0	10	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	038	0	1	01	01	H1026_038_0	11	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								17.00		51.00					7.00		21.00					7.00		21.00																17.00				7.00			0.55	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	038	0	1	01	01	H1026_038_0	11	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								17.00		51.00					7.00		21.00					7.00		21.00																17.00				7.00			0.55	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	038	0	1	01	01	H1026_038_0	11	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	038	0	1	01	01	H1026_038_0	11	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	038	0	1	01	01	H1026_038_0	11	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	038	0	1	01	01	H1026_038_0	11	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	038	0	1	01	01	H1026_038_0	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											581.55	33						581.55	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	038	0	1	01	01	H1026_038_0	11	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	038	0	1	01	01	H1026_038_0	11	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	040	0	1	01	01	H1026_040_0	13	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	040	0	1	01	01	H1026_040_0	13	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	040	0	1	01	01	H1026_040_0	13	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	040	0	1	01	01	H1026_040_0	13	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	040	0	1	01	01	H1026_040_0	13	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	040	0	1	01	01	H1026_040_0	13	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											610.26	33						610.26	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	040	0	1	01	01	H1026_040_0	13	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	040	0	1	01	01	H1026_040_0	13	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	056	0	1	01	01	H1026_056_0	11	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					5.00		15.00					5.00		15.00																15.00				5.00			0.48	0.16	0.16			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	056	0	1	01	01	H1026_056_0	11	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					5.00		15.00					5.00		15.00																15.00				5.00			0.48	0.16	0.16			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	056	0	1	01	01	H1026_056_0	11	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	056	0	1	01	01	H1026_056_0	11	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	056	0	1	01	01	H1026_056_0	11	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	056	0	1	01	01	H1026_056_0	11	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	056	0	1	01	01	H1026_056_0	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											636.62	33						636.62	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	056	0	1	01	01	H1026_056_0	11	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	056	0	1	01	01	H1026_056_0	11	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	057	0	1	01	01	H1026_057_0	11	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								14.00		42.00					4.00		12.00					4.00		12.00																14.00				4.00			0.45	0.13	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	057	0	1	01	01	H1026_057_0	11	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								14.00		42.00					4.00		12.00					4.00		12.00																14.00				4.00			0.45	0.13	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	057	0	1	01	01	H1026_057_0	11	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	057	0	1	01	01	H1026_057_0	11	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	057	0	1	01	01	H1026_057_0	11	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	057	0	1	01	01	H1026_057_0	11	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	057	0	1	01	01	H1026_057_0	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											610.26	33						610.26	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	057	0	1	01	01	H1026_057_0	11	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	057	0	1	01	01	H1026_057_0	11	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	058	0	1	01	01	H1026_058_0	10	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	058	0	1	01	01	H1026_058_0	10	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	058	0	1	01	01	H1026_058_0	10	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					5.00		15.00					5.00		15.00																15.00				5.00			0.48	0.16	0.16			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	058	0	1	01	01	H1026_058_0	10	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					5.00		15.00					5.00		15.00																15.00				5.00			0.48	0.16	0.16			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	058	0	1	01	01	H1026_058_0	10	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	058	0	1	01	01	H1026_058_0	10	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	058	0	1	01	01	H1026_058_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											528.24	33						528.24	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	058	0	1	01	01	H1026_058_0	10	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	058	0	1	01	01	H1026_058_0	10	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	059	0	1	01	01	H1026_059_0	10	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	059	0	1	01	01	H1026_059_0	10	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	059	0	1	01	01	H1026_059_0	10	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	059	0	1	01	01	H1026_059_0	10	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	059	0	1	01	01	H1026_059_0	10	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					35.00		105.00					35.00		105.00																45.00				35.00			1.45	1.13	1.13			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	059	0	1	01	01	H1026_059_0	10	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								90.00		270.00					80.00		240.00					80.00		240.00																90.00				80.00			2.90	2.58	2.58			2.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	059	0	1	01	01	H1026_059_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											528.24	33						528.24	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	059	0	1	01	01	H1026_059_0	10	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	059	0	1	01	01	H1026_059_0	10	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		3
H1026	060	0	1	01	01	H1026_060_0	12	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	060	0	1	01	01	H1026_060_0	12	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	060	0	1	01	01	H1026_060_0	12	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	060	0	1	01	01	H1026_060_0	12	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	060	0	1	01	01	H1026_060_0	12	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								12.00		36.00					0.00		0.00					0.00		0.00																12.00				0.00			0.39	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	060	0	1	01	01	H1026_060_0	12	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								75.00		225.00					65.00		195.00					65.00		195.00																75.00				65.00			2.42	2.10	2.10			2.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	060	0	1	01	01	H1026_060_0	12	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											582.02	33						582.02	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	060	0	1	01	01	H1026_060_0	12	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	060	0	1	01	01	H1026_060_0	12	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		3
H1026	061	0	1	01	01	H1026_061_0	10	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	061	0	1	01	01	H1026_061_0	10	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	061	0	1	01	01	H1026_061_0	10	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	061	0	1	01	01	H1026_061_0	10	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	061	0	1	01	01	H1026_061_0	10	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					35.00		105.00					35.00		105.00																45.00				35.00			1.45	1.13	1.13			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	061	0	1	01	01	H1026_061_0	10	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	061	0	1	01	01	H1026_061_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											582.02	33						582.02	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	061	0	1	01	01	H1026_061_0	10	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	061	0	1	01	01	H1026_061_0	10	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		3
H1026	062	0	1	01	01	H1026_062_0	10	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	062	0	1	01	01	H1026_062_0	10	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	062	0	1	01	01	H1026_062_0	10	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	062	0	1	01	01	H1026_062_0	10	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H1026	062	0	1	01	01	H1026_062_0	10	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					30.00		90.00					30.00		90.00																40.00				30.00			1.29	0.97	0.97			0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	062	0	1	01	01	H1026_062_0	10	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	062	0	1	01	01	H1026_062_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											528.24	33						528.24	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	062	0	1	01	01	H1026_062_0	10	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1026	062	0	1	01	01	H1026_062_0	10	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		3
H1026	063	0	1	01	01	H1026_063_0	11	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	063	0	1	01	01	H1026_063_0	11	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1026	063	0	1	01	01	H1026_063_0	11	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	063	0	1	01	01	H1026_063_0	11	Generic	4	01	1	2	2	3	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1026	063	0	1	01	01	H1026_063_0	11	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	1	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	063	0	1	01	01	H1026_063_0	11	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	31		90				1	1	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	063	0	1	01	01	H1026_063_0	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				583.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	063	0	1	01	01	H1026_063_0	11	Supplemental Drugs	4	10	2	2	6	1	010		01	010		1	31								31						31		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	063	0	1	01	01	H1026_063_0	11	Supplemental Drugs	4	10	2	2	6	3	010		01	010		1	31								31						31		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1026	064	0	1	01	01	H1026_064_0	12	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	064	0	1	01	01	H1026_064_0	12	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1026	064	0	1	01	01	H1026_064_0	12	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	064	0	1	01	01	H1026_064_0	12	Generic	4	01	1	2	2	3	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1026	064	0	1	01	01	H1026_064_0	12	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	1	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	064	0	1	01	01	H1026_064_0	12	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	31		90				1	1	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	064	0	1	01	01	H1026_064_0	12	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				583.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	064	0	1	01	01	H1026_064_0	12	Supplemental Drugs	4	10	2	2	6	1	010		01	010		1	31								31						31		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	064	0	1	01	01	H1026_064_0	12	Supplemental Drugs	4	10	2	2	6	3	010		01	010		1	31								31						31		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1026	065	0	1	01	01	H1026_065_0	11	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	065	0	1	01	01	H1026_065_0	11	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1026	065	0	1	01	01	H1026_065_0	11	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	065	0	1	01	01	H1026_065_0	11	Generic	4	01	1	2	2	3	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1026	065	0	1	01	01	H1026_065_0	11	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	1	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	065	0	1	01	01	H1026_065_0	11	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	31		90				1	1	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	065	0	1	01	01	H1026_065_0	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				583.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	065	0	1	01	01	H1026_065_0	11	Supplemental Drugs	4	10	2	2	6	1	010		01	010		1	31								31						31		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	065	0	1	01	01	H1026_065_0	11	Supplemental Drugs	4	10	2	2	6	3	010		01	010		1	31								31						31		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1026	066	0	1	01	01	H1026_066_0	11	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	066	0	1	01	01	H1026_066_0	11	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1026	066	0	1	01	01	H1026_066_0	11	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	066	0	1	01	01	H1026_066_0	11	Generic	4	01	1	2	2	3	110		01	110		1	31		90				1	1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1026	066	0	1	01	01	H1026_066_0	11	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	1	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	066	0	1	01	01	H1026_066_0	11	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	31		90				1	1	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	066	0	1	01	01	H1026_066_0	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				583.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	066	0	1	01	01	H1026_066_0	11	Supplemental Drugs	4	10	2	2	6	1	010		01	010		1	31								31						31		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H1026	066	0	1	01	01	H1026_066_0	11	Supplemental Drugs	4	10	2	2	6	3	010		01	010		1	31								31						31		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs											1		
H1032	032	0	1	01	01	H1032_032_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	032	0	1	01	01	H1032_032_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	032	0	1	01	01	H1032_032_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	25.00		75.00																									25.00		75.00				25.00		62.50				25.00				25.00		0.83				0.83	0.83	0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	032	0	1	01	01	H1032_032_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		187.50				75.00				75.00		2.50				2.50	2.50	2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	032	0	1	01	01	H1032_032_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				793.87	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	040	0	1	01	01	H1032_040_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	040	0	1	01	01	H1032_040_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	040	0	1	01	01	H1032_040_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	25.00		75.00																									25.00		75.00				25.00		62.50				25.00				25.00		0.83				0.83	0.83	0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	040	0	1	01	01	H1032_040_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	50.00		150.00																									50.00		150.00				50.00		125.00				50.00				50.00		1.67				1.67	1.67	1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	040	0	1	01	01	H1032_040_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				755.19	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	061	0	1	01	01	H1032_061_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	061	0	1	01	01	H1032_061_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	061	0	1	01	01	H1032_061_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	061	0	1	01	01	H1032_061_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.22	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	061	0	1	01	01	H1032_061_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				515.80	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	073	0	1	01	01	H1032_073_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	073	0	1	01	01	H1032_073_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	073	0	1	01	01	H1032_073_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	073	0	1	01	01	H1032_073_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				64.27	47		47																								47		47				47		47			47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	073	0	1	01	01	H1032_073_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				643.01	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	079	0	1	02	01	H1032_079_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	079	0	1	02	01	H1032_079_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	079	0	1	02	01	H1032_079_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		100.00				40.00				40.00		1.33				1.33	1.33	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	079	0	1	02	01	H1032_079_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				60.73	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	079	0	1	02	01	H1032_079_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				783.18	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	091	0	1	02	01	H1032_091_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	091	0	1	02	01	H1032_091_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	091	0	1	02	01	H1032_091_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	091	0	1	02	01	H1032_091_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		187.50				75.00				75.00		2.50				2.50	2.50	2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	091	0	1	02	01	H1032_091_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				780.83	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	124	0	1	01	01	H1032_124_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	124	0	1	01	01	H1032_124_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	124	0	1	01	01	H1032_124_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	124	0	1	01	01	H1032_124_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.03	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	124	0	1	01	01	H1032_124_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				513.90	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	133	0	1	02	01	H1032_133_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	133	0	1	02	01	H1032_133_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	133	0	1	02	01	H1032_133_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	133	0	1	02	01	H1032_133_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				59.05	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	133	0	1	02	01	H1032_133_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				610.22	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	170	0	1	01	01	H1032_170_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	170	0	1	01	01	H1032_170_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	170	0	1	01	01	H1032_170_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	170	0	1	01	01	H1032_170_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				79.39	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	170	0	1	01	01	H1032_170_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				479.39	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	174	0	1	02	01	H1032_174_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	174	0	1	02	01	H1032_174_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	174	0	1	02	01	H1032_174_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	174	0	1	02	01	H1032_174_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		187.50				75.00				75.00		2.50				2.50	2.50	2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	174	0	1	02	01	H1032_174_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				717.20	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	175	0	1	01	01	H1032_175_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	175	0	1	01	01	H1032_175_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		10.00				4.00				4.00		0.13				0.13	0.13	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	175	0	1	01	01	H1032_175_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	175	0	1	01	01	H1032_175_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.10	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	175	0	1	01	01	H1032_175_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				478.21	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	176	0	1	01	01	H1032_176_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	176	0	1	01	01	H1032_176_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	176	0	1	01	01	H1032_176_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	46.00		138.00																									46.00		138.00				46.00		115.00				46.00				46.00		1.53				1.53	1.53	1.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	176	0	1	01	01	H1032_176_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.47	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	176	0	1	01	01	H1032_176_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				462.31	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	182	0	1	01	01	H1032_182_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	182	0	1	01	01	H1032_182_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	182	0	1	01	01	H1032_182_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	182	0	1	01	01	H1032_182_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.65	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	182	0	1	01	01	H1032_182_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				501.29	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	184	0	1	01	01	H1032_184_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	184	0	1	01	01	H1032_184_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	184	0	1	01	01	H1032_184_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	25.00		75.00																									25.00		75.00				25.00		62.50				25.00				25.00		0.83				0.83	0.83	0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	184	0	1	01	01	H1032_184_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		187.50				75.00				75.00		2.50				2.50	2.50	2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	184	0	1	01	01	H1032_184_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				833.64	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	186	0	1	01	01	H1032_186_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	186	0	1	01	01	H1032_186_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	186	0	1	01	01	H1032_186_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	25.00		75.00																									25.00		75.00				25.00		62.50				25.00				25.00		0.83				0.83	0.83	0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	186	0	1	01	01	H1032_186_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	50.00		150.00																									50.00		150.00				50.00		125.00				50.00				50.00		1.67				1.67	1.67	1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	186	0	1	01	01	H1032_186_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				833.75	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	187	1	1	01	01	H1032_187_1	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	187	1	1	01	01	H1032_187_1	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	187	1	1	01	01	H1032_187_1	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	187	1	1	01	01	H1032_187_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		187.50				75.00				75.00		2.50				2.50	2.50	2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	187	1	1	01	01	H1032_187_1	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				834.01	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	187	2	1	01	01	H1032_187_2	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	187	2	1	01	01	H1032_187_2	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	187	2	1	01	01	H1032_187_2	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	187	2	1	01	01	H1032_187_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		187.50				75.00				75.00		2.50				2.50	2.50	2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	187	2	1	01	01	H1032_187_2	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				834.01	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	188	1	1	01	01	H1032_188_1	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	188	1	1	01	01	H1032_188_1	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	188	1	1	01	01	H1032_188_1	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	188	1	1	01	01	H1032_188_1	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				59.47	46		46																								46		46				46		46			46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	188	1	1	01	01	H1032_188_1	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				790.79	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	188	2	1	01	01	H1032_188_2	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	188	2	1	01	01	H1032_188_2	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	188	2	1	01	01	H1032_188_2	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	188	2	1	01	01	H1032_188_2	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				59.47	46		46																								46		46				46		46			46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1032	188	2	1	01	01	H1032_188_2	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				790.79	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1035	002	0	1	02	01	H1035_002_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			0.32	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	002	0	1	02	01	H1035_002_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			0.32	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier											1		
H1035	002	0	1	02	01	H1035_002_0	5	Generic	4	01	1	2	2	1		110	01	100		1				31		93	2	1			93				31		31								20.00		60.00					4.00		12.00							9.00																20.00				20.00			0.65	0.13				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	002	0	1	02	01	H1035_002_0	5	Generic	4	01	1	2	2	3		110	01	100		1				31		93	2	1			93				31		31								20.00		60.00					4.00		12.00							9.00																20.00				20.00			0.65	0.13				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier											1		
H1035	002	0	1	02	01	H1035_002_0	5	Preferred Brand	4	10	1	2	3	1		110	01	100		1				31		93	2	1			93				31		31								47.00		141.00					40.00		120.00							117.00																47.00				47.00			1.52	1.29				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	002	0	1	02	01	H1035_002_0	5	Non-Preferred Brand	4	10	1	2	4	1		110	01	100		1				31		93	2	1			93				31		31								100.00		300.00					80.00		240.00							237.00																100.00				100.00			3.23	2.58				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	002	0	1	02	01	H1035_002_0	5	Injectable Drugs	4	11	1	1	5	1		010	01			1				31											31		31											57.33	33						26.89	25																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	002	0	1	02	01	H1035_002_0	5	Specialty Tier	4	11	1	1	6	1		010	01			1				31											31		31											974.08	33						793.86	33																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	006	0	1	01	01	H1035_006_0	4	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					2.00		6.00							3.00																10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	006	0	1	01	01	H1035_006_0	4	Generic	4	01	1	2	2	1		110	01	100		1				31		93	2	1			93				31		31								20.00		60.00					7.00		21.00							18.00																20.00				20.00			0.65	0.23				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	006	0	1	01	01	H1035_006_0	4	Preferred Brand	4	10	1	2	3	1		110	01	100		1				31		93	2	1			93				31		31								47.00		141.00					42.00		126.00							123.00																47.00				47.00			1.52	1.35				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	006	0	1	01	01	H1035_006_0	4	Non-Preferred Brand	4	10	1	2	4	1		110	01	100		1				31		93	2	1			93				31		31								100.00		300.00					90.00		270.00							267.00																100.00				100.00			3.23	2.90				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	006	0	1	01	01	H1035_006_0	4	Injectable Drugs	4	11	1	1	5	1		010	01			1				31											31		31											32.51	27						30.51	25																							27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	006	0	1	01	01	H1035_006_0	4	Specialty Tier	4	11	1	1	6	1		010	01			1				31											31		31											798.84	27						708.24	27																							27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	010	0	1	01	01	H1035_010_0	4	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			0.32	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	010	0	1	01	01	H1035_010_0	4	Generic	4	01	1	2	2	1		110	01	100		1				31		93	2	1			93				31		31								20.00		60.00					7.00		21.00							18.00																20.00				20.00			0.65	0.23				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	010	0	1	01	01	H1035_010_0	4	Preferred Brand	4	10	1	2	3	1		110	01	100		1				31		93	2	1			93				31		31								47.00		141.00					42.00		126.00							123.00																47.00				47.00			1.52	1.35				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	010	0	1	01	01	H1035_010_0	4	Non-Preferred Brand	4	10	1	2	4	1		110	01	100		1				31		93	2	1			93				31		31								100.00		300.00					90.00		270.00							267.00																100.00				100.00			3.23	2.90				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	010	0	1	01	01	H1035_010_0	4	Injectable Drugs	4	11	1	1	5	1		010	01			1				31											31		31											33.46	33						28.46	25																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	010	0	1	01	01	H1035_010_0	4	Specialty Tier	4	11	1	1	6	1		010	01			1				31											31		31											1175.58	33						1175.58	33																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	011	0	1	01	01	H1035_011_0	4	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			0.32	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	011	0	1	01	01	H1035_011_0	4	Preferred Generic	4	01	1	2	1	3		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			0.32	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier											1		
H1035	011	0	1	01	01	H1035_011_0	4	Generic	4	01	1	2	2	1		110	01	100		1				31		93	2	1			93				31		31								20.00		60.00					7.00		21.00							18.00																20.00				20.00			0.65	0.23				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	011	0	1	01	01	H1035_011_0	4	Generic	4	01	1	2	2	3		110	01	100		1				31		93	2	1			93				31		31								20.00		60.00					7.00		21.00							18.00																20.00				20.00			0.65	0.23				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier											1		
H1035	011	0	1	01	01	H1035_011_0	4	Preferred Brand	4	10	1	2	3	1		110	01	100		1				31		93	2	1			93				31		31								47.00		141.00					42.00		126.00							123.00																47.00				47.00			1.52	1.35				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	011	0	1	01	01	H1035_011_0	4	Non-Preferred Brand	4	10	1	2	4	1		110	01	100		1				31		93	2	1			93				31		31								100.00		300.00					90.00		270.00							267.00																100.00				100.00			3.23	2.90				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	011	0	1	01	01	H1035_011_0	4	Injectable Drugs	4	11	1	1	5	1		010	01			1				31											31		31											33.36	33						28.36	25																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	011	0	1	01	01	H1035_011_0	4	Specialty Tier	4	11	1	1	6	1		010	01			1				31											31		31											974.08	33						1175.58	33																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	014	0	1	01	01	H1035_014_0	5	Preferred Generic	2	01	1	2	1	1		110	01	100		1				31		93	1	1			93				31		31								17.00		51.00					4.00		12.00							9.00																17.00				17.00			0.55	0.13				0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	014	0	1	01	01	H1035_014_0	5	Generic	2	01	1	2	2	1		110	01	100		1				31		93	2	1			93				31		31								20.00		60.00					8.00		24.00							21.00																20.00				20.00			0.65	0.26				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	014	0	1	01	01	H1035_014_0	5	Preferred Brand	2	10	1	2	3	1		110	01	100		1				31		93	2	1			93				31		31								47.00		141.00					45.00		135.00							132.00																47.00				47.00			1.52	1.45				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	014	0	1	01	01	H1035_014_0	5	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				31		93	2	1			93				31		31								100.00		300.00					98.00		294.00							291.00																100.00				100.00			3.23	3.16				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	014	0	1	01	01	H1035_014_0	5	Injectable Drugs	2	11	1	1	5	1		010	01			1				31											31		31											75.39	25						27.42	25																							25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	014	0	1	01	01	H1035_014_0	5	Specialty Tier	2	11	1	1	6	1		010	01			1				31											31		31											718.51	25						708.24	25																							25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	015	0	1	01	01	H1035_015_0	5	Preferred Generic	2	01	1	2	1	1		110	01	100		1				31		93	1	1			93				31		31								17.00		51.00					4.00		12.00							9.00																17.00				17.00			0.55	0.13				0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	015	0	1	01	01	H1035_015_0	5	Generic	2	01	1	2	2	1		110	01	100		1				31		93	2	1			93				31		31								20.00		60.00					8.00		24.00							21.00																20.00				20.00			0.65	0.26				0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	015	0	1	01	01	H1035_015_0	5	Preferred Brand	2	10	1	2	3	1		110	01	100		1				31		93	2	1			93				31		31								47.00		141.00					45.00		135.00							132.00																47.00				47.00			1.52	1.45				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	015	0	1	01	01	H1035_015_0	5	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				31		93	2	1			93				31		31								100.00		300.00					98.00		294.00							291.00																100.00				100.00			3.23	3.16				3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	015	0	1	01	01	H1035_015_0	5	Injectable Drugs	2	11	1	1	5	1		010	01			1				31											31		31											75.39	25						27.42	25																							25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1035	015	0	1	01	01	H1035_015_0	5	Specialty Tier	2	11	1	1	6	1		010	01			1				31											31		31											718.51	25						708.24	25																							25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H1036	025	0	1	01	01	H1036_025_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	025	0	1	01	01	H1036_025_0	2	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	025	0	1	01	01	H1036_025_0	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	025	0	1	01	01	H1036_025_0	2	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1036	025	0	1	01	01	H1036_025_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					10.00		30.00											47.00		141.00				10.00		20.00				47.00				47.00			1.57	0.33		1.57	0.33	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	025	0	1	01	01	H1036_025_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					55.00		165.00											100.00		300.00				55.00		155.00				100.00				100.00			3.33	1.83		3.33	1.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	025	0	1	01	01	H1036_025_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	044	0	1	01	01	H1036_044_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	044	0	1	01	01	H1036_044_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	044	0	1	01	01	H1036_044_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	044	0	1	01	01	H1036_044_0	3	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1036	044	0	1	01	01	H1036_044_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	044	0	1	01	01	H1036_044_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	044	0	1	01	01	H1036_044_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	054	0	1	01	01	H1036_054_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	054	0	1	01	01	H1036_054_0	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	054	0	1	01	01	H1036_054_0	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	054	0	1	01	01	H1036_054_0	4	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1036	054	0	1	01	01	H1036_054_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	054	0	1	01	01	H1036_054_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								50.00		150.00					45.00		135.00											50.00		150.00				45.00		125.00				50.00				50.00			1.67	1.50		1.67	1.50	1.61	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	054	0	1	01	01	H1036_054_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	062	0	1	01	01	H1036_062_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	062	0	1	01	01	H1036_062_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	062	0	1	01	01	H1036_062_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	062	0	1	01	01	H1036_062_0	3	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1036	062	0	1	01	01	H1036_062_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	062	0	1	01	01	H1036_062_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	062	0	1	01	01	H1036_062_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	065	0	1	01	01	H1036_065_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	065	0	1	01	01	H1036_065_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	065	0	1	01	01	H1036_065_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	065	0	1	01	01	H1036_065_0	3	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1036	065	0	1	01	01	H1036_065_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					20.00		60.00											47.00		141.00				20.00		50.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	065	0	1	01	01	H1036_065_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	065	0	1	01	01	H1036_065_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	067	0	1	01	01	H1036_067_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	067	0	1	01	01	H1036_067_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	067	0	1	01	01	H1036_067_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	067	0	1	01	01	H1036_067_0	3	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1036	067	0	1	01	01	H1036_067_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					10.00		30.00											47.00		141.00				10.00		20.00				47.00				47.00			1.57	0.33		1.57	0.33	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	067	0	1	01	01	H1036_067_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					55.00		165.00											100.00		300.00				55.00		155.00				100.00				100.00			3.33	1.83		3.33	1.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	067	0	1	01	01	H1036_067_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	068	0	1	01	01	H1036_068_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	068	0	1	01	01	H1036_068_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	068	0	1	01	01	H1036_068_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	068	0	1	01	01	H1036_068_0	3	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	068	0	1	01	01	H1036_068_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	068	0	1	01	01	H1036_068_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					89.00		267.00											100.00		300.00				89.00		257.00				100.00				100.00			3.33	2.97		3.33	2.97	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	068	0	1	01	01	H1036_068_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	074	0	1	01	01	H1036_074_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	074	0	1	01	01	H1036_074_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	074	0	1	01	01	H1036_074_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	074	0	1	01	01	H1036_074_0	3	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1036	074	0	1	01	01	H1036_074_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					15.00		45.00											47.00		141.00				15.00		35.00				47.00				47.00			1.57	0.50		1.57	0.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	074	0	1	01	01	H1036_074_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	074	0	1	01	01	H1036_074_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	077	0	1	01	01	H1036_077_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	077	0	1	01	01	H1036_077_0	5	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	077	0	1	01	01	H1036_077_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	077	0	1	01	01	H1036_077_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	077	0	1	01	01	H1036_077_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	081	0	1	01	01	H1036_081_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	081	0	1	01	01	H1036_081_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	081	0	1	01	01	H1036_081_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	081	0	1	01	01	H1036_081_0	3	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	081	0	1	01	01	H1036_081_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	081	0	1	01	01	H1036_081_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					89.00		267.00											100.00		300.00				89.00		257.00				100.00				100.00			3.33	2.97		3.33	2.97	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	081	0	1	01	01	H1036_081_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	102	0	1	01	01	H1036_102_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	102	0	1	01	01	H1036_102_0	5	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	102	0	1	01	01	H1036_102_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	102	0	1	01	01	H1036_102_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	102	0	1	01	01	H1036_102_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	103	0	1	01	01	H1036_103_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	103	0	1	01	01	H1036_103_0	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	103	0	1	01	01	H1036_103_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	103	0	1	01	01	H1036_103_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	103	0	1	01	01	H1036_103_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	104	0	1	01	01	H1036_104_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	104	0	1	01	01	H1036_104_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	104	0	1	01	01	H1036_104_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	104	0	1	01	01	H1036_104_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	104	0	1	01	01	H1036_104_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	121	0	1	01	01	H1036_121_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	121	0	1	01	01	H1036_121_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	121	0	1	01	01	H1036_121_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	121	0	1	01	01	H1036_121_0	3	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1036	121	0	1	01	01	H1036_121_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	121	0	1	01	01	H1036_121_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	121	0	1	01	01	H1036_121_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	130	0	1	01	01	H1036_130_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	130	0	1	01	01	H1036_130_0	2	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	130	0	1	01	01	H1036_130_0	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	130	0	1	01	01	H1036_130_0	2	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1036	130	0	1	01	01	H1036_130_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	130	0	1	01	01	H1036_130_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	130	0	1	01	01	H1036_130_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	137	0	1	01	01	H1036_137_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	137	0	1	01	01	H1036_137_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	137	0	1	01	01	H1036_137_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	137	0	1	01	01	H1036_137_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	137	0	1	01	01	H1036_137_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	138	0	1	01	01	H1036_138_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	138	0	1	01	01	H1036_138_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	138	0	1	01	01	H1036_138_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	138	0	1	01	01	H1036_138_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	138	0	1	01	01	H1036_138_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	140	0	1	01	01	H1036_140_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	140	0	1	01	01	H1036_140_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H1036	140	0	1	01	01	H1036_140_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	140	0	1	01	01	H1036_140_0	3	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H1036	140	0	1	01	01	H1036_140_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	140	0	1	01	01	H1036_140_0	3	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	2	
H1036	140	0	1	01	01	H1036_140_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					75.00		225.00											100.00		300.00				75.00		215.00				100.00				100.00			3.33	2.50		3.33	2.50	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	140	0	1	01	01	H1036_140_0	3	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					75.00		225.00											100.00		300.00				75.00		215.00				100.00				100.00			3.33	2.50		3.33	2.50	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H1036	140	0	1	01	01	H1036_140_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	140	0	1	01	01	H1036_140_0	3	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												24							24												24						24					24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H1036	143	0	1	01	01	H1036_143_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	143	0	1	01	01	H1036_143_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	2	
H1036	143	0	1	01	01	H1036_143_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	143	0	1	01	01	H1036_143_0	3	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H1036	143	0	1	01	01	H1036_143_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	143	0	1	01	01	H1036_143_0	3	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	2	
H1036	143	0	1	01	01	H1036_143_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	143	0	1	01	01	H1036_143_0	3	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H1036	143	0	1	01	01	H1036_143_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	143	0	1	01	01	H1036_143_0	3	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												24							24												24						24					24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H1036	146	0	1	01	01	H1036_146_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	146	0	1	01	01	H1036_146_0	2	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1036	146	0	1	01	01	H1036_146_0	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	146	0	1	01	01	H1036_146_0	2	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1036	146	0	1	01	01	H1036_146_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	146	0	1	01	01	H1036_146_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	146	0	1	01	01	H1036_146_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	151	0	1	01	01	H1036_151_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	151	0	1	01	01	H1036_151_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	151	0	1	01	01	H1036_151_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	151	0	1	01	01	H1036_151_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	151	0	1	01	01	H1036_151_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	153	0	1	01	01	H1036_153_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	153	0	1	01	01	H1036_153_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	153	0	1	01	01	H1036_153_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	153	0	1	01	01	H1036_153_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	153	0	1	01	01	H1036_153_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	156	0	1	01	01	H1036_156_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	156	0	1	01	01	H1036_156_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	156	0	1	01	01	H1036_156_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	156	0	1	01	01	H1036_156_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	156	0	1	01	01	H1036_156_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	156	0	1	01	01	H1036_156_0	4	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	156	0	1	01	01	H1036_156_0	4	Select Care Drugs	4	11	1	2	6	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1036	157	0	1	01	01	H1036_157_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	157	0	1	01	01	H1036_157_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	157	0	1	01	01	H1036_157_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	157	0	1	01	01	H1036_157_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	157	0	1	01	01	H1036_157_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	160	0	1	01	01	H1036_160_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	160	0	1	01	01	H1036_160_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	3	
H1036	160	0	1	01	01	H1036_160_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	160	0	1	01	01	H1036_160_0	3	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	3	3
H1036	160	0	1	01	01	H1036_160_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					15.00		45.00											47.00		141.00				15.00		35.00				47.00				47.00			1.57	0.50		1.57	0.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	160	0	1	01	01	H1036_160_0	3	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					15.00		45.00											47.00		141.00				15.00		35.00				47.00				47.00			1.57	0.50		1.57	0.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H1036	160	0	1	01	01	H1036_160_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	160	0	1	01	01	H1036_160_0	3	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	3	
H1036	160	0	1	01	01	H1036_160_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	160	0	1	01	01	H1036_160_0	3	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												24							24												24						24					24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	3	
H1036	160	0	1	01	01	H1036_160_0	3	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	160	0	1	01	01	H1036_160_0	3	Select Care Drugs	4	11	1	2	6	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1036	167	0	1	01	01	H1036_167_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	167	0	1	01	01	H1036_167_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								18.00		54.00					13.00		39.00											18.00		54.00				13.00		0.00				18.00				18.00			0.60	0.43		0.60	0.43	0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	167	0	1	01	01	H1036_167_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	167	0	1	01	01	H1036_167_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	167	0	1	01	01	H1036_167_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	168	0	1	01	01	H1036_168_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	168	0	1	01	01	H1036_168_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	168	0	1	01	01	H1036_168_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	168	0	1	01	01	H1036_168_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	168	0	1	01	01	H1036_168_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	171	0	1	01	01	H1036_171_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	171	0	1	01	01	H1036_171_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	171	0	1	01	01	H1036_171_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	171	0	1	01	01	H1036_171_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	171	0	1	01	01	H1036_171_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	175	0	1	01	01	H1036_175_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	175	0	1	01	01	H1036_175_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	175	0	1	01	01	H1036_175_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	175	0	1	01	01	H1036_175_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					89.00		267.00											100.00		300.00				89.00		257.00				100.00				100.00			3.33	2.97		3.33	2.97	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	175	0	1	01	01	H1036_175_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	175	0	1	01	01	H1036_175_0	4	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	175	0	1	01	01	H1036_175_0	4	Select Care Drugs	4	11	1	2	6	3		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1036	199	0	1	01	01	H1036_199_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	199	0	1	01	01	H1036_199_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	199	0	1	01	01	H1036_199_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	199	0	1	01	01	H1036_199_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	199	0	1	01	01	H1036_199_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	209	0	1	01	01	H1036_209_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	209	0	1	01	01	H1036_209_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	209	0	1	01	01	H1036_209_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	209	0	1	01	01	H1036_209_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	209	0	1	01	01	H1036_209_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	210	0	1	01	01	H1036_210_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	210	0	1	01	01	H1036_210_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	210	0	1	01	01	H1036_210_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	210	0	1	01	01	H1036_210_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	210	0	1	01	01	H1036_210_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	213	0	1	01	01	H1036_213_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	213	0	1	01	01	H1036_213_0	5	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	213	0	1	01	01	H1036_213_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	213	0	1	01	01	H1036_213_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	213	0	1	01	01	H1036_213_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	214	0	1	01	01	H1036_214_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	214	0	1	01	01	H1036_214_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	214	0	1	01	01	H1036_214_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	214	0	1	01	01	H1036_214_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	214	0	1	01	01	H1036_214_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	215	0	1	01	01	H1036_215_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	215	0	1	01	01	H1036_215_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	215	0	1	01	01	H1036_215_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	215	0	1	01	01	H1036_215_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	215	0	1	01	01	H1036_215_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	217	0	1	01	01	H1036_217_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	217	0	1	01	01	H1036_217_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	217	0	1	01	01	H1036_217_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	217	0	1	01	01	H1036_217_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	217	0	1	01	01	H1036_217_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	219	0	1	01	01	H1036_219_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	219	0	1	01	01	H1036_219_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	219	0	1	01	01	H1036_219_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	219	0	1	01	01	H1036_219_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	219	0	1	01	01	H1036_219_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	222	0	1	01	01	H1036_222_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	222	0	1	01	01	H1036_222_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	222	0	1	01	01	H1036_222_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	222	0	1	01	01	H1036_222_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	222	0	1	01	01	H1036_222_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	223	0	1	01	01	H1036_223_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	223	0	1	01	01	H1036_223_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	223	0	1	01	01	H1036_223_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	223	0	1	01	01	H1036_223_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	223	0	1	01	01	H1036_223_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	226	0	1	01	01	H1036_226_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	226	0	1	01	01	H1036_226_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	226	0	1	01	01	H1036_226_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	226	0	1	01	01	H1036_226_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	226	0	1	01	01	H1036_226_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	229	0	1	01	01	H1036_229_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	229	0	1	01	01	H1036_229_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	229	0	1	01	01	H1036_229_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		80.00				47.00				47.00			1.57	1		1.57	1	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	229	0	1	01	01	H1036_229_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	229	0	1	01	01	H1036_229_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	230	0	1	01	01	H1036_230_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	230	0	1	01	01	H1036_230_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	230	0	1	01	01	H1036_230_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	230	0	1	01	01	H1036_230_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	230	0	1	01	01	H1036_230_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	231	0	1	01	01	H1036_231_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	231	0	1	01	01	H1036_231_0	5	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					1.00		3.00											20.00		60.00				1.00		0.00				20.00				20.00			0.67	0.03		0.67	0.03	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	231	0	1	01	01	H1036_231_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	231	0	1	01	01	H1036_231_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	231	0	1	01	01	H1036_231_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	233	0	1	01	01	H1036_233_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	233	0	1	01	01	H1036_233_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	233	0	1	01	01	H1036_233_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	233	0	1	01	01	H1036_233_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	233	0	1	01	01	H1036_233_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	234	0	1	01	01	H1036_234_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	234	0	1	01	01	H1036_234_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	234	0	1	01	01	H1036_234_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	234	0	1	01	01	H1036_234_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	234	0	1	01	01	H1036_234_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	234	0	1	01	01	H1036_234_0	6	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1036	235	0	1	01	01	H1036_235_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	235	0	1	01	01	H1036_235_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	235	0	1	01	01	H1036_235_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	235	0	1	01	01	H1036_235_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	235	0	1	01	01	H1036_235_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	236	0	1	01	01	H1036_236_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	236	0	1	01	01	H1036_236_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	236	0	1	01	01	H1036_236_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	236	0	1	01	01	H1036_236_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	236	0	1	01	01	H1036_236_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	237	1	1	01	01	H1036_237_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	237	1	1	01	01	H1036_237_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	237	1	1	01	01	H1036_237_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	237	1	1	01	01	H1036_237_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	237	1	1	01	01	H1036_237_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	237	2	1	01	01	H1036_237_2	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	237	2	1	01	01	H1036_237_2	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	237	2	1	01	01	H1036_237_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	237	2	1	01	01	H1036_237_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	237	2	1	01	01	H1036_237_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	241	0	1	01	01	H1036_241_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	241	0	1	01	01	H1036_241_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	241	0	1	01	01	H1036_241_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	241	0	1	01	01	H1036_241_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	241	0	1	01	01	H1036_241_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	243	0	1	01	01	H1036_243_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	243	0	1	01	01	H1036_243_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	243	0	1	01	01	H1036_243_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	243	0	1	01	01	H1036_243_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	243	0	1	01	01	H1036_243_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	245	0	1	01	01	H1036_245_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	245	0	1	01	01	H1036_245_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	245	0	1	01	01	H1036_245_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	245	0	1	01	01	H1036_245_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	245	0	1	01	01	H1036_245_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	247	0	1	01	01	H1036_247_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	247	0	1	01	01	H1036_247_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	247	0	1	01	01	H1036_247_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	247	0	1	01	01	H1036_247_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	247	0	1	01	01	H1036_247_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	249	0	1	01	01	H1036_249_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	249	0	1	01	01	H1036_249_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	249	0	1	01	01	H1036_249_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	249	0	1	01	01	H1036_249_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	249	0	1	01	01	H1036_249_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	251	0	1	01	01	H1036_251_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	251	0	1	01	01	H1036_251_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	251	0	1	01	01	H1036_251_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	251	0	1	01	01	H1036_251_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	251	0	1	01	01	H1036_251_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	253	0	1	01	01	H1036_253_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	253	0	1	01	01	H1036_253_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					1.00		3.00											20.00		60.00				1.00		0.00				20.00				20.00			0.67	0.03		0.67	0.03	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	253	0	1	01	01	H1036_253_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	253	0	1	01	01	H1036_253_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	253	0	1	01	01	H1036_253_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	255	0	1	01	01	H1036_255_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	255	0	1	01	01	H1036_255_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	255	0	1	01	01	H1036_255_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	255	0	1	01	01	H1036_255_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	255	0	1	01	01	H1036_255_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	257	0	1	01	01	H1036_257_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	257	0	1	01	01	H1036_257_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	257	0	1	01	01	H1036_257_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	257	0	1	01	01	H1036_257_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	257	0	1	01	01	H1036_257_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	259	0	1	01	01	H1036_259_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	259	0	1	01	01	H1036_259_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	259	0	1	01	01	H1036_259_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	259	0	1	01	01	H1036_259_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	259	0	1	01	01	H1036_259_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	261	0	1	01	01	H1036_261_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	261	0	1	01	01	H1036_261_0	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	261	0	1	01	01	H1036_261_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	261	0	1	01	01	H1036_261_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	261	0	1	01	01	H1036_261_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	262	0	1	01	01	H1036_262_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	262	0	1	01	01	H1036_262_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	262	0	1	01	01	H1036_262_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	262	0	1	01	01	H1036_262_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	262	0	1	01	01	H1036_262_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	263	0	1	01	01	H1036_263_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	263	0	1	01	01	H1036_263_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	263	0	1	01	01	H1036_263_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	263	0	1	01	01	H1036_263_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	263	0	1	01	01	H1036_263_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	264	0	1	01	01	H1036_264_0	5	Preferred Generic	4	11	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											2.00	25		25				1.00	24		24										25		25				24		24			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	264	0	1	01	01	H1036_264_0	5	Generic	4	11	3	1	2	1		110	01		110	1				30		90	2	2				30		90	30		31											6.00	25		25				5.00	24		24										25		25				24		24			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	264	0	1	01	01	H1036_264_0	5	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	25		25				33.00	24		24										25		25				24		24			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	264	0	1	01	01	H1036_264_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	25		25				45.00	24		24										25		25				24		24			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	264	0	1	01	01	H1036_264_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	265	1	1	01	01	H1036_265_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	265	1	1	01	01	H1036_265_1	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	265	1	1	01	01	H1036_265_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	265	1	1	01	01	H1036_265_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	265	1	1	01	01	H1036_265_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	265	2	1	01	01	H1036_265_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	265	2	1	01	01	H1036_265_2	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	265	2	1	01	01	H1036_265_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	265	2	1	01	01	H1036_265_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	265	2	1	01	01	H1036_265_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	266	0	1	01	01	H1036_266_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	266	0	1	01	01	H1036_266_0	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	266	0	1	01	01	H1036_266_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	266	0	1	01	01	H1036_266_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	266	0	1	01	01	H1036_266_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	267	0	1	01	01	H1036_267_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	267	0	1	01	01	H1036_267_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	267	0	1	01	01	H1036_267_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	267	0	1	01	01	H1036_267_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	267	0	1	01	01	H1036_267_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	268	0	1	01	01	H1036_268_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	268	0	1	01	01	H1036_268_0	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	268	0	1	01	01	H1036_268_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	268	0	1	01	01	H1036_268_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	268	0	1	01	01	H1036_268_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	269	0	1	01	01	H1036_269_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	269	0	1	01	01	H1036_269_0	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	269	0	1	01	01	H1036_269_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	269	0	1	01	01	H1036_269_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	269	0	1	01	01	H1036_269_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	270	0	1	01	01	H1036_270_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	270	0	1	01	01	H1036_270_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	270	0	1	01	01	H1036_270_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	270	0	1	01	01	H1036_270_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	270	0	1	01	01	H1036_270_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	271	0	1	01	01	H1036_271_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	271	0	1	01	01	H1036_271_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	271	0	1	01	01	H1036_271_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	271	0	1	01	01	H1036_271_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	271	0	1	01	01	H1036_271_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	274	0	1	01	01	H1036_274_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	274	0	1	01	01	H1036_274_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	274	0	1	01	01	H1036_274_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	274	0	1	01	01	H1036_274_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1036	274	0	1	01	01	H1036_274_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	001	0	1	01	01	H1045_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	001	0	1	01	01	H1045_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1045	001	0	1	01	01	H1045_001_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	001	0	1	01	01	H1045_001_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1045	001	0	1	01	01	H1045_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	001	0	1	01	01	H1045_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	40.00		120.00																											120.00						110.00				40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	001	0	1	01	01	H1045_001_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				825.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	005	0	1	01	01	H1045_005_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	005	0	1	01	01	H1045_005_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1045	005	0	1	01	01	H1045_005_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	005	0	1	01	01	H1045_005_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1045	005	0	1	01	01	H1045_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	005	0	1	01	01	H1045_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	005	0	1	01	01	H1045_005_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				789.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	012	0	1	01	01	H1045_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	012	0	1	01	01	H1045_012_0	3	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1045	012	0	1	01	01	H1045_012_0	3	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	012	0	1	01	01	H1045_012_0	3	Generic	4	01	3	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1045	012	0	1	01	01	H1045_012_0	3	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				47.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	012	0	1	01	01	H1045_012_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				37.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	012	0	1	01	01	H1045_012_0	3	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				543.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	018	0	1	01	01	H1045_018_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	018	0	1	01	01	H1045_018_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1045	018	0	1	01	01	H1045_018_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	018	0	1	01	01	H1045_018_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1045	018	0	1	01	01	H1045_018_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	15.00		45.00																											45.00						35.00				15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	018	0	1	01	01	H1045_018_0	3	Preferred Brand	4	11	1	2	3	3	110		01		100	1	30		90				1	2						90	30		31	15.00		45.00																											45.00						35.00				15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1045	018	0	1	01	01	H1045_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	018	0	1	01	01	H1045_018_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				807.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	025	0	1	01	01	H1045_025_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	025	0	1	01	01	H1045_025_0	6	Generic	4	01	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	025	0	1	01	01	H1045_025_0	6	Generic	4	01	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2		2
H1045	025	0	1	01	01	H1045_025_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	025	0	1	01	01	H1045_025_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	025	0	1	01	01	H1045_025_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				929.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	026	0	1	01	01	H1045_026_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	026	0	1	01	01	H1045_026_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	026	0	1	01	01	H1045_026_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	026	0	1	01	01	H1045_026_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	026	0	1	01	01	H1045_026_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				494.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	027	0	1	02	01	H1045_027_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	027	0	1	02	01	H1045_027_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	027	0	1	02	01	H1045_027_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2		2
H1045	027	0	1	02	01	H1045_027_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	027	0	1	02	01	H1045_027_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	027	0	1	02	01	H1045_027_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				604.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	028	0	1	01	01	H1045_028_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	028	0	1	01	01	H1045_028_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	028	0	1	01	01	H1045_028_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	028	0	1	01	01	H1045_028_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	028	0	1	01	01	H1045_028_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				767.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	030	0	1	01	01	H1045_030_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	030	0	1	01	01	H1045_030_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	030	0	1	01	01	H1045_030_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	030	0	1	01	01	H1045_030_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	030	0	1	01	01	H1045_030_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				798.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	031	0	1	01	01	H1045_031_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	031	0	1	01	01	H1045_031_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	031	0	1	01	01	H1045_031_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	031	0	1	01	01	H1045_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	031	0	1	01	01	H1045_031_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				944.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	032	0	1	01	01	H1045_032_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	032	0	1	01	01	H1045_032_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	032	0	1	01	01	H1045_032_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	032	0	1	01	01	H1045_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	032	0	1	01	01	H1045_032_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				899.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	033	0	1	01	01	H1045_033_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	033	0	1	01	01	H1045_033_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	033	0	1	01	01	H1045_033_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	033	0	1	01	01	H1045_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	033	0	1	01	01	H1045_033_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				792.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	034	0	1	01	01	H1045_034_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	034	0	1	01	01	H1045_034_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1045	034	0	1	01	01	H1045_034_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	034	0	1	01	01	H1045_034_0	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1045	034	0	1	01	01	H1045_034_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	034	0	1	01	01	H1045_034_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	034	0	1	01	01	H1045_034_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				956.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	035	0	1	01	01	H1045_035_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	035	0	1	01	01	H1045_035_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	035	0	1	01	01	H1045_035_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	035	0	1	01	01	H1045_035_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	035	0	1	01	01	H1045_035_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				723.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	036	0	1	01	01	H1045_036_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	036	0	1	01	01	H1045_036_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	036	0	1	01	01	H1045_036_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	036	0	1	01	01	H1045_036_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	036	0	1	01	01	H1045_036_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				601.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	037	0	1	01	01	H1045_037_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	037	0	1	01	01	H1045_037_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1045	037	0	1	01	01	H1045_037_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	037	0	1	01	01	H1045_037_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1045	037	0	1	01	01	H1045_037_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	42.00		126.00																											126.00						116.00				42.00				42.00		1.40						1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	037	0	1	01	01	H1045_037_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	037	0	1	01	01	H1045_037_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				538.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	038	0	1	01	01	H1045_038_0	3	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	038	0	1	01	01	H1045_038_0	3	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1045	038	0	1	01	01	H1045_038_0	3	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	038	0	1	01	01	H1045_038_0	3	Generic	4	01	3	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1045	038	0	1	01	01	H1045_038_0	3	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				48.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	038	0	1	01	01	H1045_038_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				37.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	038	0	1	01	01	H1045_038_0	3	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				532.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	041	0	1	02	01	H1045_041_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	041	0	1	02	01	H1045_041_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	041	0	1	02	01	H1045_041_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	041	0	1	02	01	H1045_041_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	041	0	1	02	01	H1045_041_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				813.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	042	0	1	01	01	H1045_042_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	042	0	1	01	01	H1045_042_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	042	0	1	01	01	H1045_042_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	042	0	1	01	01	H1045_042_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	042	0	1	01	01	H1045_042_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				813.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	043	0	1	01	01	H1045_043_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	043	0	1	01	01	H1045_043_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	043	0	1	01	01	H1045_043_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	043	0	1	01	01	H1045_043_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1045	043	0	1	01	01	H1045_043_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				748.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1099	001	0	1	02	01	H1099_001_0	14	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	001	0	1	02	01	H1099_001_0	14	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1099	001	0	1	02	01	H1099_001_0	14	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	001	0	1	02	01	H1099_001_0	14	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1099	001	0	1	02	01	H1099_001_0	14	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	001	0	1	02	01	H1099_001_0	14	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	001	0	1	02	01	H1099_001_0	14	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1331.60	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	001	0	1	02	01	H1099_001_0	14	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	001	0	1	02	01	H1099_001_0	14	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1099	006	0	1	01	01	H1099_006_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	006	0	1	01	01	H1099_006_0	12	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	006	0	1	01	01	H1099_006_0	12	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	006	0	1	01	01	H1099_006_0	12	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	006	0	1	01	01	H1099_006_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1165.76	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	006	0	1	01	01	H1099_006_0	12	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	006	0	1	01	01	H1099_006_0	12	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1099	014	0	1	01	01	H1099_014_0	11	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	014	0	1	01	01	H1099_014_0	11	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	014	0	1	01	01	H1099_014_0	11	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	014	0	1	01	01	H1099_014_0	11	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	014	0	1	01	01	H1099_014_0	11	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1117.90	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	014	0	1	01	01	H1099_014_0	11	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	016	0	1	02	01	H1099_016_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	016	0	1	02	01	H1099_016_0	12	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					0.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	016	0	1	02	01	H1099_016_0	12	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	016	0	1	02	01	H1099_016_0	12	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	016	0	1	02	01	H1099_016_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1315.43	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	016	0	1	02	01	H1099_016_0	12	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1099	016	0	1	02	01	H1099_016_0	12	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1100	001	0	1	04	01	H1100_001_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1100	001	0	1	04	01	H1100_001_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1100	001	0	1	04	01	H1100_001_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1100	001	0	1	04	01	H1100_001_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1100	001	0	1	04	01	H1100_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1100	001	0	1	04	01	H1100_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1100	001	0	1	04	01	H1100_001_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1109	005	0	1	01	01	H1109_005_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1109	005	0	1	01	01	H1109_005_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1109	005	0	1	01	01	H1109_005_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1109	005	0	1	01	01	H1109_005_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1109	005	0	1	01	01	H1109_005_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1109	005	0	1	01	01	H1109_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1109	005	0	1	01	01	H1109_005_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1111	006	0	1	01	01	H1111_006_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1111	006	0	1	01	01	H1111_006_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1111	006	0	1	01	01	H1111_006_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1111	006	0	1	01	01	H1111_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1111	006	0	1	01	01	H1111_006_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				840.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1111	007	0	1	01	01	H1111_007_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1111	007	0	1	01	01	H1111_007_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1111	007	0	1	01	01	H1111_007_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1111	007	0	1	01	01	H1111_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1111	007	0	1	01	01	H1111_007_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1059.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	006	0	1	01	01	H1112_006_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	006	0	1	01	01	H1112_006_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		27.50				11.00				11.00		0.37				0.37	0.37	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	006	0	1	01	01	H1112_006_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	006	0	1	01	01	H1112_006_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.41	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	006	0	1	01	01	H1112_006_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				516.39	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	027	0	1	01	01	H1112_027_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	027	0	1	01	01	H1112_027_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	027	0	1	01	01	H1112_027_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		110.00				44.00				44.00		1.47				1.47	1.47	1.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	027	0	1	01	01	H1112_027_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				57.03	45		45																								45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	027	0	1	01	01	H1112_027_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				751.49	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	033	0	1	01	01	H1112_033_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	033	0	1	01	01	H1112_033_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	033	0	1	01	01	H1112_033_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	033	0	1	01	01	H1112_033_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.23	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	033	0	1	01	01	H1112_033_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				517.56	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	035	0	1	01	01	H1112_035_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	035	0	1	01	01	H1112_035_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	035	0	1	01	01	H1112_035_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	035	0	1	01	01	H1112_035_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				57.85	45		45																								45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1112	035	0	1	01	01	H1112_035_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				749.61	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1170	002	0	1	01	01	H1170_002_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	002	0	1	01	01	H1170_002_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1170	002	0	1	01	01	H1170_002_0	8	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	15.00		45.00																			15.00		0.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	002	0	1	01	01	H1170_002_0	8	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1170	002	0	1	01	01	H1170_002_0	8	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	44.00		132.00																			44.00		88.00																44.00				44.00		1.46			1.46			1.41	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	002	0	1	01	01	H1170_002_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	002	0	1	01	01	H1170_002_0	8	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				2153.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	002	0	1	01	01	H1170_002_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	002	0	1	01	01	H1170_002_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1170	008	0	1	01	01	H1170_008_0	7	Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.26			0.26			0.25	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	008	0	1	01	01	H1170_008_0	7	Generic	3	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	16.00		48.00																			16.00		32.00																16.00				16.00		0.53			0.53			0.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	008	0	1	01	01	H1170_008_0	7	Preferred Brand	3	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	008	0	1	01	01	H1170_008_0	7	Non-Preferred Brand	3	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	008	0	1	01	01	H1170_008_0	7	Specialty Tier	3	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				2880.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	008	0	1	01	01	H1170_008_0	7	Vaccines	3	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	009	0	1	01	01	H1170_009_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	2.00		6.00																			2.00		0.00																2.00				2.00		0.06			0.06			0.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	009	0	1	01	01	H1170_009_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	2.00		6.00																			2.00		0.00																2.00				2.00		0.06			0.06			0.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1170	009	0	1	01	01	H1170_009_0	8	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		0.00																20.00				20.00		0.66			0.66			0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	009	0	1	01	01	H1170_009_0	8	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		0.00																20.00				20.00		0.66			0.66			0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1170	009	0	1	01	01	H1170_009_0	8	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	009	0	1	01	01	H1170_009_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	009	0	1	01	01	H1170_009_0	8	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1632.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	009	0	1	01	01	H1170_009_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1170	009	0	1	01	01	H1170_009_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1189	001	0	1	01	01	H1189_001_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					8.00																4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	001	0	1	01	01	H1189_001_0	6	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					20.00																10.00				10.00		0.32						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	001	0	1	01	01	H1189_001_0	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	35.00		105.00																					70.00																35.00				35.00		1.13						1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	001	0	1	01	01	H1189_001_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		34	90.00		270.00																					180.00																90.00				90.00		2.90						2.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	001	0	1	01	01	H1189_001_0	6	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				1255.90	29		29																				29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	002	0	1	01	01	H1189_002_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					8.00																4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	002	0	1	01	01	H1189_002_0	6	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					20.00																10.00				10.00		0.32						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	002	0	1	01	01	H1189_002_0	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	35.00		105.00																					70.00																35.00				35.00		1.13						1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	002	0	1	01	01	H1189_002_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		34	90.00		270.00																					180.00																90.00				90.00		2.90						2.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	002	0	1	01	01	H1189_002_0	6	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				1364.19	29		29																				29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	003	0	1	01	01	H1189_003_0	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					8.00																4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	003	0	1	01	01	H1189_003_0	4	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					20.00																10.00				10.00		0.32						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	003	0	1	01	01	H1189_003_0	4	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	35.00		105.00																					70.00																35.00				35.00		1.13						1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	003	0	1	01	01	H1189_003_0	4	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		34	90.00		270.00																					180.00																90.00				90.00		2.90						2.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	003	0	1	01	01	H1189_003_0	4	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				1255.90	29		29																				29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	004	0	1	01	01	H1189_004_0	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					8.00																4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	004	0	1	01	01	H1189_004_0	4	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					20.00																10.00				10.00		0.32						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	004	0	1	01	01	H1189_004_0	4	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	35.00		105.00																					70.00																35.00				35.00		1.13						1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	004	0	1	01	01	H1189_004_0	4	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		34	90.00		270.00																					180.00																90.00				90.00		2.90						2.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1189	004	0	1	01	01	H1189_004_0	4	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				1255.90	29		29																				29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1225	001	0	1	01	01	H1225_001_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1225	001	0	1	01	01	H1225_001_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1225	001	0	1	01	01	H1225_001_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	15.00	20.00																			10.00	15.00	20.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1225	001	0	1	01	01	H1225_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	70.50	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1225	001	0	1	01	01	H1225_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1225	001	0	1	01	01	H1225_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1225	002	0	1	01	01	H1225_002_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1225	002	0	1	01	01	H1225_002_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1225	002	0	1	01	01	H1225_002_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	15.00	20.00																			10.00	15.00	20.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1225	002	0	1	01	01	H1225_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	70.50	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1225	002	0	1	01	01	H1225_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1225	002	0	1	01	01	H1225_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1230	001	0	1	01	01	H1230_001_0	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.09	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	001	0	1	01	01	H1230_001_0	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.09	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1230	001	0	1	01	01	H1230_001_0	7	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.38	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	001	0	1	01	01	H1230_001_0	7	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.38	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1230	001	0	1	01	01	H1230_001_0	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	001	0	1	01	01	H1230_001_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	001	0	1	01	01	H1230_001_0	7	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1326.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	001	0	1	01	01	H1230_001_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	001	0	1	01	01	H1230_001_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1230	003	0	1	01	01	H1230_003_0	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.09	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	003	0	1	01	01	H1230_003_0	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.09	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1230	003	0	1	01	01	H1230_003_0	7	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.38	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	003	0	1	01	01	H1230_003_0	7	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.38	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1230	003	0	1	01	01	H1230_003_0	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	003	0	1	01	01	H1230_003_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	003	0	1	01	01	H1230_003_0	7	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1485.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	003	0	1	01	01	H1230_003_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	003	0	1	01	01	H1230_003_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H1230	013	0	1	01	01	H1230_013_0	8	Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.12	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	013	0	1	01	01	H1230_013_0	8	Generic	3	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	13.00		39.00																			13.00		26.00																13.00				13.00		0.43			0.43			0.41	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	013	0	1	01	01	H1230_013_0	8	Preferred Brand	3	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	013	0	1	01	01	H1230_013_0	8	Non-Preferred Brand	3	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	013	0	1	01	01	H1230_013_0	8	Specialty Tier	3	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				2158.00	25		25																		25		25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	013	0	1	01	01	H1230_013_0	8	Vaccines	3	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	014	0	1	01	01	H1230_014_0	8	Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.12	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	014	0	1	01	01	H1230_014_0	8	Generic	3	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	16.00		48.00																			16.00		32.00																16.00				16.00		0.53			0.53			0.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	014	0	1	01	01	H1230_014_0	8	Preferred Brand	3	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	014	0	1	01	01	H1230_014_0	8	Non-Preferred Brand	3	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	014	0	1	01	01	H1230_014_0	8	Specialty Tier	3	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1537.00	25		25																		25		25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1230	014	0	1	01	01	H1230_014_0	8	Vaccines	3	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H1264	007	0	1	01	01	H1264_007_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	007	0	1	01	01	H1264_007_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	007	0	1	01	01	H1264_007_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	007	0	1	01	01	H1264_007_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.98	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	007	0	1	01	01	H1264_007_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				488.50	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	008	0	1	01	01	H1264_008_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	008	0	1	01	01	H1264_008_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	008	0	1	01	01	H1264_008_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	008	0	1	01	01	H1264_008_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				72.18	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	008	0	1	01	01	H1264_008_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				553.15	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	020	0	1	01	01	H1264_020_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	020	0	1	01	01	H1264_020_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		40.00				16.00				16.00		0.53				0.53	0.53	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	020	0	1	01	01	H1264_020_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	020	0	1	01	01	H1264_020_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.53	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	020	0	1	01	01	H1264_020_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				489.62	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	021	0	1	01	01	H1264_021_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	021	0	1	01	01	H1264_021_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	021	0	1	01	01	H1264_021_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	021	0	1	01	01	H1264_021_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.53	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	021	0	1	01	01	H1264_021_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				489.62	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	022	0	1	01	01	H1264_022_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	022	0	1	01	01	H1264_022_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	022	0	1	01	01	H1264_022_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	022	0	1	01	01	H1264_022_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				72.86	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	022	0	1	01	01	H1264_022_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				546.67	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	024	1	1	02	01	H1264_024_1	5	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	024	1	1	02	01	H1264_024_1	5	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	024	1	1	02	01	H1264_024_1	5	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	024	1	1	02	01	H1264_024_1	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				78.07	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	024	1	1	02	01	H1264_024_1	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				731.96	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	024	2	1	02	01	H1264_024_2	5	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	024	2	1	02	01	H1264_024_2	5	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	024	2	1	02	01	H1264_024_2	5	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	024	2	1	02	01	H1264_024_2	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				78.07	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1264	024	2	1	02	01	H1264_024_2	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				731.96	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1286	002	0	1	01	01	H1286_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1286	002	0	1	01	01	H1286_002_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1286	002	0	1	01	01	H1286_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1286	002	0	1	01	01	H1286_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1286	002	0	1	01	01	H1286_002_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				675.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1286	009	0	1	01	01	H1286_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1286	009	0	1	01	01	H1286_009_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1286	009	0	1	01	01	H1286_009_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1286	009	0	1	01	01	H1286_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1286	009	0	1	01	01	H1286_009_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				812.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1304	002	0	1	04	01	H1304_002_0	9	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	002	0	1	04	01	H1304_002_0	9	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	002	0	1	04	01	H1304_002_0	9	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	002	0	1	04	01	H1304_002_0	9	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	002	0	1	04	01	H1304_002_0	9	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1238.22	27						1238.22	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	002	0	1	04	01	H1304_002_0	9	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	004	0	1	04	01	H1304_004_0	10	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					3.00	6.00	6.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	004	0	1	04	01	H1304_004_0	10	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	004	0	1	04	01	H1304_004_0	10	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	004	0	1	04	01	H1304_004_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	004	0	1	04	01	H1304_004_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1513.38	33						1513.38	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	004	0	1	04	01	H1304_004_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	009	0	1	04	01	H1304_009_0	9	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	009	0	1	04	01	H1304_009_0	9	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	009	0	1	04	01	H1304_009_0	9	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	009	0	1	04	01	H1304_009_0	9	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	009	0	1	04	01	H1304_009_0	9	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1192.36	26						1192.36	26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	009	0	1	04	01	H1304_009_0	9	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	010	0	1	04	01	H1304_010_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					3.00	6.00	6.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	010	0	1	04	01	H1304_010_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	010	0	1	04	01	H1304_010_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	010	0	1	04	01	H1304_010_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	010	0	1	04	01	H1304_010_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1513.38	33						1513.38	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1304	010	0	1	04	01	H1304_010_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1343	001	0	1	01	01	H1343_001_0	5	Preferred Generic	4	01	1	2	1	1	110		10	100		1	31		90				1	2			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1343	001	0	1	01	01	H1343_001_0	5	Generic	4	01	1	1	2	1	110		10	100		1	31		90				1	2			90					10	31				12.54	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1343	001	0	1	01	01	H1343_001_0	5	Preferred Brand	4	10	1	1	3	1	110		10	100		1	31		90				1	2			90					10	31				139.69	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1343	001	0	1	01	01	H1343_001_0	5	Non-Preferred Brand	4	10	1	1	4	1	110		10	100		1	31		90				1	2			90					10	31				59.63	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1343	001	0	1	01	01	H1343_001_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	31								30							10	31				1.00	25																				25																		25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1350	015	1	1	01	01	H1350_015_1	4	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				0.00			0.17	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	015	1	1	01	01	H1350_015_1	4	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													36.00						18.00				12.00				6.00			0.40	0.20				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	015	1	1	01	01	H1350_015_1	4	Preferred Brand	4	10	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						105.00				45.00				35.00			1.50	1.17				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	015	1	1	01	01	H1350_015_1	4	Non-Preferred Drug	4	10	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								95.00		285.00					85.00		255.00													285.00						255.00				95.00				85.00			3.17	2.83				2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	015	1	1	01	01	H1350_015_1	4	Specialty Tier	4	11	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	33		33				990.00	33		33										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	015	2	1	01	01	H1350_015_2	4	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				0.00			0.17	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	015	2	1	01	01	H1350_015_2	4	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													36.00						18.00				12.00				6.00			0.40	0.20				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	015	2	1	01	01	H1350_015_2	4	Preferred Brand	4	10	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						105.00				45.00				35.00			1.50	1.17				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	015	2	1	01	01	H1350_015_2	4	Non-Preferred Drug	4	10	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								95.00		285.00					85.00		255.00													285.00						255.00				95.00				85.00			3.17	2.83				2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	015	2	1	01	01	H1350_015_2	4	Specialty Tier	4	11	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	33		33				990.00	33		33										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	016	1	1	01	01	H1350_016_1	4	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				0.00			0.33	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	016	1	1	01	01	H1350_016_1	4	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					12.00		36.00													60.00						36.00				20.00				12.00			0.67	0.40				0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	016	1	1	01	01	H1350_016_1	4	Preferred Brand	4	10	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				37.00			1.57	1.23				1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	016	1	1	01	01	H1350_016_1	4	Non-Preferred Drug	4	10	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				90.00			3.33	3.00				2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	016	1	1	01	01	H1350_016_1	4	Specialty Tier	4	11	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	29		29				990.00	29		29										29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	016	2	1	01	01	H1350_016_2	4	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				0.00			0.33	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	016	2	1	01	01	H1350_016_2	4	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					12.00		36.00													60.00						36.00				20.00				12.00			0.67	0.40				0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	016	2	1	01	01	H1350_016_2	4	Preferred Brand	4	10	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				37.00			1.57	1.23				1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	016	2	1	01	01	H1350_016_2	4	Non-Preferred Drug	4	10	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				90.00			3.33	3.00				2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	016	2	1	01	01	H1350_016_2	4	Specialty Tier	4	11	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	29		29				990.00	29		29										29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	019	1	1	01	01	H1350_019_1	4	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				0.00			0.50	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	019	1	1	01	01	H1350_019_1	4	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				6.00			0.67	0.20				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	019	1	1	01	01	H1350_019_1	4	Preferred Brand	4	10	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				31.00			1.57	1.03				1.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	019	1	1	01	01	H1350_019_1	4	Non-Preferred Drug	4	10	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				90.00			3.33	3.00				2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	019	1	1	01	01	H1350_019_1	4	Specialty Tier	4	11	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	33		33				990.00	33		33										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	019	2	1	01	01	H1350_019_2	4	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				0.00			0.50	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	019	2	1	01	01	H1350_019_2	4	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				6.00			0.67	0.20				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	019	2	1	01	01	H1350_019_2	4	Preferred Brand	4	10	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				31.00			1.57	1.03				1.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	019	2	1	01	01	H1350_019_2	4	Non-Preferred Drug	4	10	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				90.00			3.33	3.00				2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1350	019	2	1	01	01	H1350_019_2	4	Specialty Tier	4	11	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	33		33				990.00	33		33										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1352	001	0	1	01	01	H1352_001_0	7	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								15.00	30.00	45.00					3.00	6.00	9.00							0.00																15.00				15.00			0.50	0.10				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1352	001	0	1	01	01	H1352_001_0	7	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								20.00	40.00	60.00					15.00	30.00	45.00							0.00																20.00				20.00			0.67	0.50				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1352	001	0	1	01	01	H1352_001_0	7	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					42.00	84.00	126.00							105.00																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1352	001	0	1	01	01	H1352_001_0	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								100.00	200.00	300.00					95.00	190.00	285.00							237.50																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1352	001	0	1	01	01	H1352_001_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1352	002	0	1	01	01	H1352_002_0	6	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	9.00							0.00																8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1352	002	0	1	01	01	H1352_002_0	6	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								13.00	26.00	39.00					8.00	16.00	24.00							0.00																13.00				13.00			0.43	0.27				0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1352	002	0	1	01	01	H1352_002_0	6	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					35.00	70.00	105.00							87.50																47.00				47.00			1.57	1.17				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1352	002	0	1	01	01	H1352_002_0	6	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								100.00	200.00	300.00					90.00	180.00	270.00							225.00																100.00				100.00			3.33	3.00				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1352	002	0	1	01	01	H1352_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1365	001	0	1	04	01	H1365_001_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	001	0	1	04	01	H1365_001_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	001	0	1	04	01	H1365_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	001	0	1	04	01	H1365_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	001	0	1	04	01	H1365_001_0	4	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	002	0	1	04	01	H1365_002_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	002	0	1	04	01	H1365_002_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	002	0	1	04	01	H1365_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	002	0	1	04	01	H1365_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	002	0	1	04	01	H1365_002_0	4	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	003	0	1	04	01	H1365_003_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	003	0	1	04	01	H1365_003_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	003	0	1	04	01	H1365_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	003	0	1	04	01	H1365_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1365	003	0	1	04	01	H1365_003_0	4	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1415	021	0	1	02	01	H1415_021_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					12.00	24.00	24.00																12.00				12.00			0.40	0.17	0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1415	021	0	1	02	01	H1415_021_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	34.00					10.00	20.00	20.00					17.00	34.00	34.00																17.00				17.00			0.57	0.33	0.57			0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1415	021	0	1	02	01	H1415_021_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1415	021	0	1	02	01	H1415_021_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											80.65	50	50	50				78.62	48	48	48				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1415	021	0	1	02	01	H1415_021_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											493.15	33						418.97	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	009	0	1	02	01	H1416_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	009	0	1	02	01	H1416_009_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	009	0	1	02	01	H1416_009_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	009	0	1	02	01	H1416_009_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				70.40	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	009	0	1	02	01	H1416_009_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				702.88	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	023	0	1	01	01	H1416_023_0	2	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	023	0	1	01	01	H1416_023_0	2	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	023	0	1	01	01	H1416_023_0	2	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	023	0	1	01	01	H1416_023_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.24	41		41																								41		41				41		41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	023	0	1	01	01	H1416_023_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				536.85	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	024	0	1	02	01	H1416_024_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	024	0	1	02	01	H1416_024_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	024	0	1	02	01	H1416_024_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	024	0	1	02	01	H1416_024_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				70.39	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	024	0	1	02	01	H1416_024_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				753.96	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	026	0	1	02	01	H1416_026_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	026	0	1	02	01	H1416_026_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	026	0	1	02	01	H1416_026_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		100.00				40.00				40.00		1.33				1.33	1.33	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	026	0	1	02	01	H1416_026_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	026	0	1	02	01	H1416_026_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				683.79	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	031	0	1	02	01	H1416_031_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	031	0	1	02	01	H1416_031_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	031	0	1	02	01	H1416_031_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	031	0	1	02	01	H1416_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	031	0	1	02	01	H1416_031_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				626.38	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	032	0	1	02	01	H1416_032_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	032	0	1	02	01	H1416_032_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	032	0	1	02	01	H1416_032_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		100.00				40.00				40.00		1.33				1.33	1.33	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	032	0	1	02	01	H1416_032_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	032	0	1	02	01	H1416_032_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				789.18	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	033	0	1	01	01	H1416_033_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	033	0	1	01	01	H1416_033_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		5.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	033	0	1	01	01	H1416_033_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	033	0	1	01	01	H1416_033_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.78	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	033	0	1	01	01	H1416_033_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				475.94	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	034	0	1	01	01	H1416_034_0	4	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	034	0	1	01	01	H1416_034_0	4	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		45.00				18.00				18.00		0.60				0.60	0.60	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	034	0	1	01	01	H1416_034_0	4	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	034	0	1	01	01	H1416_034_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.16	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	034	0	1	01	01	H1416_034_0	4	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				500.28	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	035	0	1	01	01	H1416_035_0	4	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	035	0	1	01	01	H1416_035_0	4	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		5.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	035	0	1	01	01	H1416_035_0	4	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		110.00				44.00				44.00		1.47				1.47	1.47	1.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	035	0	1	01	01	H1416_035_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.09	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	035	0	1	01	01	H1416_035_0	4	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				456.47	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	036	0	1	01	01	H1416_036_0	4	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	036	0	1	01	01	H1416_036_0	4	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	036	0	1	01	01	H1416_036_0	4	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	036	0	1	01	01	H1416_036_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.62	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	036	0	1	01	01	H1416_036_0	4	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				430.30	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	038	0	1	01	01	H1416_038_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	038	0	1	01	01	H1416_038_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	038	0	1	01	01	H1416_038_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	038	0	1	01	01	H1416_038_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	038	0	1	01	01	H1416_038_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				603.07	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	039	0	1	01	01	H1416_039_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	039	0	1	01	01	H1416_039_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	039	0	1	01	01	H1416_039_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	039	0	1	01	01	H1416_039_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	039	0	1	01	01	H1416_039_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				714.86	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	041	0	1	01	01	H1416_041_0	4	Preferred Generic	2	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	041	0	1	01	01	H1416_041_0	4	Generic	2	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	041	0	1	01	01	H1416_041_0	4	Preferred Brand	2	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	36.00		108.00																									36.00		108.00				36.00		90.00				36.00				36.00		1.20				1.20	1.20	1.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	041	0	1	01	01	H1416_041_0	4	Non-Preferred Drug	2	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	041	0	1	01	01	H1416_041_0	4	Specialty Tier	2	11	1	1	5	1	010		01		010	1	30											30			30		31				514.10	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	042	0	1	01	01	H1416_042_0	4	Preferred Generic	2	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	042	0	1	01	01	H1416_042_0	4	Generic	2	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	042	0	1	01	01	H1416_042_0	4	Preferred Brand	2	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	042	0	1	01	01	H1416_042_0	4	Non-Preferred Drug	2	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	042	0	1	01	01	H1416_042_0	4	Specialty Tier	2	11	1	1	5	1	010		01		010	1	30											30			30		31				480.30	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	043	0	1	01	01	H1416_043_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	043	0	1	01	01	H1416_043_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		5.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	043	0	1	01	01	H1416_043_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		100.00				40.00				40.00		1.33				1.33	1.33	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	043	0	1	01	01	H1416_043_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				73.11	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	043	0	1	01	01	H1416_043_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				469.09	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	044	0	1	01	01	H1416_044_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	044	0	1	01	01	H1416_044_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		35.00				14.00				14.00		0.47				0.47	0.47	0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	044	0	1	01	01	H1416_044_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	044	0	1	01	01	H1416_044_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				79.02	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	044	0	1	01	01	H1416_044_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				504.06	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	048	0	1	01	01	H1416_048_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	048	0	1	01	01	H1416_048_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	048	0	1	01	01	H1416_048_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	048	0	1	01	01	H1416_048_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.99	47		47																								47		47				47		47			47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	048	0	1	01	01	H1416_048_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				497.57	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	050	0	1	02	01	H1416_050_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	050	0	1	02	01	H1416_050_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	050	0	1	02	01	H1416_050_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	050	0	1	02	01	H1416_050_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				42.64	35		35																								35		35				35		35			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	050	0	1	02	01	H1416_050_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				768.66	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	051	0	1	02	01	H1416_051_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	051	0	1	02	01	H1416_051_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	051	0	1	02	01	H1416_051_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	051	0	1	02	01	H1416_051_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	051	0	1	02	01	H1416_051_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				753.02	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	052	1	1	01	01	H1416_052_1	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	052	1	1	01	01	H1416_052_1	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	052	1	1	01	01	H1416_052_1	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	052	1	1	01	01	H1416_052_1	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				42.20	35		35																								35		35				35		35			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	052	1	1	01	01	H1416_052_1	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				741.07	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	052	2	1	01	01	H1416_052_2	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	052	2	1	01	01	H1416_052_2	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	052	2	1	01	01	H1416_052_2	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	052	2	1	01	01	H1416_052_2	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				42.20	35		35																								35		35				35		35			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1416	052	2	1	01	01	H1416_052_2	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				741.07	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1436	001	0	1	01	01	H1436_001_0	2	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	001	0	1	01	01	H1436_001_0	2	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	001	0	1	01	01	H1436_001_0	2	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	001	0	1	01	01	H1436_001_0	2	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	001	0	1	01	01	H1436_001_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	001	0	1	01	01	H1436_001_0	2	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	002	0	1	01	01	H1436_002_0	2	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	002	0	1	01	01	H1436_002_0	2	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	002	0	1	01	01	H1436_002_0	2	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	002	0	1	01	01	H1436_002_0	2	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	002	0	1	01	01	H1436_002_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	002	0	1	01	01	H1436_002_0	2	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	003	0	1	01	01	H1436_003_0	2	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	003	0	1	01	01	H1436_003_0	2	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	003	0	1	01	01	H1436_003_0	2	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	003	0	1	01	01	H1436_003_0	2	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	003	0	1	01	01	H1436_003_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	003	0	1	01	01	H1436_003_0	2	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	004	0	1	01	01	H1436_004_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	004	0	1	01	01	H1436_004_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	004	0	1	01	01	H1436_004_0	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	004	0	1	01	01	H1436_004_0	3	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	004	0	1	01	01	H1436_004_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	004	0	1	01	01	H1436_004_0	3	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1436	006	0	1	01	01	H1436_006_0	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1436	006	0	1	01	01	H1436_006_0	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1436	006	0	1	01	01	H1436_006_0	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1436	006	0	1	01	01	H1436_006_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1436	006	0	1	01	01	H1436_006_0	4	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1436	006	0	1	01	01	H1436_006_0	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1463	003	0	1	01	01	H1463_003_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	003	0	1	01	01	H1463_003_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	003	0	1	01	01	H1463_003_0	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	003	0	1	01	01	H1463_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											49.03	50	50	50				49.03	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	003	0	1	01	01	H1463_003_0	4	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											688.14	33	33	33				688.14	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	009	0	1	01	01	H1463_009_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	009	0	1	01	01	H1463_009_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	009	0	1	01	01	H1463_009_0	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	009	0	1	01	01	H1463_009_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											59.88	50	50	50				59.88	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	009	0	1	01	01	H1463_009_0	4	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											697.78	33	33	33				697.78	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	010	0	1	01	01	H1463_010_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	010	0	1	01	01	H1463_010_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	010	0	1	01	01	H1463_010_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	010	0	1	01	01	H1463_010_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											44.85	50	50	50				44.85	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	010	0	1	01	01	H1463_010_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											810.44	33	33	33				810.44	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	012	0	1	01	01	H1463_012_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	012	0	1	01	01	H1463_012_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	012	0	1	01	01	H1463_012_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	012	0	1	01	01	H1463_012_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											53.25	50	50	50				53.25	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	012	0	1	01	01	H1463_012_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											647.04	33	33	33				647.04	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	013	0	1	01	01	H1463_013_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	013	0	1	01	01	H1463_013_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	013	0	1	01	01	H1463_013_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	013	0	1	01	01	H1463_013_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											48.66	50	50	50				48.66	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	013	0	1	01	01	H1463_013_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											734.04	33	33	33				734.04	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	015	0	1	02	01	H1463_015_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	015	0	1	02	01	H1463_015_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	015	0	1	02	01	H1463_015_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	015	0	1	02	01	H1463_015_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											46.51	50	50	50				46.51	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	015	0	1	02	01	H1463_015_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											668.18	33	33	33				668.18	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	017	0	1	02	01	H1463_017_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	017	0	1	02	01	H1463_017_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	017	0	1	02	01	H1463_017_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	017	0	1	02	01	H1463_017_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											40.53	50	50	50				40.53	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	017	0	1	02	01	H1463_017_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											622.17	33	33	33				622.17	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	019	0	1	02	01	H1463_019_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	019	0	1	02	01	H1463_019_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	019	0	1	02	01	H1463_019_0	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	019	0	1	02	01	H1463_019_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											46.23	50	50	50				46.23	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1463	019	0	1	02	01	H1463_019_0	4	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											622.31	33	33	33				622.31	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	007	0	1	01	01	H1468_007_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	007	0	1	01	01	H1468_007_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	007	0	1	01	01	H1468_007_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	007	0	1	01	01	H1468_007_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	007	0	1	01	01	H1468_007_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	013	0	1	01	01	H1468_013_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	013	0	1	01	01	H1468_013_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	013	0	1	01	01	H1468_013_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	013	0	1	01	01	H1468_013_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	013	0	1	01	01	H1468_013_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	014	0	1	01	01	H1468_014_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	014	0	1	01	01	H1468_014_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	014	0	1	01	01	H1468_014_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	014	0	1	01	01	H1468_014_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	014	0	1	01	01	H1468_014_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	015	0	1	01	01	H1468_015_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	015	0	1	01	01	H1468_015_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	015	0	1	01	01	H1468_015_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	015	0	1	01	01	H1468_015_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	015	0	1	01	01	H1468_015_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	016	0	1	01	01	H1468_016_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	016	0	1	01	01	H1468_016_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	016	0	1	01	01	H1468_016_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	016	0	1	01	01	H1468_016_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	016	0	1	01	01	H1468_016_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1468	017	0	1	01	01	H1468_017_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1468	017	0	1	01	01	H1468_017_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1468	017	0	1	01	01	H1468_017_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1468	017	0	1	01	01	H1468_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1468	017	0	1	01	01	H1468_017_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1468	017	0	1	01	01	H1468_017_0	3	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1537	004	0	1	04	01	H1537_004_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1537	004	0	1	04	01	H1537_004_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1537	004	0	1	04	01	H1537_004_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1537	004	0	1	04	01	H1537_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1537	004	0	1	04	01	H1537_004_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				647.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1587	002	0	1	02	01	H1587_002_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1587	002	0	1	02	01	H1587_002_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1587	002	0	1	02	01	H1587_002_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1587	002	0	1	02	01	H1587_002_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1587	002	0	1	02	01	H1587_002_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1587	003	0	1	02	01	H1587_003_0	11	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1587	003	0	1	02	01	H1587_003_0	11	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1587	003	0	1	02	01	H1587_003_0	11	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1587	003	0	1	02	01	H1587_003_0	11	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1587	003	0	1	02	01	H1587_003_0	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1607	012	0	1	04	01	H1607_012_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1607	012	0	1	04	01	H1607_012_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1607	012	0	1	04	01	H1607_012_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1607	012	0	1	04	01	H1607_012_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1607	012	0	1	04	01	H1607_012_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1607	012	0	1	04	01	H1607_012_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1607	012	0	1	04	01	H1607_012_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1608	001	0	1	04	01	H1608_001_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	001	0	1	04	01	H1608_001_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	001	0	1	04	01	H1608_001_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	001	0	1	04	01	H1608_001_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	001	0	1	04	01	H1608_001_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	001	0	1	04	01	H1608_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	001	0	1	04	01	H1608_001_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	004	0	1	04	01	H1608_004_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	004	0	1	04	01	H1608_004_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	004	0	1	04	01	H1608_004_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	004	0	1	04	01	H1608_004_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	004	0	1	04	01	H1608_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	004	0	1	04	01	H1608_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	004	0	1	04	01	H1608_004_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	007	0	1	04	01	H1608_007_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	007	0	1	04	01	H1608_007_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	007	0	1	04	01	H1608_007_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	007	0	1	04	01	H1608_007_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	007	0	1	04	01	H1608_007_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	007	0	1	04	01	H1608_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	007	0	1	04	01	H1608_007_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	008	0	1	04	01	H1608_008_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	008	0	1	04	01	H1608_008_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	008	0	1	04	01	H1608_008_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	008	0	1	04	01	H1608_008_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	008	0	1	04	01	H1608_008_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	008	0	1	04	01	H1608_008_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	008	0	1	04	01	H1608_008_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	012	0	1	04	01	H1608_012_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	012	0	1	04	01	H1608_012_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	012	0	1	04	01	H1608_012_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	012	0	1	04	01	H1608_012_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	012	0	1	04	01	H1608_012_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	012	0	1	04	01	H1608_012_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	012	0	1	04	01	H1608_012_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	013	0	1	04	01	H1608_013_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	013	0	1	04	01	H1608_013_0	5	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	013	0	1	04	01	H1608_013_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	013	0	1	04	01	H1608_013_0	5	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	013	0	1	04	01	H1608_013_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	013	0	1	04	01	H1608_013_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	013	0	1	04	01	H1608_013_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	016	0	1	04	01	H1608_016_0	6	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	016	0	1	04	01	H1608_016_0	6	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	016	0	1	04	01	H1608_016_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	016	0	1	04	01	H1608_016_0	6	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	016	0	1	04	01	H1608_016_0	6	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	016	0	1	04	01	H1608_016_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	016	0	1	04	01	H1608_016_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	017	0	1	04	01	H1608_017_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	017	0	1	04	01	H1608_017_0	5	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	017	0	1	04	01	H1608_017_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	017	0	1	04	01	H1608_017_0	5	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	017	0	1	04	01	H1608_017_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	017	0	1	04	01	H1608_017_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	017	0	1	04	01	H1608_017_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	018	0	1	04	01	H1608_018_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	018	0	1	04	01	H1608_018_0	4	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	018	0	1	04	01	H1608_018_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	018	0	1	04	01	H1608_018_0	4	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	018	0	1	04	01	H1608_018_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	018	0	1	04	01	H1608_018_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	018	0	1	04	01	H1608_018_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	021	0	1	04	01	H1608_021_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	021	0	1	04	01	H1608_021_0	5	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	021	0	1	04	01	H1608_021_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	021	0	1	04	01	H1608_021_0	5	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	021	0	1	04	01	H1608_021_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	021	0	1	04	01	H1608_021_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	021	0	1	04	01	H1608_021_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	023	0	1	04	01	H1608_023_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	023	0	1	04	01	H1608_023_0	4	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	023	0	1	04	01	H1608_023_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	023	0	1	04	01	H1608_023_0	4	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	023	0	1	04	01	H1608_023_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	023	0	1	04	01	H1608_023_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	023	0	1	04	01	H1608_023_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	024	0	1	04	01	H1608_024_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	024	0	1	04	01	H1608_024_0	4	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	024	0	1	04	01	H1608_024_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	024	0	1	04	01	H1608_024_0	4	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	024	0	1	04	01	H1608_024_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	024	0	1	04	01	H1608_024_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	024	0	1	04	01	H1608_024_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	026	0	1	04	01	H1608_026_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	026	0	1	04	01	H1608_026_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	026	0	1	04	01	H1608_026_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	026	0	1	04	01	H1608_026_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	026	0	1	04	01	H1608_026_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	026	0	1	04	01	H1608_026_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	026	0	1	04	01	H1608_026_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	027	0	1	04	01	H1608_027_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	027	0	1	04	01	H1608_027_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	027	0	1	04	01	H1608_027_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	027	0	1	04	01	H1608_027_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	027	0	1	04	01	H1608_027_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	027	0	1	04	01	H1608_027_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	027	0	1	04	01	H1608_027_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	028	0	1	04	01	H1608_028_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	028	0	1	04	01	H1608_028_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	028	0	1	04	01	H1608_028_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	028	0	1	04	01	H1608_028_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	028	0	1	04	01	H1608_028_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	028	0	1	04	01	H1608_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	028	0	1	04	01	H1608_028_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	029	0	1	04	01	H1608_029_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	029	0	1	04	01	H1608_029_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	029	0	1	04	01	H1608_029_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	029	0	1	04	01	H1608_029_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	029	0	1	04	01	H1608_029_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	029	0	1	04	01	H1608_029_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	029	0	1	04	01	H1608_029_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	031	0	1	04	01	H1608_031_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	031	0	1	04	01	H1608_031_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	031	0	1	04	01	H1608_031_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	031	0	1	04	01	H1608_031_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	031	0	1	04	01	H1608_031_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	031	0	1	04	01	H1608_031_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	031	0	1	04	01	H1608_031_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	035	0	1	04	01	H1608_035_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	035	0	1	04	01	H1608_035_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	035	0	1	04	01	H1608_035_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	035	0	1	04	01	H1608_035_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	035	0	1	04	01	H1608_035_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	035	0	1	04	01	H1608_035_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	035	0	1	04	01	H1608_035_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	036	0	1	04	01	H1608_036_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	036	0	1	04	01	H1608_036_0	5	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	036	0	1	04	01	H1608_036_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	036	0	1	04	01	H1608_036_0	5	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	036	0	1	04	01	H1608_036_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	036	0	1	04	01	H1608_036_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	036	0	1	04	01	H1608_036_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	037	0	1	04	01	H1608_037_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	037	0	1	04	01	H1608_037_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	037	0	1	04	01	H1608_037_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	037	0	1	04	01	H1608_037_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	037	0	1	04	01	H1608_037_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	037	0	1	04	01	H1608_037_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	037	0	1	04	01	H1608_037_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	038	0	1	04	01	H1608_038_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	038	0	1	04	01	H1608_038_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	038	0	1	04	01	H1608_038_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	038	0	1	04	01	H1608_038_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1608	038	0	1	04	01	H1608_038_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	038	0	1	04	01	H1608_038_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1608	038	0	1	04	01	H1608_038_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	001	0	1	01	01	H1609_001_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	001	0	1	01	01	H1609_001_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1609	001	0	1	01	01	H1609_001_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	001	0	1	01	01	H1609_001_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1609	001	0	1	01	01	H1609_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	001	0	1	01	01	H1609_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	001	0	1	01	01	H1609_001_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	009	0	1	01	01	H1609_009_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	009	0	1	01	01	H1609_009_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1609	009	0	1	01	01	H1609_009_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	009	0	1	01	01	H1609_009_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1609	009	0	1	01	01	H1609_009_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	009	0	1	01	01	H1609_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	009	0	1	01	01	H1609_009_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	014	0	1	01	01	H1609_014_0	7	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	014	0	1	01	01	H1609_014_0	7	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	014	0	1	01	01	H1609_014_0	7	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	014	0	1	01	01	H1609_014_0	7	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	014	0	1	01	01	H1609_014_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					3.00	6.00	9.00											47.00	94.00	141.00				3.00	6.00	9.00					47.00			47.00			1.57	0.10		1.57	0.10	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	014	0	1	01	01	H1609_014_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	014	0	1	01	01	H1609_014_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	015	0	1	01	01	H1609_015_0	7	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	015	0	1	01	01	H1609_015_0	7	Preferred Generic	4	01	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	015	0	1	01	01	H1609_015_0	7	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	015	0	1	01	01	H1609_015_0	7	Generic	4	01	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	015	0	1	01	01	H1609_015_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	015	0	1	01	01	H1609_015_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	015	0	1	01	01	H1609_015_0	7	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	016	0	1	01	01	H1609_016_0	5	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	016	0	1	01	01	H1609_016_0	5	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.17	0.00		0.17	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	016	0	1	01	01	H1609_016_0	5	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	016	0	1	01	01	H1609_016_0	5	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.33	0.00		0.33	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	016	0	1	01	01	H1609_016_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					3.00	6.00	9.00											47.00	94.00	141.00				3.00	6.00	9.00					47.00			47.00			1.57	0.10		1.57	0.10	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	016	0	1	01	01	H1609_016_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	016	0	1	01	01	H1609_016_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	017	0	1	01	01	H1609_017_0	7	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	017	0	1	01	01	H1609_017_0	7	Preferred Generic	4	01	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	017	0	1	01	01	H1609_017_0	7	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	017	0	1	01	01	H1609_017_0	7	Generic	4	01	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	017	0	1	01	01	H1609_017_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	017	0	1	01	01	H1609_017_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	017	0	1	01	01	H1609_017_0	7	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	018	0	1	01	01	H1609_018_0	5	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	018	0	1	01	01	H1609_018_0	5	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	018	0	1	01	01	H1609_018_0	5	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	018	0	1	01	01	H1609_018_0	5	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	018	0	1	01	01	H1609_018_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					3.00	6.00	9.00											47.00	94.00	141.00				3.00	6.00	9.00					47.00			47.00			1.57	0.10		1.57	0.10	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	018	0	1	01	01	H1609_018_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	018	0	1	01	01	H1609_018_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	019	0	1	01	01	H1609_019_0	7	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	019	0	1	01	01	H1609_019_0	7	Preferred Generic	4	01	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	019	0	1	01	01	H1609_019_0	7	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	019	0	1	01	01	H1609_019_0	7	Generic	4	01	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	019	0	1	01	01	H1609_019_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	019	0	1	01	01	H1609_019_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	019	0	1	01	01	H1609_019_0	7	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	020	0	1	01	01	H1609_020_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	020	0	1	01	01	H1609_020_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	020	0	1	01	01	H1609_020_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	020	0	1	01	01	H1609_020_0	4	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	020	0	1	01	01	H1609_020_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	020	0	1	01	01	H1609_020_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	020	0	1	01	01	H1609_020_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	021	0	1	01	01	H1609_021_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	021	0	1	01	01	H1609_021_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	021	0	1	01	01	H1609_021_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	021	0	1	01	01	H1609_021_0	4	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	021	0	1	01	01	H1609_021_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	021	0	1	01	01	H1609_021_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	021	0	1	01	01	H1609_021_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	022	0	1	01	01	H1609_022_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	022	0	1	01	01	H1609_022_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	022	0	1	01	01	H1609_022_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	022	0	1	01	01	H1609_022_0	4	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	022	0	1	01	01	H1609_022_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	022	0	1	01	01	H1609_022_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	022	0	1	01	01	H1609_022_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	023	0	1	01	01	H1609_023_0	7	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	023	0	1	01	01	H1609_023_0	7	Preferred Generic	4	01	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	023	0	1	01	01	H1609_023_0	7	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	023	0	1	01	01	H1609_023_0	7	Generic	4	01	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	023	0	1	01	01	H1609_023_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	023	0	1	01	01	H1609_023_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	023	0	1	01	01	H1609_023_0	7	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	024	0	1	01	01	H1609_024_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	024	0	1	01	01	H1609_024_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	024	0	1	01	01	H1609_024_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	024	0	1	01	01	H1609_024_0	4	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	024	0	1	01	01	H1609_024_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	024	0	1	01	01	H1609_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	024	0	1	01	01	H1609_024_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	025	0	1	01	01	H1609_025_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	025	0	1	01	01	H1609_025_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	025	0	1	01	01	H1609_025_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	025	0	1	01	01	H1609_025_0	4	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H1609	025	0	1	01	01	H1609_025_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	025	0	1	01	01	H1609_025_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	025	0	1	01	01	H1609_025_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	026	0	1	01	01	H1609_026_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	026	0	1	01	01	H1609_026_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1609	026	0	1	01	01	H1609_026_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	026	0	1	01	01	H1609_026_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1609	026	0	1	01	01	H1609_026_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	026	0	1	01	01	H1609_026_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	026	0	1	01	01	H1609_026_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	027	0	1	01	01	H1609_027_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	027	0	1	01	01	H1609_027_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1609	027	0	1	01	01	H1609_027_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	027	0	1	01	01	H1609_027_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1609	027	0	1	01	01	H1609_027_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	027	0	1	01	01	H1609_027_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	027	0	1	01	01	H1609_027_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	028	0	1	02	01	H1609_028_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	028	0	1	02	01	H1609_028_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1609	028	0	1	02	01	H1609_028_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	028	0	1	02	01	H1609_028_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1609	028	0	1	02	01	H1609_028_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	028	0	1	02	01	H1609_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1609	028	0	1	02	01	H1609_028_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	001	0	1	04	01	H1659_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		15.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	001	0	1	04	01	H1659_001_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		54.00																									18.00		45.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	001	0	1	04	01	H1659_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		100.00				40.00		100.00				40.00				40.00		1.33				1.33	1.33	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	001	0	1	04	01	H1659_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		225.00				90.00		225.00				90.00				90.00		3.00				3.00	3.00	2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	001	0	1	04	01	H1659_001_0	4	Specialty Tier	4	11	1	1	5	1	110		01		110	1	30		90				1	2				30		90	30		31				275.00	25		25																								25		25				25		25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	002	0	1	04	01	H1659_002_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		20.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	002	0	1	04	01	H1659_002_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		54.00																									18.00		45.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	002	0	1	04	01	H1659_002_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		112.50				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	002	0	1	04	01	H1659_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	95.00		285.00																									95.00		237.50				95.00		237.50				95.00				95.00		3.17				3.17	3.17	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	002	0	1	04	01	H1659_002_0	4	Specialty Tier	4	11	1	1	5	1	110		01		110	1	30		90				1	2				30		90	30		31				275.00	25		25																								25		25				25		25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	003	0	1	04	01	H1659_003_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		25.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	003	0	1	04	01	H1659_003_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		50.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	003	0	1	04	01	H1659_003_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		117.50				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	003	0	1	04	01	H1659_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		250.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1659	003	0	1	04	01	H1659_003_0	4	Specialty Tier	4	11	1	1	5	1	110		01		110	1	30		90				1	2				30		90	30		31				275.00	25		25																								25		25				25		25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1660	001	0	1	01	01	H1660_001_0	4	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	001	0	1	01	01	H1660_001_0	4	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H1660	001	0	1	01	01	H1660_001_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	001	0	1	01	01	H1660_001_0	4	Preferred Brand	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	001	0	1	01	01	H1660_001_0	4	Non-Preferred Brand	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	001	0	1	01	01	H1660_001_0	4	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	33	33	33																		33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	005	0	1	01	01	H1660_005_0	4	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	005	0	1	01	01	H1660_005_0	4	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H1660	005	0	1	01	01	H1660_005_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	005	0	1	01	01	H1660_005_0	4	Preferred Brand	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	005	0	1	01	01	H1660_005_0	4	Non-Preferred Brand	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	005	0	1	01	01	H1660_005_0	4	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	33	33	33																		33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	009	0	1	01	01	H1660_009_0	4	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	009	0	1	01	01	H1660_009_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	009	0	1	01	01	H1660_009_0	4	Preferred Brand	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	009	0	1	01	01	H1660_009_0	4	Non-Preferred Brand	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	009	0	1	01	01	H1660_009_0	4	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	26	26	26																		26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	012	0	1	01	01	H1660_012_0	4	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	012	0	1	01	01	H1660_012_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	012	0	1	01	01	H1660_012_0	4	Preferred Brand	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	012	0	1	01	01	H1660_012_0	4	Non-Preferred Brand	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	012	0	1	01	01	H1660_012_0	4	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	26	26	26																		26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	013	0	1	01	01	H1660_013_0	4	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	013	0	1	01	01	H1660_013_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	013	0	1	01	01	H1660_013_0	4	Preferred Brand	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	013	0	1	01	01	H1660_013_0	4	Non-Preferred Brand	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	013	0	1	01	01	H1660_013_0	4	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				245.00	27	27	27																		27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	014	0	1	01	01	H1660_014_0	4	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	014	0	1	01	01	H1660_014_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	014	0	1	01	01	H1660_014_0	4	Preferred Brand	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	014	0	1	01	01	H1660_014_0	4	Non-Preferred Brand	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1660	014	0	1	01	01	H1660_014_0	4	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				227.00	25	25	25																		25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1664	001	0	1	01	01	H1664_001_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1664	001	0	1	01	01	H1664_001_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					5.00	10.00	15.00					5.00	10.00	15.00																20.00				20.00			0.67	0.17	0.17			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1664	001	0	1	01	01	H1664_001_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1664	001	0	1	01	01	H1664_001_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1664	001	0	1	01	01	H1664_001_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1664	001	0	1	01	01	H1664_001_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1664	002	0	1	01	01	H1664_002_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1664	002	0	1	01	01	H1664_002_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					5.00	10.00	15.00					5.00	10.00	15.00																20.00				20.00			0.67	0.17	0.17			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1664	002	0	1	01	01	H1664_002_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1664	002	0	1	01	01	H1664_002_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1664	002	0	1	01	01	H1664_002_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1664	002	0	1	01	01	H1664_002_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H1666	001	0	1	04	01	H1666_001_0	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	001	0	1	04	01	H1666_001_0	10	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	001	0	1	04	01	H1666_001_0	10	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	001	0	1	04	01	H1666_001_0	10	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	001	0	1	04	01	H1666_001_0	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	001	0	1	04	01	H1666_001_0	10	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	001	0	1	04	01	H1666_001_0	10	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											420.40	25		25				424.12	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	002	0	1	04	01	H1666_002_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	002	0	1	04	01	H1666_002_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	002	0	1	04	01	H1666_002_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	002	0	1	04	01	H1666_002_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	002	0	1	04	01	H1666_002_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	002	0	1	04	01	H1666_002_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	002	0	1	04	01	H1666_002_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											375.29	25		25				368.19	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	003	0	1	04	01	H1666_003_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	003	0	1	04	01	H1666_003_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	003	0	1	04	01	H1666_003_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	003	0	1	04	01	H1666_003_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	003	0	1	04	01	H1666_003_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	003	0	1	04	01	H1666_003_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	003	0	1	04	01	H1666_003_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											469.51	25		25				478.06	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	004	0	1	04	01	H1666_004_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	004	0	1	04	01	H1666_004_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	004	0	1	04	01	H1666_004_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	004	0	1	04	01	H1666_004_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	004	0	1	04	01	H1666_004_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	004	0	1	04	01	H1666_004_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	004	0	1	04	01	H1666_004_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											484.25	25		25				488.20	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	005	0	1	04	01	H1666_005_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	005	0	1	04	01	H1666_005_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	005	0	1	04	01	H1666_005_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	005	0	1	04	01	H1666_005_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	005	0	1	04	01	H1666_005_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	005	0	1	04	01	H1666_005_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	005	0	1	04	01	H1666_005_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											334.79	25		25				348.95	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	006	0	1	04	01	H1666_006_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	006	0	1	04	01	H1666_006_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	006	0	1	04	01	H1666_006_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	006	0	1	04	01	H1666_006_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	006	0	1	04	01	H1666_006_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	006	0	1	04	01	H1666_006_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	006	0	1	04	01	H1666_006_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											556.51	25		25				616.26	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	008	0	1	04	01	H1666_008_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	008	0	1	04	01	H1666_008_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	008	0	1	04	01	H1666_008_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	008	0	1	04	01	H1666_008_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	008	0	1	04	01	H1666_008_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	008	0	1	04	01	H1666_008_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	008	0	1	04	01	H1666_008_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											525.32	25		25				515.34	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	009	0	1	04	01	H1666_009_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	009	0	1	04	01	H1666_009_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	009	0	1	04	01	H1666_009_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	009	0	1	04	01	H1666_009_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H1666	009	0	1	04	01	H1666_009_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	009	0	1	04	01	H1666_009_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1666	009	0	1	04	01	H1666_009_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											471.72	25		25				464.48	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1692	002	0	1	01	01	H1692_002_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	002	0	1	01	01	H1692_002_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1692	002	0	1	01	01	H1692_002_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	002	0	1	01	01	H1692_002_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1692	002	0	1	01	01	H1692_002_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	002	0	1	01	01	H1692_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	002	0	1	01	01	H1692_002_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	003	0	1	01	01	H1692_003_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	003	0	1	01	01	H1692_003_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1692	003	0	1	01	01	H1692_003_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	003	0	1	01	01	H1692_003_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1692	003	0	1	01	01	H1692_003_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	003	0	1	01	01	H1692_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	003	0	1	01	01	H1692_003_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	004	0	1	01	01	H1692_004_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	004	0	1	01	01	H1692_004_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1692	004	0	1	01	01	H1692_004_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	004	0	1	01	01	H1692_004_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1692	004	0	1	01	01	H1692_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	004	0	1	01	01	H1692_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1692	004	0	1	01	01	H1692_004_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1723	001	0	1	48	05	H1723_001_0	1	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1723	001	0	1	48	05	H1723_001_0	1	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1723	001	0	1	48	05	H1723_001_0	1	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1737	001	0	1	01	01	H1737_001_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1737	001	0	1	01	01	H1737_001_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1737	001	0	1	01	01	H1737_001_0	2	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1737	001	0	1	01	01	H1737_001_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											72.53	50	50	50				72.53	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1737	001	0	1	01	01	H1737_001_0	2	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											764.48	33	33	33				764.48	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1846	004	0	1	04	01	H1846_004_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1846	004	0	1	04	01	H1846_004_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1846	004	0	1	04	01	H1846_004_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1846	004	0	1	04	01	H1846_004_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1846	004	0	1	04	01	H1846_004_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1846	004	0	1	04	01	H1846_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1894	001	0	1	01	01	H1894_001_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	001	0	1	01	01	H1894_001_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	001	0	1	01	01	H1894_001_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	001	0	1	01	01	H1894_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	001	0	1	01	01	H1894_001_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	001	0	1	01	01	H1894_001_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	001	0	1	01	01	H1894_001_0	8	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1894	002	0	1	01	01	H1894_002_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	002	0	1	01	01	H1894_002_0	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								16.00	32.00	48.00					16.00	32.00	48.00					16.00	48.00	48.00																16.00				16.00			0.53	0.53	0.53			0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	002	0	1	01	01	H1894_002_0	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	002	0	1	01	01	H1894_002_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	002	0	1	01	01	H1894_002_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	002	0	1	01	01	H1894_002_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1894	002	0	1	01	01	H1894_002_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1944	001	0	1	01	01	H1944_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	001	0	1	01	01	H1944_001_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	001	0	1	01	01	H1944_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	001	0	1	01	01	H1944_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	001	0	1	01	01	H1944_001_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				549.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	004	0	1	01	01	H1944_004_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	004	0	1	01	01	H1944_004_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	004	0	1	01	01	H1944_004_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	004	0	1	01	01	H1944_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	004	0	1	01	01	H1944_004_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				621.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	005	0	1	01	01	H1944_005_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	005	0	1	01	01	H1944_005_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	005	0	1	01	01	H1944_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	005	0	1	01	01	H1944_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	005	0	1	01	01	H1944_005_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				881.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	006	0	1	01	01	H1944_006_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	006	0	1	01	01	H1944_006_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	006	0	1	01	01	H1944_006_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	006	0	1	01	01	H1944_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	006	0	1	01	01	H1944_006_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				977.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	009	0	1	01	01	H1944_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	009	0	1	01	01	H1944_009_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	009	0	1	01	01	H1944_009_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	009	0	1	01	01	H1944_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	009	0	1	01	01	H1944_009_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				595.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	010	0	1	01	01	H1944_010_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	010	0	1	01	01	H1944_010_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	010	0	1	01	01	H1944_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	010	0	1	01	01	H1944_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	010	0	1	01	01	H1944_010_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				886.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	011	0	1	01	01	H1944_011_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	011	0	1	01	01	H1944_011_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	011	0	1	01	01	H1944_011_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	011	0	1	01	01	H1944_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	011	0	1	01	01	H1944_011_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				958.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	012	0	1	01	01	H1944_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	012	0	1	01	01	H1944_012_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	012	0	1	01	01	H1944_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	012	0	1	01	01	H1944_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	012	0	1	01	01	H1944_012_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				880.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	013	0	1	01	01	H1944_013_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	013	0	1	01	01	H1944_013_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	013	0	1	01	01	H1944_013_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	013	0	1	01	01	H1944_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	013	0	1	01	01	H1944_013_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				818.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	014	0	1	01	01	H1944_014_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	014	0	1	01	01	H1944_014_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	014	0	1	01	01	H1944_014_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	014	0	1	01	01	H1944_014_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	014	0	1	01	01	H1944_014_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				621.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	016	0	1	01	01	H1944_016_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	016	0	1	01	01	H1944_016_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	016	0	1	01	01	H1944_016_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	016	0	1	01	01	H1944_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	016	0	1	01	01	H1944_016_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				581.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	017	0	1	01	01	H1944_017_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	017	0	1	01	01	H1944_017_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	017	0	1	01	01	H1944_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	017	0	1	01	01	H1944_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	017	0	1	01	01	H1944_017_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				777.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	018	0	1	01	01	H1944_018_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	018	0	1	01	01	H1944_018_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	018	0	1	01	01	H1944_018_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	018	0	1	01	01	H1944_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	018	0	1	01	01	H1944_018_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				697.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	019	0	1	01	01	H1944_019_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	019	0	1	01	01	H1944_019_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	019	0	1	01	01	H1944_019_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	019	0	1	01	01	H1944_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	019	0	1	01	01	H1944_019_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				556.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	020	0	1	01	01	H1944_020_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	020	0	1	01	01	H1944_020_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	020	0	1	01	01	H1944_020_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	020	0	1	01	01	H1944_020_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	020	0	1	01	01	H1944_020_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				645.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	021	0	1	01	01	H1944_021_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	021	0	1	01	01	H1944_021_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	021	0	1	01	01	H1944_021_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	021	0	1	01	01	H1944_021_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	021	0	1	01	01	H1944_021_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				585.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	022	0	1	01	01	H1944_022_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	022	0	1	01	01	H1944_022_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	022	0	1	01	01	H1944_022_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	022	0	1	01	01	H1944_022_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	022	0	1	01	01	H1944_022_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				945.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	024	0	1	01	01	H1944_024_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	024	0	1	01	01	H1944_024_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	024	0	1	01	01	H1944_024_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	024	0	1	01	01	H1944_024_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	024	0	1	01	01	H1944_024_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				729.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	025	0	1	01	01	H1944_025_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	025	0	1	01	01	H1944_025_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	025	0	1	01	01	H1944_025_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	025	0	1	01	01	H1944_025_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	025	0	1	01	01	H1944_025_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				822.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	026	0	1	01	01	H1944_026_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	026	0	1	01	01	H1944_026_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	026	0	1	01	01	H1944_026_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	026	0	1	01	01	H1944_026_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	026	0	1	01	01	H1944_026_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				822.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	028	0	1	01	01	H1944_028_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	028	0	1	01	01	H1944_028_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	028	0	1	01	01	H1944_028_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	028	0	1	01	01	H1944_028_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1944	028	0	1	01	01	H1944_028_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				727.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	013	0	1	01	01	H1951_013_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	013	0	1	01	01	H1951_013_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	013	0	1	01	01	H1951_013_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	013	0	1	01	01	H1951_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	013	0	1	01	01	H1951_013_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	024	0	1	01	01	H1951_024_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	024	0	1	01	01	H1951_024_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	024	0	1	01	01	H1951_024_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	024	0	1	01	01	H1951_024_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	024	0	1	01	01	H1951_024_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	028	0	1	01	01	H1951_028_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	028	0	1	01	01	H1951_028_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	028	0	1	01	01	H1951_028_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	028	0	1	01	01	H1951_028_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	028	0	1	01	01	H1951_028_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	032	0	1	01	01	H1951_032_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	032	0	1	01	01	H1951_032_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	032	0	1	01	01	H1951_032_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	032	0	1	01	01	H1951_032_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	032	0	1	01	01	H1951_032_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	033	0	1	01	01	H1951_033_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	033	0	1	01	01	H1951_033_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	033	0	1	01	01	H1951_033_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	033	0	1	01	01	H1951_033_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	033	0	1	01	01	H1951_033_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	034	0	1	01	01	H1951_034_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	034	0	1	01	01	H1951_034_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	034	0	1	01	01	H1951_034_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	034	0	1	01	01	H1951_034_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	034	0	1	01	01	H1951_034_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	038	0	1	01	01	H1951_038_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	038	0	1	01	01	H1951_038_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	038	0	1	01	01	H1951_038_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	038	0	1	01	01	H1951_038_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	038	0	1	01	01	H1951_038_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	039	0	1	01	01	H1951_039_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	039	0	1	01	01	H1951_039_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	039	0	1	01	01	H1951_039_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	039	0	1	01	01	H1951_039_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	039	0	1	01	01	H1951_039_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	041	0	1	01	01	H1951_041_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	041	0	1	01	01	H1951_041_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	041	0	1	01	01	H1951_041_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	041	0	1	01	01	H1951_041_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	041	0	1	01	01	H1951_041_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	044	0	1	01	01	H1951_044_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1951	044	0	1	01	01	H1951_044_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H1951	044	0	1	01	01	H1951_044_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1951	044	0	1	01	01	H1951_044_0	3	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	3	3
H1951	044	0	1	01	01	H1951_044_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1951	044	0	1	01	01	H1951_044_0	3	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H1951	044	0	1	01	01	H1951_044_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1951	044	0	1	01	01	H1951_044_0	3	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	3	
H1951	044	0	1	01	01	H1951_044_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1951	044	0	1	01	01	H1951_044_0	3	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												24							24												24						24					24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	3	
H1951	044	0	1	01	01	H1951_044_0	3	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1951	044	0	1	01	01	H1951_044_0	3	Select Care Drugs	4	11	1	2	6	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H1951	047	1	1	01	01	H1951_047_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	047	1	1	01	01	H1951_047_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	047	1	1	01	01	H1951_047_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	047	1	1	01	01	H1951_047_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	047	1	1	01	01	H1951_047_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	047	2	1	01	01	H1951_047_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	047	2	1	01	01	H1951_047_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	047	2	1	01	01	H1951_047_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	047	2	1	01	01	H1951_047_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	047	2	1	01	01	H1951_047_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	048	1	1	01	01	H1951_048_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	048	1	1	01	01	H1951_048_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	048	1	1	01	01	H1951_048_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	048	1	1	01	01	H1951_048_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	048	1	1	01	01	H1951_048_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	048	2	1	01	01	H1951_048_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	048	2	1	01	01	H1951_048_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	048	2	1	01	01	H1951_048_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	048	2	1	01	01	H1951_048_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	048	2	1	01	01	H1951_048_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	1	1	01	01	H1951_049_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	1	1	01	01	H1951_049_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	1	1	01	01	H1951_049_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	1	1	01	01	H1951_049_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	1	1	01	01	H1951_049_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	2	1	01	01	H1951_049_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	2	1	01	01	H1951_049_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	2	1	01	01	H1951_049_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	2	1	01	01	H1951_049_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	2	1	01	01	H1951_049_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	3	1	01	01	H1951_049_3	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	3	1	01	01	H1951_049_3	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	3	1	01	01	H1951_049_3	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	3	1	01	01	H1951_049_3	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1951	049	3	1	01	01	H1951_049_3	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	007	0	1	01	01	H1961_007_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					0.00		0.00													9.00						0.00				3.00				3.00			0.10	0.00				0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	007	0	1	01	01	H1961_007_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					0.00		0.00													9.00						0.00				3.00				3.00			0.10	0.00				0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1961	007	0	1	01	01	H1961_007_0	8	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					12.00		36.00													51.00						36.00				17.00				17.00			0.57	0.40				0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	007	0	1	01	01	H1961_007_0	8	Generic	4	01	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					12.00		36.00													51.00						36.00				17.00				17.00			0.57	0.40				0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1961	007	0	1	01	01	H1961_007_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				47.00			1.57	1.23				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	007	0	1	01	01	H1961_007_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.33	3.00				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	007	0	1	01	01	H1961_007_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											515.27	33		33				515.27	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	014	1	1	01	01	H1961_014_1	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	014	1	1	01	01	H1961_014_1	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1961	014	1	1	01	01	H1961_014_1	8	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	014	1	1	01	01	H1961_014_1	8	Generic	4	01	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				15.00			0.50	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1961	014	1	1	01	01	H1961_014_1	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				47.00			1.57	1.23				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	014	1	1	01	01	H1961_014_1	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								90.00		270.00					80.00		240.00													270.00						240.00				90.00				90.00			3.00	2.67				2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	014	1	1	01	01	H1961_014_1	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											498.94	33		33				498.94	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	014	2	1	01	01	H1961_014_2	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	014	2	1	01	01	H1961_014_2	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1961	014	2	1	01	01	H1961_014_2	8	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	014	2	1	01	01	H1961_014_2	8	Generic	4	01	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				15.00			0.50	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1961	014	2	1	01	01	H1961_014_2	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				47.00			1.57	1.23				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	014	2	1	01	01	H1961_014_2	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								90.00		270.00					80.00		240.00													270.00						240.00				90.00				90.00			3.00	2.67				2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	014	2	1	01	01	H1961_014_2	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											498.94	33		33				498.94	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	017	0	1	01	01	H1961_017_0	4	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	017	0	1	01	01	H1961_017_0	4	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1961	017	0	1	01	01	H1961_017_0	4	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	017	0	1	01	01	H1961_017_0	4	Generic	4	01	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				15.00			0.50	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H1961	017	0	1	01	01	H1961_017_0	4	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				47.00			1.57	1.23				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	017	0	1	01	01	H1961_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								90.00		270.00					80.00		240.00													270.00						240.00				90.00				90.00			3.00	2.67				2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1961	017	0	1	01	01	H1961_017_0	4	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											498.94	33		33				498.94	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H1969	002	0	1	01	01	H1969_002_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1969	002	0	1	01	01	H1969_002_0	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1969	002	0	1	01	01	H1969_002_0	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1969	002	0	1	01	01	H1969_002_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1969	002	0	1	01	01	H1969_002_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1329.94	29						1329.94	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1969	002	0	1	01	01	H1969_002_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1969	004	0	1	01	01	H1969_004_0	10	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					3.00	6.00	6.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1969	004	0	1	01	01	H1969_004_0	10	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1969	004	0	1	01	01	H1969_004_0	10	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1969	004	0	1	01	01	H1969_004_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1969	004	0	1	01	01	H1969_004_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1513.38	33						1513.38	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1969	004	0	1	01	01	H1969_004_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1977	001	0	1	48	05	H1977_001_0	5	Generic Drugs	4	01			1	1	010		01			1	30														30		31																																																						Generic Drugs, Brand Drugs	3		0.00	0.00	0.00	0.00			0.00	0.00			
H1977	001	0	1	48	05	H1977_001_0	5	Brand Drugs	4	10			2	1	010		01			1	30														30		31																																																						Generic Drugs, Brand Drugs	3		0.00	0.00	0.00	0.00			0.00	0.00			
H1994	001	0	1	01	01	H1994_001_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	001	0	1	01	01	H1994_001_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	001	0	1	01	01	H1994_001_0	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	001	0	1	01	01	H1994_001_0	5	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	001	0	1	01	01	H1994_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1229.68	28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	002	0	1	01	01	H1994_002_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	002	0	1	01	01	H1994_002_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	002	0	1	01	01	H1994_002_0	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	002	0	1	01	01	H1994_002_0	5	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	002	0	1	01	01	H1994_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1198.10	28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	003	0	1	01	01	H1994_003_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	003	0	1	01	01	H1994_003_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	003	0	1	01	01	H1994_003_0	4	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	003	0	1	01	01	H1994_003_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	003	0	1	01	01	H1994_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1171.68	30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	004	0	1	01	01	H1994_004_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	004	0	1	01	01	H1994_004_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	004	0	1	01	01	H1994_004_0	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	004	0	1	01	01	H1994_004_0	5	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	004	0	1	01	01	H1994_004_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				980.18	30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	005	0	1	01	01	H1994_005_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	005	0	1	01	01	H1994_005_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	005	0	1	01	01	H1994_005_0	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	005	0	1	01	01	H1994_005_0	5	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	005	0	1	01	01	H1994_005_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				989.97	28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	007	0	1	01	01	H1994_007_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	007	0	1	01	01	H1994_007_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	007	0	1	01	01	H1994_007_0	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	007	0	1	01	01	H1994_007_0	5	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	007	0	1	01	01	H1994_007_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				841.35	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	008	0	1	01	01	H1994_008_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	008	0	1	01	01	H1994_008_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	008	0	1	01	01	H1994_008_0	4	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	008	0	1	01	01	H1994_008_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1994	008	0	1	01	01	H1994_008_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1387.05	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H1997	002	0	1	01	01	H1997_002_0	10	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1997	002	0	1	01	01	H1997_002_0	10	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1997	002	0	1	01	01	H1997_002_0	10	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1997	002	0	1	01	01	H1997_002_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1997	002	0	1	01	01	H1997_002_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1329.94	29						1329.94	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1997	002	0	1	01	01	H1997_002_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1997	006	0	1	01	01	H1997_006_0	9	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1997	006	0	1	01	01	H1997_006_0	9	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1997	006	0	1	01	01	H1997_006_0	9	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1997	006	0	1	01	01	H1997_006_0	9	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1997	006	0	1	01	01	H1997_006_0	9	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1146.50	25						1146.50	25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H1997	006	0	1	01	01	H1997_006_0	9	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2001	001	0	1	04	01	H2001_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	001	0	1	04	01	H2001_001_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	001	0	1	04	01	H2001_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	001	0	1	04	01	H2001_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	001	0	1	04	01	H2001_001_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				646.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	010	0	1	04	01	H2001_010_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	010	0	1	04	01	H2001_010_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	010	0	1	04	01	H2001_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	010	0	1	04	01	H2001_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	010	0	1	04	01	H2001_010_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				821.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	017	0	1	04	01	H2001_017_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				1	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	017	0	1	04	01	H2001_017_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		100				1	2						100	30		31	13.00		39.00																											39.00						0.00				13.00				13.00		0.43						0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	017	0	1	04	01	H2001_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				1	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	017	0	1	04	01	H2001_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				1	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2001	017	0	1	04	01	H2001_017_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		100				1	2						100	30		31				457.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2029	001	0	1	04	01	H2029_001_0	4	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2029	001	0	1	04	01	H2029_001_0	4	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2029	001	0	1	04	01	H2029_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2029	001	0	1	04	01	H2029_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2029	001	0	1	04	01	H2029_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2032	001	0	1	04	01	H2032_001_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2032	001	0	1	04	01	H2032_001_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	28.00																14.00				14.00		0.47			0.47			0.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2032	001	0	1	04	01	H2032_001_0	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2032	001	0	1	04	01	H2032_001_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2032	001	0	1	04	01	H2032_001_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2032	002	0	1	04	01	H2032_002_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2032	002	0	1	04	01	H2032_002_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	28.00																14.00				14.00		0.47			0.47			0.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2032	002	0	1	04	01	H2032_002_0	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2032	002	0	1	04	01	H2032_002_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2032	002	0	1	04	01	H2032_002_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	022	0	1	01	01	H2108_022_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	18.00					4.00	8.00	8.00					9.00	18.00	18.00																9.00				9.00			0.30	0.13	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	022	0	1	01	01	H2108_022_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					20.00	40.00	40.00																20.00				20.00			0.67	0.50	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	022	0	1	01	01	H2108_022_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	022	0	1	01	01	H2108_022_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	285.00																95.00				95.00			3.17	3.00	3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	022	0	1	01	01	H2108_022_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											322.71	27						372.52	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	028	0	1	01	01	H2108_028_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	18.00					4.00	8.00	8.00					9.00	18.00	18.00																9.00				9.00			0.30	0.13	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	028	0	1	01	01	H2108_028_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					20.00	40.00	40.00																20.00				20.00			0.67	0.50	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	028	0	1	01	01	H2108_028_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	028	0	1	01	01	H2108_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	285.00																95.00				95.00			3.17	3.00	3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	028	0	1	01	01	H2108_028_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											446.46	27						425.10	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	029	0	1	01	01	H2108_029_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	18.00					4.00	8.00	8.00					9.00	18.00	18.00																9.00				9.00			0.30	0.13	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	029	0	1	01	01	H2108_029_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					20.00	40.00	40.00																20.00				20.00			0.67	0.50	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	029	0	1	01	01	H2108_029_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	029	0	1	01	01	H2108_029_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	285.00																95.00				95.00			3.17	3.00	3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	029	0	1	01	01	H2108_029_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											283.81	27						290.46	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	029	0	1	01	01	H2108_029_0	5	Select Diabetic Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	12.00					5.00	10.00	10.00					6.00	12.00	12.00																6.00				6.00			0.20	0.17	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	030	0	1	01	01	H2108_030_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	18.00					4.00	8.00	8.00					9.00	18.00	18.00																9.00				9.00			0.30	0.13	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	030	0	1	01	01	H2108_030_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					20.00	40.00	40.00																20.00				20.00			0.67	0.50	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	030	0	1	01	01	H2108_030_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	030	0	1	01	01	H2108_030_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	285.00																95.00				95.00			3.17	3.00	3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	030	0	1	01	01	H2108_030_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											305.31	27						293.25	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	030	0	1	01	01	H2108_030_0	5	Select Diabetic Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	22.00					10.00	20.00	20.00					11.00	22.00	22.00																11.00				11.00			0.37	0.33	0.37			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H2108	032	0	1	01	01	H2108_032_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	18.00					4.00	8.00	8.00					9.00	18.00	18.00																9.00				9.00			0.30	0.13	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	032	0	1	01	01	H2108_032_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					20.00	40.00	40.00																20.00				20.00			0.67	0.50	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	032	0	1	01	01	H2108_032_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	032	0	1	01	01	H2108_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	285.00																95.00				95.00			3.17	3.00	3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	032	0	1	01	01	H2108_032_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											303.44	26						292.36	26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	033	0	1	01	01	H2108_033_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	18.00					4.00	8.00	8.00					9.00	18.00	18.00																9.00				9.00			0.30	0.13	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	033	0	1	01	01	H2108_033_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					20.00	40.00	40.00																20.00				20.00			0.67	0.50	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	033	0	1	01	01	H2108_033_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	033	0	1	01	01	H2108_033_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	285.00																95.00				95.00			3.17	3.00	3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2108	033	0	1	01	01	H2108_033_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											304.82	26						354.50	26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2150	002	0	1	18	06	H2150_002_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	002	0	1	18	06	H2150_002_0	8	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2150	002	0	1	18	06	H2150_002_0	8	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	002	0	1	18	06	H2150_002_0	8	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2150	002	0	1	18	06	H2150_002_0	8	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	002	0	1	18	06	H2150_002_0	8	Non-Preferred Brand	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		160.00				100.00				100.00			3.33	2.66		3.33	2.66	3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	002	0	1	18	06	H2150_002_0	8	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31											1878.00	33		33				1878.00	33		33										33		33				33		33			33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	002	0	1	18	06	H2150_002_0	8	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	002	0	1	18	06	H2150_002_0	8	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2150	009	0	1	18	06	H2150_009_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	009	0	1	18	06	H2150_009_0	8	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	009	0	1	18	06	H2150_009_0	8	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	009	0	1	18	06	H2150_009_0	8	Non-Preferred Brand	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		190.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	009	0	1	18	06	H2150_009_0	8	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31											1464.00	27		27				1464.00	27		27										27		27				27		27			27			27								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	009	0	1	18	06	H2150_009_0	8	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	009	0	1	18	06	H2150_009_0	8	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2150	029	0	2	18	06	H2150_029_0	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	029	0	2	18	06	H2150_029_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	029	0	2	18	06	H2150_029_0	7	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	029	0	2	18	06	H2150_029_0	7	Non-Preferred Brand	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		190.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	029	0	2	18	06	H2150_029_0	7	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31											1887.00	27		27				1887.00	27		27										27		27				27		27			27			27								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	029	0	2	18	06	H2150_029_0	7	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2150	029	0	2	18	06	H2150_029_0	7	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2161	002	0	1	01	01	H2161_002_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	7.50	7.50																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2161	002	0	1	01	01	H2161_002_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			10.00	15.00	15.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2161	002	0	1	01	01	H2161_002_0	4	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	84.00																			42.00	63.00	63.00																42.00				42.00		1.40			1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2161	002	0	1	01	01	H2161_002_0	4	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	190.00																			95.00	142.50	142.50																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2161	002	0	1	01	01	H2161_002_0	4	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2161	003	0	1	01	01	H2161_003_0	5	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	14.00																			7.00	10.50	10.50																7.00				7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2161	003	0	1	01	01	H2161_003_0	5	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	15.00	30.00	30.00																			15.00	22.50	22.50																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2161	003	0	1	01	01	H2161_003_0	5	Preferred Brand	3	10	1	2	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	47.00	94.00	94.00																			47.00	70.50	70.50																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2161	003	0	1	01	01	H2161_003_0	5	Non-Preferred Drug	3	10	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	100.00	200.00	200.00																			100.00	150.00	150.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2161	003	0	1	01	01	H2161_003_0	5	Specialty Tier	3	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2171	001	0	1	01	01	H2171_001_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2171	001	0	1	01	01	H2171_001_0	5	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	10.00	20.00	20.00																			10.00	20.00	20.00																	10.00			10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2171	001	0	1	01	01	H2171_001_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	43.00	86.00	86.00																			43.00	86.00	86.00																	43.00			43.00		1.43			1.43			1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2171	001	0	1	01	01	H2171_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	95.00	190.00	190.00																			95.00	190.00	190.00																	95.00			95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2171	001	0	1	01	01	H2171_001_0	5	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				933.29	33	33	33																		33	33	33																33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2172	001	0	1	01	01	H2172_001_0	12	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	001	0	1	01	01	H2172_001_0	12	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2172	001	0	1	01	01	H2172_001_0	12	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	001	0	1	01	01	H2172_001_0	12	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2172	001	0	1	01	01	H2172_001_0	12	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	001	0	1	01	01	H2172_001_0	12	Non-Preferred Brand	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		160.00				100.00				100.00			3.33	2.66		3.33	2.66	3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	001	0	1	01	01	H2172_001_0	12	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31											1877.00	33		33				1877.00	33		33										33		33				33		33			33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	001	0	1	01	01	H2172_001_0	12	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	001	0	1	01	01	H2172_001_0	12	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2172	002	0	1	01	01	H2172_002_0	11	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	002	0	1	01	01	H2172_002_0	11	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2172	002	0	1	01	01	H2172_002_0	11	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	002	0	1	01	01	H2172_002_0	11	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2172	002	0	1	01	01	H2172_002_0	11	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	002	0	1	01	01	H2172_002_0	11	Non-Preferred Brand	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		160.00				100.00				100.00			3.33	2.66		3.33	2.66	3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	002	0	1	01	01	H2172_002_0	11	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31											1781.00	33		33				1781.00	33		33										33		33				33		33			33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	002	0	1	01	01	H2172_002_0	11	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	002	0	1	01	01	H2172_002_0	11	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2172	003	0	1	01	01	H2172_003_0	11	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	003	0	1	01	01	H2172_003_0	11	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	003	0	1	01	01	H2172_003_0	11	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	003	0	1	01	01	H2172_003_0	11	Non-Preferred Brand	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	003	0	1	01	01	H2172_003_0	11	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31											1789.00	33		33				1789.00	33		33										33		33				33		33			33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	003	0	1	01	01	H2172_003_0	11	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	003	0	1	01	01	H2172_003_0	11	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2172	004	0	1	01	01	H2172_004_0	11	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	004	0	1	01	01	H2172_004_0	11	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	004	0	1	01	01	H2172_004_0	11	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	004	0	1	01	01	H2172_004_0	11	Non-Preferred Brand	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	004	0	1	01	01	H2172_004_0	11	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31											1823.00	33		33				1823.00	33		33										33		33				33		33			33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	004	0	1	01	01	H2172_004_0	11	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H2172	004	0	1	01	01	H2172_004_0	11	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H2228	011	0	1	04	01	H2228_011_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	011	0	1	04	01	H2228_011_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	011	0	1	04	01	H2228_011_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	011	0	1	04	01	H2228_011_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	011	0	1	04	01	H2228_011_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1082.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	012	0	1	04	01	H2228_012_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	012	0	1	04	01	H2228_012_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	012	0	1	04	01	H2228_012_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	012	0	1	04	01	H2228_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	012	0	1	04	01	H2228_012_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1045.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	017	0	1	04	01	H2228_017_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	017	0	1	04	01	H2228_017_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	017	0	1	04	01	H2228_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	017	0	1	04	01	H2228_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	017	0	1	04	01	H2228_017_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1046.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	018	0	1	04	01	H2228_018_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	018	0	1	04	01	H2228_018_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	018	0	1	04	01	H2228_018_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	018	0	1	04	01	H2228_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	018	0	1	04	01	H2228_018_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				897.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	019	0	1	04	01	H2228_019_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	019	0	1	04	01	H2228_019_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	019	0	1	04	01	H2228_019_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	019	0	1	04	01	H2228_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	019	0	1	04	01	H2228_019_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				737.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	020	0	1	04	01	H2228_020_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	020	0	1	04	01	H2228_020_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	020	0	1	04	01	H2228_020_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	020	0	1	04	01	H2228_020_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	020	0	1	04	01	H2228_020_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				598.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	021	0	1	04	01	H2228_021_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	021	0	1	04	01	H2228_021_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	021	0	1	04	01	H2228_021_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	021	0	1	04	01	H2228_021_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	021	0	1	04	01	H2228_021_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				873.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	022	0	1	04	01	H2228_022_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	022	0	1	04	01	H2228_022_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	022	0	1	04	01	H2228_022_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	022	0	1	04	01	H2228_022_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	022	0	1	04	01	H2228_022_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				848.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	023	0	1	04	01	H2228_023_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	023	0	1	04	01	H2228_023_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	023	0	1	04	01	H2228_023_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	023	0	1	04	01	H2228_023_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	023	0	1	04	01	H2228_023_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				865.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	024	0	1	04	01	H2228_024_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	024	0	1	04	01	H2228_024_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	024	0	1	04	01	H2228_024_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	024	0	1	04	01	H2228_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	024	0	1	04	01	H2228_024_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				617.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	029	0	1	04	01	H2228_029_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	029	0	1	04	01	H2228_029_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	029	0	1	04	01	H2228_029_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	029	0	1	04	01	H2228_029_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	029	0	1	04	01	H2228_029_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				665.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	030	0	1	04	01	H2228_030_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	030	0	1	04	01	H2228_030_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	030	0	1	04	01	H2228_030_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	030	0	1	04	01	H2228_030_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	030	0	1	04	01	H2228_030_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				630.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	031	0	1	04	01	H2228_031_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	031	0	1	04	01	H2228_031_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	031	0	1	04	01	H2228_031_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	031	0	1	04	01	H2228_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	031	0	1	04	01	H2228_031_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				522.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	032	0	1	04	01	H2228_032_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	032	0	1	04	01	H2228_032_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	032	0	1	04	01	H2228_032_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	032	0	1	04	01	H2228_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	032	0	1	04	01	H2228_032_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				519.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	033	0	1	04	01	H2228_033_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	033	0	1	04	01	H2228_033_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	033	0	1	04	01	H2228_033_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	033	0	1	04	01	H2228_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	033	0	1	04	01	H2228_033_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				857.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	035	0	1	04	01	H2228_035_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	035	0	1	04	01	H2228_035_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	035	0	1	04	01	H2228_035_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	035	0	1	04	01	H2228_035_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	035	0	1	04	01	H2228_035_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				808.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	036	0	1	04	01	H2228_036_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	036	0	1	04	01	H2228_036_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	036	0	1	04	01	H2228_036_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	036	0	1	04	01	H2228_036_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	036	0	1	04	01	H2228_036_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				662.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	037	0	1	04	01	H2228_037_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	037	0	1	04	01	H2228_037_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	037	0	1	04	01	H2228_037_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	037	0	1	04	01	H2228_037_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	037	0	1	04	01	H2228_037_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				797.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	039	0	1	04	01	H2228_039_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	039	0	1	04	01	H2228_039_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	039	0	1	04	01	H2228_039_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	039	0	1	04	01	H2228_039_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	039	0	1	04	01	H2228_039_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				994.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	047	0	1	04	01	H2228_047_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	047	0	1	04	01	H2228_047_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	047	0	1	04	01	H2228_047_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	047	0	1	04	01	H2228_047_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	047	0	1	04	01	H2228_047_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				738.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	048	0	1	04	01	H2228_048_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	048	0	1	04	01	H2228_048_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	048	0	1	04	01	H2228_048_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	048	0	1	04	01	H2228_048_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	048	0	1	04	01	H2228_048_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				634.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	049	0	1	04	01	H2228_049_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	049	0	1	04	01	H2228_049_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	049	0	1	04	01	H2228_049_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	049	0	1	04	01	H2228_049_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2228	049	0	1	04	01	H2228_049_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				739.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2230	002	0	1	04	01	H2230_002_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	002	0	1	04	01	H2230_002_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	002	0	1	04	01	H2230_002_0	8	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	002	0	1	04	01	H2230_002_0	8	Non-Preferred Brand	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	002	0	1	04	01	H2230_002_0	8	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												25	25	25					25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	017	0	1	04	01	H2230_017_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	5.00	5.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	017	0	1	04	01	H2230_017_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					11.00	22.00	33.00					11.00	22.00	22.00																16.00				16.00			0.53	0.37	0.37			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	017	0	1	04	01	H2230_017_0	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	017	0	1	04	01	H2230_017_0	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	017	0	1	04	01	H2230_017_0	7	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												25	25	25					25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	018	1	1	04	01	H2230_018_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	3.00	3.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	018	1	1	04	01	H2230_018_1	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	018	1	1	04	01	H2230_018_1	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	018	1	1	04	01	H2230_018_1	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	018	1	1	04	01	H2230_018_1	7	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	018	2	1	04	01	H2230_018_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	3.00	3.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	018	2	1	04	01	H2230_018_2	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	018	2	1	04	01	H2230_018_2	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	018	2	1	04	01	H2230_018_2	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2230	018	2	1	04	01	H2230_018_2	7	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2237	001	0	1	01	01	H2237_001_0	11	Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45		Generic, Brand, Specialty Tier													
H2237	001	0	1	01	01	H2237_001_0	11	Brand	3	10	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	52.00	104.00	156.00																			52.00	104.00	156.00																52.00				52.00		1.73			1.73			1.68		Generic, Brand, Specialty Tier													
H2237	001	0	1	01	01	H2237_001_0	11	Specialty Tier	3	11	1	1	3	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25									Generic, Brand, Specialty Tier													
H2237	007	0	1	01	01	H2237_007_0	9	Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39		Generic, Brand, Specialty Tier													
H2237	007	0	1	01	01	H2237_007_0	9	Brand	3	10	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	49.00	98.00	147.00																			49.00	98.00	147.00																49.00				49.00		1.63			1.63			1.58		Generic, Brand, Specialty Tier													
H2237	007	0	1	01	01	H2237_007_0	9	Specialty Tier	3	11	1	1	3	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25									Generic, Brand, Specialty Tier													
H2237	009	0	1	01	01	H2237_009_0	11	Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48		Generic, Brand, Specialty Tier													
H2237	009	0	1	01	01	H2237_009_0	11	Brand	3	10	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	50.00	100.00	150.00																			50.00	100.00	150.00																50.00				50.00		1.67			1.67			1.61		Generic, Brand, Specialty Tier													
H2237	009	0	1	01	01	H2237_009_0	11	Specialty Tier	3	11	1	1	3	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25									Generic, Brand, Specialty Tier													
H2237	010	0	1	01	01	H2237_010_0	9	Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39		Generic, Brand, Specialty Tier													
H2237	010	0	1	01	01	H2237_010_0	9	Brand	3	10	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	49.00	98.00	147.00																			49.00	98.00	147.00																49.00				49.00		1.63			1.63			1.58		Generic, Brand, Specialty Tier													
H2237	010	0	1	01	01	H2237_010_0	9	Specialty Tier	3	11	1	1	3	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25									Generic, Brand, Specialty Tier													
H2241	007	1	1	01	01	H2241_007_1	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		.16						.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	1	1	01	01	H2241_007_1	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		.16						.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2241	007	1	1	01	01	H2241_007_1	7	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	10.00		30.00																					20.00																10.00				10.00		.32						.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	1	1	01	01	H2241_007_1	7	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	10.00		30.00																					20.00																10.00				10.00		.32						.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2241	007	1	1	01	01	H2241_007_1	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	45.00		135.00																					90.00																45.00				45.00		1.45						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	1	1	01	01	H2241_007_1	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	95.00		285.00																					190.00																95.00				95.00		3.06						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	1	1	01	01	H2241_007_1	7	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		31				120.78	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	2	1	01	01	H2241_007_2	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		.16						.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	2	1	01	01	H2241_007_2	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		.16						.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2241	007	2	1	01	01	H2241_007_2	7	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	10.00		30.00																					20.00																10.00				10.00		.32						.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	2	1	01	01	H2241_007_2	7	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	10.00		30.00																					20.00																10.00				10.00		.32						.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2241	007	2	1	01	01	H2241_007_2	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	45.00		135.00																					90.00																45.00				45.00		1.45						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	2	1	01	01	H2241_007_2	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	95.00		285.00																					190.00																95.00				95.00		3.06						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	2	1	01	01	H2241_007_2	7	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		31				120.78	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	3	1	01	01	H2241_007_3	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		.16						.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	3	1	01	01	H2241_007_3	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		.16						.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2241	007	3	1	01	01	H2241_007_3	7	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	10.00		30.00																					20.00																10.00				10.00		.32						.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	3	1	01	01	H2241_007_3	7	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	10.00		30.00																					20.00																10.00				10.00		.32						.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2241	007	3	1	01	01	H2241_007_3	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	45.00		135.00																					90.00																45.00				45.00		1.45						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	3	1	01	01	H2241_007_3	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	95.00		285.00																					190.00																95.00				95.00		3.06						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2241	007	3	1	01	01	H2241_007_3	7	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		31				120.78	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	1	1	01	01	H2256_001_1	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	1	1	01	01	H2256_001_1	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2256	001	1	1	01	01	H2256_001_1	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	1	1	01	01	H2256_001_1	7	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2256	001	1	1	01	01	H2256_001_1	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	60.00																30.00				30.00		1.00			1.00			0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	1	1	01	01	H2256_001_1	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	1	1	01	01	H2256_001_1	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	2	1	01	01	H2256_001_2	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	2	1	01	01	H2256_001_2	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2256	001	2	1	01	01	H2256_001_2	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	2	1	01	01	H2256_001_2	7	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2256	001	2	1	01	01	H2256_001_2	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	60.00																30.00				30.00		1.00			1.00			0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	2	1	01	01	H2256_001_2	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	2	1	01	01	H2256_001_2	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	6	1	01	01	H2256_001_6	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	6	1	01	01	H2256_001_6	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2256	001	6	1	01	01	H2256_001_6	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	6	1	01	01	H2256_001_6	7	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2256	001	6	1	01	01	H2256_001_6	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	60.00																30.00				30.00		1.00			1.00			0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	6	1	01	01	H2256_001_6	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	001	6	1	01	01	H2256_001_6	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	1	1	01	01	H2256_015_1	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	1	1	01	01	H2256_015_1	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	1	1	01	01	H2256_015_1	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	1	1	01	01	H2256_015_1	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	1	1	01	01	H2256_015_1	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	2	1	01	01	H2256_015_2	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	2	1	01	01	H2256_015_2	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	2	1	01	01	H2256_015_2	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	2	1	01	01	H2256_015_2	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	2	1	01	01	H2256_015_2	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	6	1	01	01	H2256_015_6	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	6	1	01	01	H2256_015_6	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	6	1	01	01	H2256_015_6	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	6	1	01	01	H2256_015_6	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	015	6	1	01	01	H2256_015_6	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	1	1	01	01	H2256_018_1	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	1	1	01	01	H2256_018_1	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	1	1	01	01	H2256_018_1	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	1	1	01	01	H2256_018_1	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	1	1	01	01	H2256_018_1	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	7	1	01	01	H2256_018_7	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	7	1	01	01	H2256_018_7	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	7	1	01	01	H2256_018_7	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	7	1	01	01	H2256_018_7	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	7	1	01	01	H2256_018_7	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	8	1	01	01	H2256_018_8	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	8	1	01	01	H2256_018_8	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	8	1	01	01	H2256_018_8	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	8	1	01	01	H2256_018_8	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	018	8	1	01	01	H2256_018_8	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	1	1	01	01	H2256_026_1	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	1	1	01	01	H2256_026_1	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	1	1	01	01	H2256_026_1	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	1	1	01	01	H2256_026_1	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	1	1	01	01	H2256_026_1	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	2	1	01	01	H2256_026_2	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	2	1	01	01	H2256_026_2	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	2	1	01	01	H2256_026_2	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	2	1	01	01	H2256_026_2	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	2	1	01	01	H2256_026_2	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	3	1	01	01	H2256_026_3	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	3	1	01	01	H2256_026_3	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	3	1	01	01	H2256_026_3	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	3	1	01	01	H2256_026_3	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	026	3	1	01	01	H2256_026_3	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	028	0	1	01	01	H2256_028_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	028	0	1	01	01	H2256_028_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	028	0	1	01	01	H2256_028_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	028	0	1	01	01	H2256_028_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	028	0	1	01	01	H2256_028_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	033	0	1	01	01	H2256_033_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	033	0	1	01	01	H2256_033_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	033	0	1	01	01	H2256_033_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	033	0	1	01	01	H2256_033_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	033	0	1	01	01	H2256_033_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	034	0	1	01	01	H2256_034_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	034	0	1	01	01	H2256_034_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	034	0	1	01	01	H2256_034_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	034	0	1	01	01	H2256_034_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	034	0	1	01	01	H2256_034_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	036	0	1	01	01	H2256_036_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	036	0	1	01	01	H2256_036_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	036	0	1	01	01	H2256_036_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	036	0	1	01	01	H2256_036_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2256	036	0	1	01	01	H2256_036_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2261	005	0	1	01	01	H2261_005_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	005	0	1	01	01	H2261_005_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	005	0	1	01	01	H2261_005_0	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	005	0	1	01	01	H2261_005_0	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	005	0	1	01	01	H2261_005_0	7	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												25	25	25					25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	022	1	1	01	01	H2261_022_1	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	3.00	3.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	022	1	1	01	01	H2261_022_1	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	022	1	1	01	01	H2261_022_1	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	022	1	1	01	01	H2261_022_1	6	Non-Preferred Brand	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	022	1	1	01	01	H2261_022_1	6	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	022	2	1	01	01	H2261_022_2	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	3.00	3.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	022	2	1	01	01	H2261_022_2	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	022	2	1	01	01	H2261_022_2	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	022	2	1	01	01	H2261_022_2	6	Non-Preferred Brand	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	022	2	1	01	01	H2261_022_2	6	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	023	1	1	02	01	H2261_023_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	023	1	1	02	01	H2261_023_1	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	023	1	1	02	01	H2261_023_1	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	023	1	1	02	01	H2261_023_1	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	023	1	1	02	01	H2261_023_1	7	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	023	2	1	02	01	H2261_023_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	023	2	1	02	01	H2261_023_2	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	023	2	1	02	01	H2261_023_2	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	023	2	1	02	01	H2261_023_2	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2261	023	2	1	02	01	H2261_023_2	7	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2320	007	0	1	02	01	H2320_007_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	007	0	1	02	01	H2320_007_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	007	0	1	02	01	H2320_007_0	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	007	0	1	02	01	H2320_007_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											91.27	45	45	45				81.13	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	007	0	1	02	01	H2320_007_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	008	0	1	02	01	H2320_008_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	008	0	1	02	01	H2320_008_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	008	0	1	02	01	H2320_008_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	008	0	1	02	01	H2320_008_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											71.05	45	45	45				63.16	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	008	0	1	02	01	H2320_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	011	0	1	02	01	H2320_011_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	011	0	1	02	01	H2320_011_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	011	0	1	02	01	H2320_011_0	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	011	0	1	02	01	H2320_011_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											87.85	50	50	50				79.07	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	011	0	1	02	01	H2320_011_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	012	0	1	02	01	H2320_012_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	012	0	1	02	01	H2320_012_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	012	0	1	02	01	H2320_012_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	012	0	1	02	01	H2320_012_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											83.52	50	50	50				75.17	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	012	0	1	02	01	H2320_012_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	013	0	1	02	01	H2320_013_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	013	0	1	02	01	H2320_013_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	013	0	1	02	01	H2320_013_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	013	0	1	02	01	H2320_013_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											85.16	45	45	45				75.70	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	013	0	1	02	01	H2320_013_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	015	0	1	02	01	H2320_015_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	015	0	1	02	01	H2320_015_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	015	0	1	02	01	H2320_015_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	015	0	1	02	01	H2320_015_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											95.53	50	50	50				85.98	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	015	0	1	02	01	H2320_015_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	016	0	1	02	01	H2320_016_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	016	0	1	02	01	H2320_016_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	016	0	1	02	01	H2320_016_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	016	0	1	02	01	H2320_016_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											83.91	45	45	45				74.59	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	016	0	1	02	01	H2320_016_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	018	0	1	02	01	H2320_018_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	018	0	1	02	01	H2320_018_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	018	0	1	02	01	H2320_018_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	018	0	1	02	01	H2320_018_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											85.78	50	50	50				77.20	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	018	0	1	02	01	H2320_018_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	019	0	1	02	01	H2320_019_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	019	0	1	02	01	H2320_019_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	019	0	1	02	01	H2320_019_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	019	0	1	02	01	H2320_019_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											76.81	45	45	45				68.28	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	019	0	1	02	01	H2320_019_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	021	0	1	02	01	H2320_021_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	021	0	1	02	01	H2320_021_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	021	0	1	02	01	H2320_021_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	021	0	1	02	01	H2320_021_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											98.49	50	50	50				88.64	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	021	0	1	02	01	H2320_021_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	1	1	02	01	H2320_022_1	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	12.50																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	1	1	02	01	H2320_022_1	4	Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	37.50																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	1	1	02	01	H2320_022_1	4	Preferred Brand	3	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	1	1	02	01	H2320_022_1	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											96.23	50	50	50				86.61	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	1	1	02	01	H2320_022_1	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	2	1	02	01	H2320_022_2	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	12.50																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	2	1	02	01	H2320_022_2	4	Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	37.50																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	2	1	02	01	H2320_022_2	4	Preferred Brand	3	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	2	1	02	01	H2320_022_2	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											96.23	50	50	50				86.61	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	2	1	02	01	H2320_022_2	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	3	1	02	01	H2320_022_3	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	12.50																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	3	1	02	01	H2320_022_3	4	Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	37.50																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	3	1	02	01	H2320_022_3	4	Preferred Brand	3	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	3	1	02	01	H2320_022_3	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											96.23	50	50	50				86.61	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	3	1	02	01	H2320_022_3	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	4	1	02	01	H2320_022_4	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	12.50																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	4	1	02	01	H2320_022_4	4	Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	37.50																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	4	1	02	01	H2320_022_4	4	Preferred Brand	3	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	4	1	02	01	H2320_022_4	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											96.23	50	50	50				86.61	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	4	1	02	01	H2320_022_4	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	5	1	02	01	H2320_022_5	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	12.50																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	5	1	02	01	H2320_022_5	4	Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	37.50																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	5	1	02	01	H2320_022_5	4	Preferred Brand	3	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	5	1	02	01	H2320_022_5	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											96.23	50	50	50				86.61	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2320	022	5	1	02	01	H2320_022_5	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2322	004	0	1	04	01	H2322_004_0	9	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	004	0	1	04	01	H2322_004_0	9	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H2322	004	0	1	04	01	H2322_004_0	9	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	004	0	1	04	01	H2322_004_0	9	Generic	4	01	3	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H2322	004	0	1	04	01	H2322_004_0	9	Preferred Brand	4	10	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	004	0	1	04	01	H2322_004_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	004	0	1	04	01	H2322_004_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	008	0	1	04	01	H2322_008_0	9	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	008	0	1	04	01	H2322_008_0	9	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	008	0	1	04	01	H2322_008_0	9	Preferred Brand	4	10	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	008	0	1	04	01	H2322_008_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	008	0	1	04	01	H2322_008_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	011	0	1	04	01	H2322_011_0	9	Preferred Generic	4	01	3	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1.25	25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	011	0	1	04	01	H2322_011_0	9	Generic	4	01	3	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				5.00	25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	011	0	1	04	01	H2322_011_0	9	Preferred Brand	4	10	3	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				80.00	25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	011	0	1	04	01	H2322_011_0	9	Non-Preferred Brand	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				36.75	25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2322	011	0	1	04	01	H2322_011_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2334	001	0	1	04	01	H2334_001_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2334	001	0	1	04	01	H2334_001_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2334	001	0	1	04	01	H2334_001_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2334	001	0	1	04	01	H2334_001_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2334	001	0	1	04	01	H2334_001_0	9	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				720.31	28	28	28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2334	001	0	1	04	01	H2334_001_0	9	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	11.00	22.00	33.00																					22.00																11.00				11.00		0.37						0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2334	003	0	1	04	01	H2334_003_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2334	003	0	1	04	01	H2334_003_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2334	003	0	1	04	01	H2334_003_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2334	003	0	1	04	01	H2334_003_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2334	003	0	1	04	01	H2334_003_0	9	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				747.88	28	28	28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2354	015	0	1	01	01	H2354_015_0	9	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	015	0	1	01	01	H2354_015_0	9	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	015	0	1	01	01	H2354_015_0	9	Preferred Brand	4	10	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	015	0	1	01	01	H2354_015_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	237.50																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	015	0	1	01	01	H2354_015_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	018	0	1	01	01	H2354_018_0	11	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	018	0	1	01	01	H2354_018_0	11	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	018	0	1	01	01	H2354_018_0	11	Preferred Brand	4	10	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	018	0	1	01	01	H2354_018_0	11	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	018	0	1	01	01	H2354_018_0	11	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	020	0	1	02	01	H2354_020_0	13	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	15.00																			6.00	12.00	15.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	020	0	1	02	01	H2354_020_0	13	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	020	0	1	02	01	H2354_020_0	13	Preferred Brand	4	10	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	020	0	1	02	01	H2354_020_0	13	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	020	0	1	02	01	H2354_020_0	13	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	021	0	1	02	01	H2354_021_0	11	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	021	0	1	02	01	H2354_021_0	11	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	021	0	1	02	01	H2354_021_0	11	Preferred Brand	4	10	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	021	0	1	02	01	H2354_021_0	11	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	021	0	1	02	01	H2354_021_0	11	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	022	0	1	02	01	H2354_022_0	11	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	022	0	1	02	01	H2354_022_0	11	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H2354	022	0	1	02	01	H2354_022_0	11	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	022	0	1	02	01	H2354_022_0	11	Generic	4	01	3	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H2354	022	0	1	02	01	H2354_022_0	11	Preferred Brand	4	10	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	022	0	1	02	01	H2354_022_0	11	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2354	022	0	1	02	01	H2354_022_0	11	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2406	008	0	1	04	01	H2406_008_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	008	0	1	04	01	H2406_008_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	008	0	1	04	01	H2406_008_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	008	0	1	04	01	H2406_008_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	008	0	1	04	01	H2406_008_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				785.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	009	0	1	04	01	H2406_009_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	009	0	1	04	01	H2406_009_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	009	0	1	04	01	H2406_009_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	009	0	1	04	01	H2406_009_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	009	0	1	04	01	H2406_009_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				785.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	010	0	1	04	01	H2406_010_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	010	0	1	04	01	H2406_010_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	010	0	1	04	01	H2406_010_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	010	0	1	04	01	H2406_010_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	010	0	1	04	01	H2406_010_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				785.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	011	0	1	04	01	H2406_011_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	011	0	1	04	01	H2406_011_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	011	0	1	04	01	H2406_011_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	011	0	1	04	01	H2406_011_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2406	011	0	1	04	01	H2406_011_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				822.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	001	0	1	18	06	H2450_001_0	2	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	001	0	1	18	06	H2450_001_0	2	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	001	0	1	18	06	H2450_001_0	2	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	001	0	1	18	06	H2450_001_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				68.49	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	001	0	1	18	06	H2450_001_0	2	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	002	0	1	18	06	H2450_002_0	2	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	002	0	1	18	06	H2450_002_0	2	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	002	0	1	18	06	H2450_002_0	2	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	002	0	1	18	06	H2450_002_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				66.02	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	002	0	1	18	06	H2450_002_0	2	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	007	0	1	18	06	H2450_007_0	4	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	007	0	1	18	06	H2450_007_0	4	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	6.00		18.00																					12.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	007	0	1	18	06	H2450_007_0	4	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	28.00		84.00																					56.00																28.00				28.00		0.93						0.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	007	0	1	18	06	H2450_007_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				58.01	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	007	0	1	18	06	H2450_007_0	4	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					27		27																				27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	016	0	1	18	06	H2450_016_0	3	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	016	0	1	18	06	H2450_016_0	3	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	6.00		18.00																					12.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	016	0	1	18	06	H2450_016_0	3	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	27.00		81.00																					54.00																27.00				27.00		0.90						0.87		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	016	0	1	18	06	H2450_016_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				63.88	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	016	0	1	18	06	H2450_016_0	3	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					27		27																				27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	017	0	1	18	06	H2450_017_0	2	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	017	0	1	18	06	H2450_017_0	2	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	6.00		18.00																					12.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	017	0	1	18	06	H2450_017_0	2	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	017	0	1	18	06	H2450_017_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				60.04	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	017	0	1	18	06	H2450_017_0	2	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					28		28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	022	0	1	18	06	H2450_022_0	3	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	022	0	1	18	06	H2450_022_0	3	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	6.00		18.00																					12.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	022	0	1	18	06	H2450_022_0	3	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	31.00		93.00																					62.00																31.00				31.00		1.03						1.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	022	0	1	18	06	H2450_022_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				66.36	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	022	0	1	18	06	H2450_022_0	3	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					27		27																				27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	023	0	1	18	06	H2450_023_0	2	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	023	0	1	18	06	H2450_023_0	2	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	023	0	1	18	06	H2450_023_0	2	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	023	0	1	18	06	H2450_023_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				65.51	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	023	0	1	18	06	H2450_023_0	2	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	035	0	1	18	06	H2450_035_0	3	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	035	0	1	18	06	H2450_035_0	3	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	6.00		18.00																					12.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	035	0	1	18	06	H2450_035_0	3	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	035	0	1	18	06	H2450_035_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				63.82	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	035	0	1	18	06	H2450_035_0	3	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					27		27																				27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	037	0	1	18	06	H2450_037_0	2	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	037	0	1	18	06	H2450_037_0	2	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	037	0	1	18	06	H2450_037_0	2	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	28.00		84.00																					56.00																28.00				28.00		0.93						0.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	037	0	1	18	06	H2450_037_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				58.79	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	037	0	1	18	06	H2450_037_0	2	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					28		28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	039	0	1	18	06	H2450_039_0	3	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	039	0	1	18	06	H2450_039_0	3	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	039	0	1	18	06	H2450_039_0	3	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	26.00		78.00																					52.00																26.00				26.00		0.87						0.84		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	039	0	1	18	06	H2450_039_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				64.72	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	039	0	1	18	06	H2450_039_0	3	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					28		28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	041	0	1	18	06	H2450_041_0	2	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	041	0	1	18	06	H2450_041_0	2	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	041	0	1	18	06	H2450_041_0	2	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	27.00		81.00																					54.00																27.00				27.00		0.90						0.87		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	041	0	1	18	06	H2450_041_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				71.52	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2450	041	0	1	18	06	H2450_041_0	2	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					28		28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	1	1	02	01	H2459_021_1	10	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								5.00		15.00					0.00		0.00											5.00		10.00				0.00		0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	1	1	02	01	H2459_021_1	10	Preferred Generic	4	01	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								5.00		15.00					0.00		0.00											5.00		10.00				0.00		0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2459	021	1	1	02	01	H2459_021_1	10	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					7.00		21.00											12.00		24.00				7.00		14.00					12.00			12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	1	1	02	01	H2459_021_1	10	Generic	4	01	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					7.00		21.00											12.00		24.00				7.00		14.00					12.00			12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2459	021	1	1	02	01	H2459_021_1	10	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								40.00		120.00					35.00		105.00											40.00		80.00				35.00		70.00					40.00			40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	1	1	02	01	H2459_021_1	10	Non-Preferred Drug	4	11	1	2	4	1		110	10		110	1				30		90	1	2				30		90		29	31								100.00		300.00					95.00		285.00											100.00		200.00				95.00		190.00					100.00			100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	1	1	02	01	H2459_021_1	10	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											961.22	29		29				571.33	29		29										29		29				29		29				29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	2	1	02	01	H2459_021_2	8	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								5.00		15.00					0.00		0.00											5.00		10.00				0.00		0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	2	1	02	01	H2459_021_2	8	Preferred Generic	4	01	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								5.00		15.00					0.00		0.00											5.00		10.00				0.00		0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2459	021	2	1	02	01	H2459_021_2	8	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					7.00		21.00											12.00		24.00				7.00		14.00					12.00			12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	2	1	02	01	H2459_021_2	8	Generic	4	01	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					7.00		21.00											12.00		24.00				7.00		14.00					12.00			12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2459	021	2	1	02	01	H2459_021_2	8	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								40.00		120.00					35.00		105.00											40.00		80.00				35.00		70.00					40.00			40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	2	1	02	01	H2459_021_2	8	Non-Preferred Drug	4	11	1	2	4	1		110	10		110	1				30		90	1	2				30		90		29	31								100.00		300.00					95.00		285.00											100.00		200.00				95.00		190.00					100.00			100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	2	1	02	01	H2459_021_2	8	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											961.22	29		29				571.33	29		29										29		29				29		29				29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	3	1	02	01	H2459_021_3	8	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								5.00		15.00					0.00		0.00											5.00		10.00				0.00		0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	3	1	02	01	H2459_021_3	8	Preferred Generic	4	01	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								5.00		15.00					0.00		0.00											5.00		10.00				0.00		0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2459	021	3	1	02	01	H2459_021_3	8	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					7.00		21.00											12.00		24.00				7.00		14.00					12.00			12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	3	1	02	01	H2459_021_3	8	Generic	4	01	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					7.00		21.00											12.00		24.00				7.00		14.00					12.00			12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2459	021	3	1	02	01	H2459_021_3	8	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								40.00		120.00					35.00		105.00											40.00		80.00				35.00		70.00					40.00			40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	3	1	02	01	H2459_021_3	8	Non-Preferred Drug	4	11	1	2	4	1		110	10		110	1				30		90	1	2				30		90		29	31								100.00		300.00					95.00		285.00											100.00		200.00				95.00		190.00					100.00			100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	021	3	1	02	01	H2459_021_3	8	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											961.22	29		29				571.33	29		29										29		29				29		29				29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	022	1	1	02	01	H2459_022_1	8	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								6.00		18.00					1.00		3.00											6.00		12.00				1.00		2.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	022	1	1	02	01	H2459_022_1	8	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					7.00		21.00											12.00		24.00				7.00		14.00					12.00			12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	022	1	1	02	01	H2459_022_1	8	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								40.00		120.00					35.00		105.00											40.00		80.00				35.00		70.00					40.00			40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	022	1	1	02	01	H2459_022_1	8	Non-Preferred Drug	4	11	1	2	4	1		110	10		110	1				30		90	1	2				30		90		29	31								100.00		300.00					95.00		285.00											100.00		200.00				95.00		190.00					100.00			100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	022	1	1	02	01	H2459_022_1	8	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1015.76	28		28				534.13	28		28										28		28				28		28				28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	022	2	1	02	01	H2459_022_2	8	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								6.00		18.00					1.00		3.00											6.00		12.00				1.00		2.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	022	2	1	02	01	H2459_022_2	8	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					7.00		21.00											12.00		24.00				7.00		14.00					12.00			12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	022	2	1	02	01	H2459_022_2	8	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								40.00		120.00					35.00		105.00											40.00		80.00				35.00		70.00					40.00			40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	022	2	1	02	01	H2459_022_2	8	Non-Preferred Drug	4	11	1	2	4	1		110	10		110	1				30		90	1	2				30		90		29	31								100.00		300.00					95.00		285.00											100.00		200.00				95.00		190.00					100.00			100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	022	2	1	02	01	H2459_022_2	8	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1015.76	28		28				534.13	28		28										28		28				28		28				28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	023	1	1	02	01	H2459_023_1	9	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								7.00		21.00					2.00		6.00											7.00		14.00				2.00		4.00					7.00			7.00			0.23	0.07		0.23	0.07	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	023	1	1	02	01	H2459_023_1	9	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								15.00		45.00					10.00		30.00											15.00		30.00				10.00		20.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	023	1	1	02	01	H2459_023_1	9	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								45.00		135.00					40.00		120.00											45.00		90.00				40.00		80.00					45.00			45.00			1.50	1.33		1.50	1.33	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	023	1	1	02	01	H2459_023_1	9	Non-Preferred Drug	4	11	1	2	4	1		110	10		110	1				30		90	1	2				30		90		29	31								100.00		300.00					95.00		285.00											100.00		200.00				95.00		190.00					100.00			100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	023	1	1	02	01	H2459_023_1	9	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											769.97	27		27				612.67	27		27										27		27				27		27				27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	023	2	1	02	01	H2459_023_2	9	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								7.00		21.00					2.00		6.00											7.00		14.00				2.00		4.00					7.00			7.00			0.23	0.07		0.23	0.07	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	023	2	1	02	01	H2459_023_2	9	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								15.00		45.00					10.00		30.00											15.00		30.00				10.00		20.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	023	2	1	02	01	H2459_023_2	9	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								45.00		135.00					40.00		120.00											45.00		90.00				40.00		80.00					45.00			45.00			1.50	1.33		1.50	1.33	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	023	2	1	02	01	H2459_023_2	9	Non-Preferred Drug	4	11	1	2	4	1		110	10		110	1				30		90	1	2				30		90		29	31								100.00		300.00					95.00		285.00											100.00		200.00				95.00		190.00					100.00			100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2459	023	2	1	02	01	H2459_023_2	9	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											769.97	27		27				612.67	27		27										27		27				27		27				27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2461	008	0	1	18	06	H2461_008_0	4	Preferred Generic	2	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	0.00	0.00																12.00				12.00			0.39	0.16	0.16			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	008	0	1	18	06	H2461_008_0	4	Generic	2	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.61	0.39	0.39			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	008	0	1	18	06	H2461_008_0	4	Preferred Brand	2	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											28.81	20	20	20				21.05	15	15	15				15	15	15															20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	008	0	1	18	06	H2461_008_0	4	Non-Preferred Brand	2	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											52.19	50	50	50				45.30	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	008	0	1	18	06	H2461_008_0	4	Specialty Tier	2	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	008	0	1	18	06	H2461_008_0	4	Select Care Drugs	2	01	1	2	6	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								5.00	10.00	10.00					0.00	0.00	0.00					5.00	0.00	0.00																5.00				5.00			0.16	0.00	0.16			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	009	0	1	18	06	H2461_009_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	0.00	0.00																12.00				12.00			0.39	0.16	0.16			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	009	0	1	18	06	H2461_009_0	4	Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								17.00	34.00	34.00					10.00	20.00	20.00					10.00	20.00	20.00																17.00				17.00			0.55	0.32	0.32			0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	009	0	1	18	06	H2461_009_0	4	Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											32.90	25	25	25				25.60	20	20	20				20	20	20															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	009	0	1	18	06	H2461_009_0	4	Non-Preferred Brand	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											46.44	50	50	50				40.25	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	009	0	1	18	06	H2461_009_0	4	Specialty Tier	4	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	009	0	1	18	06	H2461_009_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								5.00	10.00	10.00					0.00	0.00	0.00					5.00	0.00	0.00																5.00				5.00			0.16	0.00	0.16			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	010	0	1	18	06	H2461_010_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								10.00	20.00	20.00					3.00	6.00	6.00					3.00	0.00	0.00																10.00				10.00			0.32	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	010	0	1	18	06	H2461_010_0	5	Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								16.00	32.00	32.00					9.00	18.00	18.00					9.00	18.00	18.00																16.00				16.00			0.52	0.29	0.29			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	010	0	1	18	06	H2461_010_0	5	Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											23.60	20	20	20				17.16	15	15	15				15	15	15															20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	010	0	1	18	06	H2461_010_0	5	Non-Preferred Brand	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											47.82	50	50	50				41.38	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	010	0	1	18	06	H2461_010_0	5	Specialty Tier	4	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2461	010	0	1	18	06	H2461_010_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								5.00	10.00	10.00					0.00	0.00	0.00					3.00	0.00	0.00																5.00				5.00			0.16	0.00	0.10			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2462	008	0	1	18	06	H2462_008_0	6	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		10.00				5.00				5.00		0.17				0.17	0.17	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	008	0	1	18	06	H2462_008_0	6	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		10.00				5.00				5.00		0.17				0.17	0.17	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2462	008	0	1	18	06	H2462_008_0	6	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		32.00				16.00				16.00		0.53				0.53	0.53	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	008	0	1	18	06	H2462_008_0	6	Generic	4	01	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		32.00				16.00				16.00		0.53				0.53	0.53	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2462	008	0	1	18	06	H2462_008_0	6	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	008	0	1	18	06	H2462_008_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.69	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	008	0	1	18	06	H2462_008_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	011	0	1	18	06	H2462_011_0	6	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		10.00				5.00				5.00		0.17				0.17	0.17	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	011	0	1	18	06	H2462_011_0	6	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		28.00				14.00				14.00		0.47				0.47	0.47	0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	011	0	1	18	06	H2462_011_0	6	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	011	0	1	18	06	H2462_011_0	6	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.36	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	011	0	1	18	06	H2462_011_0	6	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	012	0	1	18	06	H2462_012_0	6	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		10.00				5.00				5.00		0.17				0.17	0.17	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	012	0	1	18	06	H2462_012_0	6	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		10.00				5.00				5.00		0.17				0.17	0.17	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2462	012	0	1	18	06	H2462_012_0	6	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		28.00				14.00				14.00		0.47				0.47	0.47	0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	012	0	1	18	06	H2462_012_0	6	Generic	4	01	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		28.00				14.00				14.00		0.47				0.47	0.47	0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2462	012	0	1	18	06	H2462_012_0	6	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		94.00																									47.00		94.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	012	0	1	18	06	H2462_012_0	6	Preferred Brand	4	11	1	1	3	3	110		01		110	1	30		90				1	2				30		90	30		31				81.67	24		24																								24		24				24		24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2462	012	0	1	18	06	H2462_012_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				70.23	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	012	0	1	18	06	H2462_012_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	017	0	1	18	06	H2462_017_0	7	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		10.00				5.00				5.00		0.17				0.17	0.17	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	017	0	1	18	06	H2462_017_0	7	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		32.00				16.00				16.00		0.53				0.53	0.53	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	017	0	1	18	06	H2462_017_0	7	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	017	0	1	18	06	H2462_017_0	7	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				74.45	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	017	0	1	18	06	H2462_017_0	7	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	019	0	1	18	06	H2462_019_0	8	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		12.00				6.00				6.00		0.20				0.20	0.20	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	019	0	1	18	06	H2462_019_0	8	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		12.00				6.00				6.00		0.20				0.20	0.20	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2462	019	0	1	18	06	H2462_019_0	8	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	019	0	1	18	06	H2462_019_0	8	Generic	4	01	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2462	019	0	1	18	06	H2462_019_0	8	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	019	0	1	18	06	H2462_019_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.30	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	019	0	1	18	06	H2462_019_0	8	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	021	0	1	18	06	H2462_021_0	6	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		12.00				6.00				6.00		0.20				0.20	0.20	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	021	0	1	18	06	H2462_021_0	6	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		12.00				6.00				6.00		0.20				0.20	0.20	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2462	021	0	1	18	06	H2462_021_0	6	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		34.00				17.00				17.00		0.57				0.57	0.57	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	021	0	1	18	06	H2462_021_0	6	Generic	4	01	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		34.00				17.00				17.00		0.57				0.57	0.57	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2462	021	0	1	18	06	H2462_021_0	6	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	021	0	1	18	06	H2462_021_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.54	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2462	021	0	1	18	06	H2462_021_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2486	003	0	1	01	01	H2486_003_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2486	003	0	1	01	01	H2486_003_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2486	003	0	1	01	01	H2486_003_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2486	003	0	1	01	01	H2486_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2486	003	0	1	01	01	H2486_003_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	004	0	1	01	01	H2491_004_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	004	0	1	01	01	H2491_004_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		5.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	004	0	1	01	01	H2491_004_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	004	0	1	01	01	H2491_004_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				96.14	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	004	0	1	01	01	H2491_004_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				402.16	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	006	0	1	01	01	H2491_006_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	006	0	1	01	01	H2491_006_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	006	0	1	01	01	H2491_006_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	006	0	1	01	01	H2491_006_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				74.41	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	006	0	1	01	01	H2491_006_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				485.59	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	007	0	1	01	01	H2491_007_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	007	0	1	01	01	H2491_007_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	007	0	1	01	01	H2491_007_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	007	0	1	01	01	H2491_007_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				64.30	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	007	0	1	01	01	H2491_007_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				616.05	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	008	0	1	01	01	H2491_008_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	008	0	1	01	01	H2491_008_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	008	0	1	01	01	H2491_008_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	008	0	1	01	01	H2491_008_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				73.37	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2491	008	0	1	01	01	H2491_008_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				493.80	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2506	001	0	1	48	05	H2506_001_0	5	Generic Drugs	4	01			1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2506	001	0	1	48	05	H2506_001_0	5	Brand Drugs	4	11			2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2506	001	0	1	48	05	H2506_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		10			1	30	60	90				1	2								29	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H2531	001	0	1	48	05	H2531_001_0	4	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	3.35	0.00	3.35	0.00	3.35	0.00	3.35			
H2531	001	0	1	48	05	H2531_001_0	4	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	8.35	0.00	8.35	0.00	8.35	0.00	8.35			
H2531	001	0	1	48	05	H2531_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2533	001	0	1	48	05	H2533_001_0	3	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2533	001	0	1	48	05	H2533_001_0	3	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2533	001	0	1	48	05	H2533_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2563	003	0	1	01	01	H2563_003_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	003	0	1	01	01	H2563_003_0	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		42.00																					28.00																14.00				14.00		0.47						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	003	0	1	01	01	H2563_003_0	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	003	0	1	01	01	H2563_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					237.50																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	003	0	1	01	01	H2563_003_0	6	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				956.13	27		27																				27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	005	1	1	01	01	H2563_005_1	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	005	1	1	01	01	H2563_005_1	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	005	1	1	01	01	H2563_005_1	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	005	1	1	01	01	H2563_005_1	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	80.00		240.00																					200.00																80.00				80.00		2.67						2.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	005	1	1	01	01	H2563_005_1	6	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				898.02	28		28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	005	2	1	01	01	H2563_005_2	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	005	2	1	01	01	H2563_005_2	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	005	2	1	01	01	H2563_005_2	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	005	2	1	01	01	H2563_005_2	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	80.00		240.00																					200.00																80.00				80.00		2.67						2.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2563	005	2	1	01	01	H2563_005_2	6	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				898.02	28		28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2593	001	0	1	01	01	H2593_001_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	001	0	1	01	01	H2593_001_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	001	0	1	01	01	H2593_001_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	001	0	1	01	01	H2593_001_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	001	0	1	01	01	H2593_001_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	001	0	1	01	01	H2593_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	001	0	1	01	01	H2593_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	001	0	1	01	01	H2593_001_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	001	0	1	01	01	H2593_001_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H2593	003	0	1	01	01	H2593_003_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	003	0	1	01	01	H2593_003_0	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	003	0	1	01	01	H2593_003_0	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		0.25						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	003	0	1	01	01	H2593_003_0	6	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		0.25						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	003	0	1	01	01	H2593_003_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	003	0	1	01	01	H2593_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	003	0	1	01	01	H2593_003_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	003	0	1	01	01	H2593_003_0	6	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	003	0	1	01	01	H2593_003_0	6	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	3	
H2593	005	0	1	01	01	H2593_005_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	005	0	1	01	01	H2593_005_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	005	0	1	01	01	H2593_005_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	005	0	1	01	01	H2593_005_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	005	0	1	01	01	H2593_005_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	005	0	1	01	01	H2593_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	005	0	1	01	01	H2593_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	005	0	1	01	01	H2593_005_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	005	0	1	01	01	H2593_005_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H2593	006	0	1	01	01	H2593_006_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	006	0	1	01	01	H2593_006_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	006	0	1	01	01	H2593_006_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	006	0	1	01	01	H2593_006_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	006	0	1	01	01	H2593_006_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	006	0	1	01	01	H2593_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	006	0	1	01	01	H2593_006_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	006	0	1	01	01	H2593_006_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	006	0	1	01	01	H2593_006_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H2593	013	0	1	01	01	H2593_013_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	013	0	1	01	01	H2593_013_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	013	0	1	01	01	H2593_013_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	013	0	1	01	01	H2593_013_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	013	0	1	01	01	H2593_013_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	013	0	1	01	01	H2593_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	013	0	1	01	01	H2593_013_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	013	0	1	01	01	H2593_013_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	013	0	1	01	01	H2593_013_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H2593	018	0	1	01	01	H2593_018_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		15.00							10.00																10.00				10.00			0.33	0.17				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	018	0	1	01	01	H2593_018_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.50		46.50					10.50		31.50							21.00																15.50				15.50			0.52	0.35				0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	018	0	1	01	01	H2593_018_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	018	0	1	01	01	H2593_018_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					90.00		270.00							180.00																95.00				95.00			3.17	3.00				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	018	0	1	01	01	H2593_018_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	018	0	1	01	01	H2593_018_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					10.00		30.00							20.00																10.00				10.00			0.33	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	019	0	1	01	01	H2593_019_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	019	0	1	01	01	H2593_019_0	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	019	0	1	01	01	H2593_019_0	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		0.25						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	019	0	1	01	01	H2593_019_0	6	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		0.25						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H2593	019	0	1	01	01	H2593_019_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	019	0	1	01	01	H2593_019_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	019	0	1	01	01	H2593_019_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	019	0	1	01	01	H2593_019_0	6	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H2593	019	0	1	01	01	H2593_019_0	6	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	3	
H2610	005	0	1	01	01	H2610_005_0	8	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							12.00																4.00				4.00			0.13	0.00				0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	005	0	1	01	01	H2610_005_0	8	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								12.00	24.00	36.00					0.00	0.00	0.00							36.00																12.00				12.00			0.40	0.00				0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	005	0	1	01	01	H2610_005_0	8	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					39.00	78.00	117.00							141.00																47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	005	0	1	01	01	H2610_005_0	8	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								100.00	200.00	300.00					75.00	150.00	225.00							300.00																100.00				100.00			3.33	2.50				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	005	0	1	01	01	H2610_005_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1852.94	33						1852.94	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	006	0	1	01	01	H2610_006_0	8	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							12.00																4.00				4.00			0.13	0.00				0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	006	0	1	01	01	H2610_006_0	8	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							12.00																4.00				4.00			0.13	0.00				0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H2610	006	0	1	01	01	H2610_006_0	8	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								12.00	24.00	36.00					0.00	0.00	0.00							36.00																12.00				12.00			0.40	0.00				0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	006	0	1	01	01	H2610_006_0	8	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	1	2			90				30		31								12.00	24.00	36.00					0.00	0.00	0.00							36.00																12.00				12.00			0.40	0.00				0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H2610	006	0	1	01	01	H2610_006_0	8	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								42.00	84.00	126.00					34.00	68.00	102.00							126.00																42.00				42.00			1.40	1.13				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	006	0	1	01	01	H2610_006_0	8	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								80.00	160.00	240.00					65.00	130.00	195.00							240.00																80.00				80.00			2.67	2.17				2.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	006	0	1	01	01	H2610_006_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1581.04	33						1581.04	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	011	0	1	01	01	H2610_011_0	8	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							21.00																7.00				7.00			0.23	0.00				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	011	0	1	01	01	H2610_011_0	8	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								12.00	24.00	36.00					0.00	0.00	0.00							36.00																12.00				12.00			0.40	0.00				0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	011	0	1	01	01	H2610_011_0	8	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					42.00	84.00	126.00							141.00																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	011	0	1	01	01	H2610_011_0	8	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								95.00	190.00	285.00					85.00	170.00	255.00							285.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	011	0	1	01	01	H2610_011_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1277.53	33						1277.53	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	015	0	1	01	01	H2610_015_0	8	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	015	0	1	01	01	H2610_015_0	8	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	6.00	12.00	18.00																					18.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	015	0	1	01	01	H2610_015_0	8	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	015	0	1	01	01	H2610_015_0	8	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2610	015	0	1	01	01	H2610_015_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1615.89	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2649	021	0	1	01	01	H2649_021_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	021	0	1	01	01	H2649_021_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	021	0	1	01	01	H2649_021_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	021	0	1	01	01	H2649_021_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	021	0	1	01	01	H2649_021_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	023	0	1	01	01	H2649_023_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	023	0	1	01	01	H2649_023_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	023	0	1	01	01	H2649_023_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	023	0	1	01	01	H2649_023_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	023	0	1	01	01	H2649_023_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	028	0	1	01	01	H2649_028_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	028	0	1	01	01	H2649_028_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	028	0	1	01	01	H2649_028_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	028	0	1	01	01	H2649_028_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	028	0	1	01	01	H2649_028_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	029	0	1	01	01	H2649_029_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	029	0	1	01	01	H2649_029_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	029	0	1	01	01	H2649_029_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	029	0	1	01	01	H2649_029_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	029	0	1	01	01	H2649_029_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	030	0	1	01	01	H2649_030_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	030	0	1	01	01	H2649_030_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	030	0	1	01	01	H2649_030_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	030	0	1	01	01	H2649_030_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	030	0	1	01	01	H2649_030_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	031	0	1	01	01	H2649_031_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	031	0	1	01	01	H2649_031_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	031	0	1	01	01	H2649_031_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	031	0	1	01	01	H2649_031_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	031	0	1	01	01	H2649_031_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	032	0	1	01	01	H2649_032_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	032	0	1	01	01	H2649_032_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	032	0	1	01	01	H2649_032_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	032	0	1	01	01	H2649_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	032	0	1	01	01	H2649_032_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	033	0	1	01	01	H2649_033_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	033	0	1	01	01	H2649_033_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	033	0	1	01	01	H2649_033_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	033	0	1	01	01	H2649_033_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	033	0	1	01	01	H2649_033_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	034	0	1	01	01	H2649_034_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	034	0	1	01	01	H2649_034_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	034	0	1	01	01	H2649_034_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	034	0	1	01	01	H2649_034_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	034	0	1	01	01	H2649_034_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	039	0	1	01	01	H2649_039_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	039	0	1	01	01	H2649_039_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	039	0	1	01	01	H2649_039_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	039	0	1	01	01	H2649_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	039	0	1	01	01	H2649_039_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	043	0	1	01	01	H2649_043_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	043	0	1	01	01	H2649_043_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	043	0	1	01	01	H2649_043_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	043	0	1	01	01	H2649_043_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	043	0	1	01	01	H2649_043_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	045	0	1	01	01	H2649_045_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	045	0	1	01	01	H2649_045_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	045	0	1	01	01	H2649_045_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	045	0	1	01	01	H2649_045_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	045	0	1	01	01	H2649_045_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	046	0	1	01	01	H2649_046_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	046	0	1	01	01	H2649_046_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	046	0	1	01	01	H2649_046_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	046	0	1	01	01	H2649_046_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	046	0	1	01	01	H2649_046_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	048	0	1	01	01	H2649_048_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	048	0	1	01	01	H2649_048_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	048	0	1	01	01	H2649_048_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	048	0	1	01	01	H2649_048_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	048	0	1	01	01	H2649_048_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	049	0	1	01	01	H2649_049_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	049	0	1	01	01	H2649_049_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	049	0	1	01	01	H2649_049_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	049	0	1	01	01	H2649_049_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	049	0	1	01	01	H2649_049_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	050	0	1	01	01	H2649_050_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	050	0	1	01	01	H2649_050_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	050	0	1	01	01	H2649_050_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	050	0	1	01	01	H2649_050_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	050	0	1	01	01	H2649_050_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	051	0	1	01	01	H2649_051_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	051	0	1	01	01	H2649_051_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	051	0	1	01	01	H2649_051_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	051	0	1	01	01	H2649_051_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	051	0	1	01	01	H2649_051_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	052	0	1	01	01	H2649_052_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	052	0	1	01	01	H2649_052_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	052	0	1	01	01	H2649_052_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	052	0	1	01	01	H2649_052_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	052	0	1	01	01	H2649_052_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	053	0	1	01	01	H2649_053_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	053	0	1	01	01	H2649_053_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	053	0	1	01	01	H2649_053_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	053	0	1	01	01	H2649_053_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	053	0	1	01	01	H2649_053_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	054	0	1	01	01	H2649_054_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	054	0	1	01	01	H2649_054_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	054	0	1	01	01	H2649_054_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	054	0	1	01	01	H2649_054_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	054	0	1	01	01	H2649_054_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	055	0	1	01	01	H2649_055_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	055	0	1	01	01	H2649_055_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	055	0	1	01	01	H2649_055_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	055	0	1	01	01	H2649_055_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	055	0	1	01	01	H2649_055_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	056	0	1	02	01	H2649_056_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	056	0	1	02	01	H2649_056_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	056	0	1	02	01	H2649_056_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	056	0	1	02	01	H2649_056_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	056	0	1	02	01	H2649_056_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	059	1	1	01	01	H2649_059_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	059	1	1	01	01	H2649_059_1	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	059	1	1	01	01	H2649_059_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	059	1	1	01	01	H2649_059_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	059	1	1	01	01	H2649_059_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	059	2	1	01	01	H2649_059_2	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	059	2	1	01	01	H2649_059_2	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	059	2	1	01	01	H2649_059_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	059	2	1	01	01	H2649_059_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	059	2	1	01	01	H2649_059_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	060	0	1	02	01	H2649_060_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	060	0	1	02	01	H2649_060_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	060	0	1	02	01	H2649_060_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	060	0	1	02	01	H2649_060_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	060	0	1	02	01	H2649_060_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	061	1	1	01	01	H2649_061_1	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	061	1	1	01	01	H2649_061_1	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	061	1	1	01	01	H2649_061_1	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	061	1	1	01	01	H2649_061_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	061	1	1	01	01	H2649_061_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	061	2	1	01	01	H2649_061_2	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	061	2	1	01	01	H2649_061_2	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	061	2	1	01	01	H2649_061_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	061	2	1	01	01	H2649_061_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	061	2	1	01	01	H2649_061_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	062	1	1	01	01	H2649_062_1	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	062	1	1	01	01	H2649_062_1	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	062	1	1	01	01	H2649_062_1	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	062	1	1	01	01	H2649_062_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	062	1	1	01	01	H2649_062_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	062	2	1	01	01	H2649_062_2	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	062	2	1	01	01	H2649_062_2	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	062	2	1	01	01	H2649_062_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	062	2	1	01	01	H2649_062_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	062	2	1	01	01	H2649_062_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	063	0	1	01	01	H2649_063_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	063	0	1	01	01	H2649_063_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	063	0	1	01	01	H2649_063_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	063	0	1	01	01	H2649_063_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	063	0	1	01	01	H2649_063_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	064	0	1	01	01	H2649_064_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	064	0	1	01	01	H2649_064_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	064	0	1	01	01	H2649_064_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	064	0	1	01	01	H2649_064_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	064	0	1	01	01	H2649_064_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	065	1	1	01	01	H2649_065_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	065	1	1	01	01	H2649_065_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	065	1	1	01	01	H2649_065_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	065	1	1	01	01	H2649_065_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	065	1	1	01	01	H2649_065_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	065	2	1	01	01	H2649_065_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	065	2	1	01	01	H2649_065_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	065	2	1	01	01	H2649_065_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	065	2	1	01	01	H2649_065_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	065	2	1	01	01	H2649_065_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	066	0	1	01	01	H2649_066_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	066	0	1	01	01	H2649_066_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	066	0	1	01	01	H2649_066_0	6	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	066	0	1	01	01	H2649_066_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	066	0	1	01	01	H2649_066_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	067	0	1	01	01	H2649_067_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	067	0	1	01	01	H2649_067_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	067	0	1	01	01	H2649_067_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	067	0	1	01	01	H2649_067_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2649	067	0	1	01	01	H2649_067_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	002	0	1	01	01	H2663_002_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	002	0	1	01	01	H2663_002_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	002	0	1	01	01	H2663_002_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	002	0	1	01	01	H2663_002_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	002	0	1	01	01	H2663_002_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	002	0	1	01	01	H2663_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	002	0	1	01	01	H2663_002_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	005	0	1	01	01	H2663_005_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	005	0	1	01	01	H2663_005_0	4	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	005	0	1	01	01	H2663_005_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	005	0	1	01	01	H2663_005_0	4	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	005	0	1	01	01	H2663_005_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	005	0	1	01	01	H2663_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	005	0	1	01	01	H2663_005_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	006	0	1	02	01	H2663_006_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	006	0	1	02	01	H2663_006_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	006	0	1	02	01	H2663_006_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	006	0	1	02	01	H2663_006_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	006	0	1	02	01	H2663_006_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	006	0	1	02	01	H2663_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	006	0	1	02	01	H2663_006_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	015	0	1	02	01	H2663_015_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	015	0	1	02	01	H2663_015_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	015	0	1	02	01	H2663_015_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	015	0	1	02	01	H2663_015_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	015	0	1	02	01	H2663_015_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	015	0	1	02	01	H2663_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	015	0	1	02	01	H2663_015_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	016	0	1	01	01	H2663_016_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	016	0	1	01	01	H2663_016_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	016	0	1	01	01	H2663_016_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	016	0	1	01	01	H2663_016_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	016	0	1	01	01	H2663_016_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	016	0	1	01	01	H2663_016_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	016	0	1	01	01	H2663_016_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	017	0	1	01	01	H2663_017_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	017	0	1	01	01	H2663_017_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	017	0	1	01	01	H2663_017_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	017	0	1	01	01	H2663_017_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	017	0	1	01	01	H2663_017_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	017	0	1	01	01	H2663_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	017	0	1	01	01	H2663_017_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	021	0	1	01	01	H2663_021_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	021	0	1	01	01	H2663_021_0	4	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	021	0	1	01	01	H2663_021_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	021	0	1	01	01	H2663_021_0	4	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	021	0	1	01	01	H2663_021_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	021	0	1	01	01	H2663_021_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	021	0	1	01	01	H2663_021_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	023	0	1	02	01	H2663_023_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	023	0	1	02	01	H2663_023_0	4	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	023	0	1	02	01	H2663_023_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	023	0	1	02	01	H2663_023_0	4	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	023	0	1	02	01	H2663_023_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	023	0	1	02	01	H2663_023_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	023	0	1	02	01	H2663_023_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	024	0	1	02	01	H2663_024_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	024	0	1	02	01	H2663_024_0	4	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	024	0	1	02	01	H2663_024_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	024	0	1	02	01	H2663_024_0	4	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	024	0	1	02	01	H2663_024_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	024	0	1	02	01	H2663_024_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	024	0	1	02	01	H2663_024_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	026	0	1	01	01	H2663_026_0	6	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	026	0	1	01	01	H2663_026_0	6	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	026	0	1	01	01	H2663_026_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	026	0	1	01	01	H2663_026_0	6	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	026	0	1	01	01	H2663_026_0	6	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	026	0	1	01	01	H2663_026_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	026	0	1	01	01	H2663_026_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	027	0	1	01	01	H2663_027_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	027	0	1	01	01	H2663_027_0	5	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	027	0	1	01	01	H2663_027_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	027	0	1	01	01	H2663_027_0	5	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	027	0	1	01	01	H2663_027_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	027	0	1	01	01	H2663_027_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	027	0	1	01	01	H2663_027_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	028	0	1	01	01	H2663_028_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	028	0	1	01	01	H2663_028_0	4	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	028	0	1	01	01	H2663_028_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	028	0	1	01	01	H2663_028_0	4	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	028	0	1	01	01	H2663_028_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	028	0	1	01	01	H2663_028_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	028	0	1	01	01	H2663_028_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	029	0	1	01	01	H2663_029_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	029	0	1	01	01	H2663_029_0	4	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	029	0	1	01	01	H2663_029_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	029	0	1	01	01	H2663_029_0	4	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	029	0	1	01	01	H2663_029_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	029	0	1	01	01	H2663_029_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	029	0	1	01	01	H2663_029_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	031	0	1	02	01	H2663_031_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	031	0	1	02	01	H2663_031_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	031	0	1	02	01	H2663_031_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	031	0	1	02	01	H2663_031_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	031	0	1	02	01	H2663_031_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	031	0	1	02	01	H2663_031_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	031	0	1	02	01	H2663_031_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	032	0	1	01	01	H2663_032_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	032	0	1	01	01	H2663_032_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	032	0	1	01	01	H2663_032_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	032	0	1	01	01	H2663_032_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2663	032	0	1	01	01	H2663_032_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	032	0	1	01	01	H2663_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2663	032	0	1	01	01	H2663_032_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2758	002	0	1	01	01	H2758_002_0	7	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	002	0	1	01	01	H2758_002_0	7	Preferred Generic	4	01	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2758	002	0	1	01	01	H2758_002_0	7	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								8.00	9.00	10.00					1.00	2.00	3.00					1.00	2.00	3.00																	8.00			1.00			0.27	0.03	0.03			0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	002	0	1	01	01	H2758_002_0	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								42.00	77.00	112.00					35.00	70.00	105.00					35.00	70.00	105.00																	42.00			35.00			1.40	1.17	1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	002	0	1	01	01	H2758_002_0	7	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	002	0	1	01	01	H2758_002_0	7	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	002	0	1	01	01	H2758_002_0	7	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	002	0	1	01	01	H2758_002_0	7	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2758	004	0	1	01	01	H2758_004_0	6	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	004	0	1	01	01	H2758_004_0	6	Preferred Generic	4	01	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2758	004	0	1	01	01	H2758_004_0	6	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								14.00	21.00	28.00					7.00	14.00	21.00					7.00	14.00	21.00																	14.00			7.00			0.47	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	004	0	1	01	01	H2758_004_0	6	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								42.00	77.00	112.00					35.00	70.00	105.00					35.00	70.00	105.00																	42.00			35.00			1.40	1.17	1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	004	0	1	01	01	H2758_004_0	6	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								92.00	177.00	262.00					85.00	170.00	255.00					85.00	170.00	255.00																	92.00			85.00			3.07	2.83	2.83			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	004	0	1	01	01	H2758_004_0	6	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	004	0	1	01	01	H2758_004_0	6	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	004	0	1	01	01	H2758_004_0	6	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2758	005	0	1	01	01	H2758_005_0	7	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	005	0	1	01	01	H2758_005_0	7	Preferred Generic	4	01	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2758	005	0	1	01	01	H2758_005_0	7	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								14.00	21.00	28.00					7.00	14.00	21.00					7.00	14.00	21.00																	14.00			7.00			0.47	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	005	0	1	01	01	H2758_005_0	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								42.00	77.00	112.00					35.00	70.00	105.00					35.00	70.00	105.00																	42.00			35.00			1.40	1.17	1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	005	0	1	01	01	H2758_005_0	7	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								92.00	177.00	262.00					85.00	170.00	255.00					85.00	170.00	255.00																	92.00			85.00			3.07	2.83	2.83			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	005	0	1	01	01	H2758_005_0	7	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	005	0	1	01	01	H2758_005_0	7	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	005	0	1	01	01	H2758_005_0	7	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2758	006	0	1	01	01	H2758_006_0	5	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	006	0	1	01	01	H2758_006_0	5	Preferred Generic	4	01	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2758	006	0	1	01	01	H2758_006_0	5	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								8.00	9.00	10.00					1.00	2.00	3.00					1.00	2.00	3.00																	8.00			1.00			0.27	0.03	0.03			0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	006	0	1	01	01	H2758_006_0	5	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								42.00	77.00	112.00					35.00	70.00	105.00					35.00	70.00	105.00																	42.00			35.00			1.40	1.17	1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	006	0	1	01	01	H2758_006_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	006	0	1	01	01	H2758_006_0	5	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	006	0	1	01	01	H2758_006_0	5	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	006	0	1	01	01	H2758_006_0	5	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2758	007	0	1	01	01	H2758_007_0	7	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	007	0	1	01	01	H2758_007_0	7	Preferred Generic	4	01	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2758	007	0	1	01	01	H2758_007_0	7	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								14.00	21.00	28.00					7.00	14.00	21.00					7.00	14.00	21.00																	14.00			7.00			0.47	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	007	0	1	01	01	H2758_007_0	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								42.00	77.00	112.00					35.00	70.00	105.00					35.00	70.00	105.00																	42.00			35.00			1.40	1.17	1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	007	0	1	01	01	H2758_007_0	7	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								92.00	177.00	262.00					85.00	170.00	255.00					85.00	170.00	255.00																	92.00			85.00			3.07	2.83	2.83			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	007	0	1	01	01	H2758_007_0	7	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	007	0	1	01	01	H2758_007_0	7	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	007	0	1	01	01	H2758_007_0	7	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2758	008	0	1	02	01	H2758_008_0	5	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	008	0	1	02	01	H2758_008_0	5	Preferred Generic	4	01	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2758	008	0	1	02	01	H2758_008_0	5	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								14.00	21.00	28.00					7.00	14.00	21.00					7.00	14.00	21.00																	14.00			7.00			0.47	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	008	0	1	02	01	H2758_008_0	5	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								42.00	77.00	112.00					35.00	70.00	105.00					35.00	70.00	105.00																	42.00			35.00			1.40	1.17	1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	008	0	1	02	01	H2758_008_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								92.00	177.00	262.00					85.00	170.00	255.00					85.00	170.00	255.00																	92.00			85.00			3.07	2.83	2.83			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	008	0	1	02	01	H2758_008_0	5	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	008	0	1	02	01	H2758_008_0	5	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2758	008	0	1	02	01	H2758_008_0	5	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	0.00					7.00	7.00	0.00					7.00	7.00	0.00																	7.00			7.00			0.23	0.23	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2773	003	0	1	01	01	H2773_003_0	12	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	003	0	1	01	01	H2773_003_0	12	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2773	003	0	1	01	01	H2773_003_0	12	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.32			0.32			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	003	0	1	01	01	H2773_003_0	12	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	30.00		90.00																			30.00		90.00																30.00				30.00		.97			.97			.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	003	0	1	01	01	H2773_003_0	12	Non-Preferred Drug	4	11	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				23.32	25		25																		25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	003	0	1	01	01	H2773_003_0	12	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	017	0	1	01	01	H2773_017_0	10	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	017	0	1	01	01	H2773_017_0	10	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2773	017	0	1	01	01	H2773_017_0	10	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.32			0.32			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	017	0	1	01	01	H2773_017_0	10	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	35.00		105.00																			35.00		105.00																35.00				35.00		1.13			1.13			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	017	0	1	01	01	H2773_017_0	10	Non-Preferred Drug	4	11	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				37.20	25		25																		25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	017	0	1	01	01	H2773_017_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	018	0	1	01	01	H2773_018_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	018	0	1	01	01	H2773_018_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2773	018	0	1	01	01	H2773_018_0	8	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.65			.65			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	018	0	1	01	01	H2773_018_0	8	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	018	0	1	01	01	H2773_018_0	8	Non-Preferred Drug	4	11	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				43.62	40		40																		40		40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	018	0	1	01	01	H2773_018_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	019	0	1	01	01	H2773_019_0	9	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		.00			.00			.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	019	0	1	01	01	H2773_019_0	9	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2773	019	0	1	01	01	H2773_019_0	9	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	15.00		45.00																			15.00		30.00																15.00				15.00		.48			.48			.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	019	0	1	01	01	H2773_019_0	9	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	35.00		105.00																			35.00		105.00																35.00				35.00		1.13			1.13			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	019	0	1	01	01	H2773_019_0	9	Non-Preferred Drug	4	11	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				27.72	25		25																		25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	019	0	1	01	01	H2773_019_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	020	0	1	01	01	H2773_020_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	020	0	1	01	01	H2773_020_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			.13			.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2773	020	0	1	01	01	H2773_020_0	8	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.32			0.32			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	020	0	1	01	01	H2773_020_0	8	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	35.00		105.00																			35.00		105.00																35.00				35.00		1.13			1.13			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	020	0	1	01	01	H2773_020_0	8	Non-Preferred Drug	4	11	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				39.12	25		25																		25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	020	0	1	01	01	H2773_020_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	022	0	1	01	01	H2773_022_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	022	0	1	01	01	H2773_022_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2773	022	0	1	01	01	H2773_022_0	8	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.32			0.32			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	022	0	1	01	01	H2773_022_0	8	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	25.00		75.00																			25.00		75.00																25.00				25.00		.81			.81			.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	022	0	1	01	01	H2773_022_0	8	Non-Preferred Drug	4	11	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				39.81	25		25																		25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2773	022	0	1	01	01	H2773_022_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	082	0	1	04	01	H2775_082_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	082	0	1	04	01	H2775_082_0	8	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	082	0	1	04	01	H2775_082_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.17		1.50	1.17	1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	082	0	1	04	01	H2775_082_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	082	0	1	04	01	H2775_082_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	083	0	1	04	01	H2775_083_0	11	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	083	0	1	04	01	H2775_083_0	11	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	083	0	1	04	01	H2775_083_0	11	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.17		1.50	1.17	1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	083	0	1	04	01	H2775_083_0	11	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	083	0	1	04	01	H2775_083_0	11	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	088	0	1	04	01	H2775_088_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.07		0.23	0.07	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	088	0	1	04	01	H2775_088_0	8	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	088	0	1	04	01	H2775_088_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	088	0	1	04	01	H2775_088_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	088	0	1	04	01	H2775_088_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	089	0	1	04	01	H2775_089_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.07		0.23	0.07	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	089	0	1	04	01	H2775_089_0	8	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	089	0	1	04	01	H2775_089_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	089	0	1	04	01	H2775_089_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	089	0	1	04	01	H2775_089_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	099	0	1	04	01	H2775_099_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	099	0	1	04	01	H2775_099_0	8	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	099	0	1	04	01	H2775_099_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.17		1.50	1.17	1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	099	0	1	04	01	H2775_099_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	099	0	1	04	01	H2775_099_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	100	0	1	04	01	H2775_100_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.07		0.23	0.07	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	100	0	1	04	01	H2775_100_0	8	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	100	0	1	04	01	H2775_100_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	100	0	1	04	01	H2775_100_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2775	100	0	1	04	01	H2775_100_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	001	0	1	01	01	H2802_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	001	0	1	01	01	H2802_001_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	001	0	1	01	01	H2802_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	001	0	1	01	01	H2802_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	001	0	1	01	01	H2802_001_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				625.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	007	0	1	01	01	H2802_007_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	007	0	1	01	01	H2802_007_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	007	0	1	01	01	H2802_007_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	007	0	1	01	01	H2802_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	007	0	1	01	01	H2802_007_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				688.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	008	0	1	01	01	H2802_008_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	008	0	1	01	01	H2802_008_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	008	0	1	01	01	H2802_008_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	008	0	1	01	01	H2802_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	008	0	1	01	01	H2802_008_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				732.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	010	0	1	01	01	H2802_010_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	010	0	1	01	01	H2802_010_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	010	0	1	01	01	H2802_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	010	0	1	01	01	H2802_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	010	0	1	01	01	H2802_010_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				688.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	012	0	1	01	01	H2802_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	012	0	1	01	01	H2802_012_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	012	0	1	01	01	H2802_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	012	0	1	01	01	H2802_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	012	0	1	01	01	H2802_012_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				825.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	013	0	1	01	01	H2802_013_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	013	0	1	01	01	H2802_013_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	013	0	1	01	01	H2802_013_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	013	0	1	01	01	H2802_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	013	0	1	01	01	H2802_013_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				836.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	014	0	1	01	01	H2802_014_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	014	0	1	01	01	H2802_014_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	014	0	1	01	01	H2802_014_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	014	0	1	01	01	H2802_014_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	014	0	1	01	01	H2802_014_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				866.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	015	0	1	01	01	H2802_015_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	015	0	1	01	01	H2802_015_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	015	0	1	01	01	H2802_015_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	015	0	1	01	01	H2802_015_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	015	0	1	01	01	H2802_015_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				717.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	016	0	1	01	01	H2802_016_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	016	0	1	01	01	H2802_016_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	016	0	1	01	01	H2802_016_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	016	0	1	01	01	H2802_016_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	016	0	1	01	01	H2802_016_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				778.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	017	0	1	01	01	H2802_017_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	017	0	1	01	01	H2802_017_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	017	0	1	01	01	H2802_017_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	017	0	1	01	01	H2802_017_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	017	0	1	01	01	H2802_017_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				836.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	018	0	1	01	01	H2802_018_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	018	0	1	01	01	H2802_018_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	018	0	1	01	01	H2802_018_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	018	0	1	01	01	H2802_018_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	018	0	1	01	01	H2802_018_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				762.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	019	0	1	01	01	H2802_019_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	019	0	1	01	01	H2802_019_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	019	0	1	01	01	H2802_019_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	019	0	1	01	01	H2802_019_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	019	0	1	01	01	H2802_019_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				866.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	020	0	1	01	01	H2802_020_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	020	0	1	01	01	H2802_020_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	020	0	1	01	01	H2802_020_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	020	0	1	01	01	H2802_020_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	020	0	1	01	01	H2802_020_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				762.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	021	0	1	01	01	H2802_021_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	021	0	1	01	01	H2802_021_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	021	0	1	01	01	H2802_021_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	021	0	1	01	01	H2802_021_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	021	0	1	01	01	H2802_021_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				866.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	022	0	1	01	01	H2802_022_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	022	0	1	01	01	H2802_022_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	022	0	1	01	01	H2802_022_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	022	0	1	01	01	H2802_022_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	022	0	1	01	01	H2802_022_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				612.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	023	0	1	01	01	H2802_023_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	023	0	1	01	01	H2802_023_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	023	0	1	01	01	H2802_023_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	023	0	1	01	01	H2802_023_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	023	0	1	01	01	H2802_023_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				500.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	024	0	1	01	01	H2802_024_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	024	0	1	01	01	H2802_024_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	024	0	1	01	01	H2802_024_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	024	0	1	01	01	H2802_024_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	024	0	1	01	01	H2802_024_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1158.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	025	0	1	01	01	H2802_025_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	025	0	1	01	01	H2802_025_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	025	0	1	01	01	H2802_025_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	025	0	1	01	01	H2802_025_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	025	0	1	01	01	H2802_025_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				870.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	026	0	1	01	01	H2802_026_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	026	0	1	01	01	H2802_026_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	026	0	1	01	01	H2802_026_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	026	0	1	01	01	H2802_026_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	026	0	1	01	01	H2802_026_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				486.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	028	0	1	01	01	H2802_028_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	028	0	1	01	01	H2802_028_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	028	0	1	01	01	H2802_028_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	028	0	1	01	01	H2802_028_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	028	0	1	01	01	H2802_028_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				700.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	029	0	1	01	01	H2802_029_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	029	0	1	01	01	H2802_029_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	029	0	1	01	01	H2802_029_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	029	0	1	01	01	H2802_029_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	029	0	1	01	01	H2802_029_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1001.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	030	0	1	01	01	H2802_030_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	030	0	1	01	01	H2802_030_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	030	0	1	01	01	H2802_030_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	030	0	1	01	01	H2802_030_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	030	0	1	01	01	H2802_030_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				677.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	031	0	1	01	01	H2802_031_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	031	0	1	01	01	H2802_031_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	031	0	1	01	01	H2802_031_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	031	0	1	01	01	H2802_031_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	031	0	1	01	01	H2802_031_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				698.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	032	0	1	01	01	H2802_032_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	032	0	1	01	01	H2802_032_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	032	0	1	01	01	H2802_032_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	032	0	1	01	01	H2802_032_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	032	0	1	01	01	H2802_032_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				459.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	033	0	1	01	01	H2802_033_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	033	0	1	01	01	H2802_033_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	033	0	1	01	01	H2802_033_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	033	0	1	01	01	H2802_033_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	033	0	1	01	01	H2802_033_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				583.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	034	0	1	01	01	H2802_034_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	034	0	1	01	01	H2802_034_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	034	0	1	01	01	H2802_034_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	034	0	1	01	01	H2802_034_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	034	0	1	01	01	H2802_034_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				556.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	035	0	1	01	01	H2802_035_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	035	0	1	01	01	H2802_035_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	035	0	1	01	01	H2802_035_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	035	0	1	01	01	H2802_035_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	035	0	1	01	01	H2802_035_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				554.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	036	0	1	01	01	H2802_036_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	036	0	1	01	01	H2802_036_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	036	0	1	01	01	H2802_036_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	036	0	1	01	01	H2802_036_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	036	0	1	01	01	H2802_036_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				552.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	037	0	1	01	01	H2802_037_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	037	0	1	01	01	H2802_037_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	037	0	1	01	01	H2802_037_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	037	0	1	01	01	H2802_037_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	037	0	1	01	01	H2802_037_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				705.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	038	0	1	01	01	H2802_038_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	038	0	1	01	01	H2802_038_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	038	0	1	01	01	H2802_038_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	038	0	1	01	01	H2802_038_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	038	0	1	01	01	H2802_038_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	039	0	1	01	01	H2802_039_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	039	0	1	01	01	H2802_039_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	039	0	1	01	01	H2802_039_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	039	0	1	01	01	H2802_039_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	039	0	1	01	01	H2802_039_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				699.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	040	0	1	01	01	H2802_040_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	040	0	1	01	01	H2802_040_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	040	0	1	01	01	H2802_040_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	040	0	1	01	01	H2802_040_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	040	0	1	01	01	H2802_040_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	041	0	1	01	01	H2802_041_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	041	0	1	01	01	H2802_041_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	041	0	1	01	01	H2802_041_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	041	0	1	01	01	H2802_041_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	041	0	1	01	01	H2802_041_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				822.00	32		32																										32						32			32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	042	0	1	01	01	H2802_042_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	042	0	1	01	01	H2802_042_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	042	0	1	01	01	H2802_042_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	042	0	1	01	01	H2802_042_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	042	0	1	01	01	H2802_042_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1038.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	045	0	1	01	01	H2802_045_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	045	0	1	01	01	H2802_045_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	045	0	1	01	01	H2802_045_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	045	0	1	01	01	H2802_045_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2802	045	0	1	01	01	H2802_045_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				666.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2816	013	0	1	09	04	H2816_013_0	11	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2816	013	0	1	09	04	H2816_013_0	11	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2816	013	0	1	09	04	H2816_013_0	11	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.17		1.50	1.17	1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2816	013	0	1	09	04	H2816_013_0	11	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2816	013	0	1	09	04	H2816_013_0	11	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2816	019	0	1	09	04	H2816_019_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.07		0.23	0.07	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2816	019	0	1	09	04	H2816_019_0	8	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2816	019	0	1	09	04	H2816_019_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2816	019	0	1	09	04	H2816_019_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2816	019	0	1	09	04	H2816_019_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2829	001	0	1	01	01	H2829_001_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2829	001	0	1	01	01	H2829_001_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2829	001	0	1	01	01	H2829_001_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2829	001	0	1	01	01	H2829_001_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2829	001	0	1	01	01	H2829_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2829	001	0	1	01	01	H2829_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2829	001	0	1	01	01	H2829_001_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2879	001	0	1	01	01	H2879_001_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2879	001	0	1	01	01	H2879_001_0	5	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2879	001	0	1	01	01	H2879_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2879	001	0	1	01	01	H2879_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				74.55	42	42	42																		42	42	42															42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2879	001	0	1	01	01	H2879_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2906	005	0	1	04	01	H2906_005_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	005	0	1	04	01	H2906_005_0	12	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2906	005	0	1	04	01	H2906_005_0	12	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	005	0	1	04	01	H2906_005_0	12	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2906	005	0	1	04	01	H2906_005_0	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	005	0	1	04	01	H2906_005_0	12	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	005	0	1	04	01	H2906_005_0	12	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	005	0	1	04	01	H2906_005_0	12	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	005	0	1	04	01	H2906_005_0	12	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2906	006	0	1	04	01	H2906_006_0	10	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		15.00																					12.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	006	0	1	04	01	H2906_006_0	10	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		35.00																					28.00																14.00				14.00		0.47						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	006	0	1	04	01	H2906_006_0	10	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	006	0	1	04	01	H2906_006_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	006	0	1	04	01	H2906_006_0	10	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	006	0	1	04	01	H2906_006_0	10	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	007	0	1	04	01	H2906_007_0	10	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	007	0	1	04	01	H2906_007_0	10	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	16.00		40.00																					32.00																16.00				16.00		0.53						0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	007	0	1	04	01	H2906_007_0	10	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	007	0	1	04	01	H2906_007_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	007	0	1	04	01	H2906_007_0	10	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2906	007	0	1	04	01	H2906_007_0	10	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	4.00		10.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2915	003	0	1	01	01	H2915_003_0	2	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2915	003	0	1	01	01	H2915_003_0	2	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2915	003	0	1	01	01	H2915_003_0	2	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2915	003	0	1	01	01	H2915_003_0	2	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2915	003	0	1	01	01	H2915_003_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2915	003	0	1	01	01	H2915_003_0	2	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2931	002	0	1	01	01	H2931_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				1	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2931	002	0	1	01	01	H2931_002_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				1	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2931	002	0	1	01	01	H2931_002_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		100				1	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2931	002	0	1	01	01	H2931_002_0	3	Generic	4	01	1	2	2	3	110		01		100	1	30		100				1	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2931	002	0	1	01	01	H2931_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				1	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2931	002	0	1	01	01	H2931_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				1	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2931	002	0	1	01	01	H2931_002_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		100				1	2						100	30		31				798.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2931	004	0	1	01	01	H2931_004_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				1	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2931	004	0	1	01	01	H2931_004_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		100				1	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2931	004	0	1	01	01	H2931_004_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				1	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2931	004	0	1	01	01	H2931_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				1	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2931	004	0	1	01	01	H2931_004_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		100				1	2						100	30		31				478.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	004	0	1	09	04	H2944_004_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	004	0	1	09	04	H2944_004_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	004	0	1	09	04	H2944_004_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	004	0	1	09	04	H2944_004_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	004	0	1	09	04	H2944_004_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	013	0	1	09	04	H2944_013_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	013	0	1	09	04	H2944_013_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	013	0	1	09	04	H2944_013_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	013	0	1	09	04	H2944_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	013	0	1	09	04	H2944_013_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	114	0	1	09	04	H2944_114_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	114	0	1	09	04	H2944_114_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	114	0	1	09	04	H2944_114_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	114	0	1	09	04	H2944_114_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	114	0	1	09	04	H2944_114_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	124	0	1	09	04	H2944_124_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	124	0	1	09	04	H2944_124_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	124	0	1	09	04	H2944_124_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	124	0	1	09	04	H2944_124_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	124	0	1	09	04	H2944_124_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	127	0	1	09	04	H2944_127_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	127	0	1	09	04	H2944_127_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	127	0	1	09	04	H2944_127_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	127	0	1	09	04	H2944_127_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2944	127	0	1	09	04	H2944_127_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2960	004	0	1	01	01	H2960_004_0	10	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		12.50																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	004	0	1	01	01	H2960_004_0	10	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		35.00																					28.00																14.00				14.00		0.47						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	004	0	1	01	01	H2960_004_0	10	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	004	0	1	01	01	H2960_004_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	004	0	1	01	01	H2960_004_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	004	0	1	01	01	H2960_004_0	10	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	2.50		6.25																					5.00																2.50				2.50		0.08						0.08		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	012	0	1	01	01	H2960_012_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		15.00																					12.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	012	0	1	01	01	H2960_012_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	16.00		40.00																					32.00																16.00				16.00		0.53						0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	012	0	1	01	01	H2960_012_0	8	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	012	0	1	01	01	H2960_012_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	012	0	1	01	01	H2960_012_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	012	0	1	01	01	H2960_012_0	8	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	018	0	1	01	01	H2960_018_0	11	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	018	0	1	01	01	H2960_018_0	11	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2960	018	0	1	01	01	H2960_018_0	11	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	018	0	1	01	01	H2960_018_0	11	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2960	018	0	1	01	01	H2960_018_0	11	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	018	0	1	01	01	H2960_018_0	11	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	018	0	1	01	01	H2960_018_0	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	018	0	1	01	01	H2960_018_0	11	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2960	018	0	1	01	01	H2960_018_0	11	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2962	001	0	1	01	01	H2962_001_0	8	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	001	0	1	01	01	H2962_001_0	8	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2962	001	0	1	01	01	H2962_001_0	8	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	001	0	1	01	01	H2962_001_0	8	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2962	001	0	1	01	01	H2962_001_0	8	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					70.00																35.00				35.00		1.17						1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	001	0	1	01	01	H2962_001_0	8	Non-Preferred Drug	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	001	0	1	01	01	H2962_001_0	8	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				761.16	33	33	33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	002	0	1	01	01	H2962_002_0	8	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	002	0	1	01	01	H2962_002_0	8	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2962	002	0	1	01	01	H2962_002_0	8	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	8.00	16.00	24.00																					16.00																8.00				8.00		.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	002	0	1	01	01	H2962_002_0	8	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	8.00	16.00	24.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2962	002	0	1	01	01	H2962_002_0	8	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	25.00	50.00	75.00																					50.00																25.00				25.00		0.83						0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	002	0	1	01	01	H2962_002_0	8	Non-Preferred Drug	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	50.00	100.00	150.00																					100.00																50.00				50.00		1.67						1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	002	0	1	01	01	H2962_002_0	8	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				776.04	33	33	33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	003	0	1	01	01	H2962_003_0	8	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	003	0	1	01	01	H2962_003_0	8	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2962	003	0	1	01	01	H2962_003_0	8	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	003	0	1	01	01	H2962_003_0	8	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H2962	003	0	1	01	01	H2962_003_0	8	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					70.00																35.00				35.00		1.17						1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	003	0	1	01	01	H2962_003_0	8	Non-Preferred Drug	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2962	003	0	1	01	01	H2962_003_0	8	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				761.16	33	33	33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H2968	001	0	1	04	01	H2968_001_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	12.50																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2968	001	0	1	04	01	H2968_001_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2968	001	0	1	04	01	H2968_001_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2968	001	0	1	04	01	H2968_001_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	99.00	198.00	247.50																			90.00	198.00	198.00																99.00				99.00		3.30			3.00			3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2968	001	0	1	04	01	H2968_001_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H2986	001	0	1	01	01	H2986_001_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	34		90				1	2			90				34		34	5.00		15.00																					10.00																5.00				5.00		0.15						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	001	0	1	01	01	H2986_001_0	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	34		90				1	2			90				34		34	5.00		15.00																					10.00																5.00				5.00		0.15						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2986	001	0	1	01	01	H2986_001_0	6	Generic	4	01	1	2	2	1	110		01	100		1	34		90				1	2			90				34		34	15.00		45.00																					30.00																15.00				15.00		0.44						0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	001	0	1	01	01	H2986_001_0	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	34		90				1	2			90				34		34	47.00		141.00																					94.00																47.00				47.00		1.38						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	001	0	1	01	01	H2986_001_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	34		90				1	2			90				34		34	100.00		300.00																					200.00																100.00				100.00		2.94						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	001	0	1	01	01	H2986_001_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		34				200.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	001	0	1	01	01	H2986_001_0	6	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	34		90				1	2			90				34		34	2.00		6.00																					4.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	001	0	1	01	01	H2986_001_0	6	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	34		90				1	2			90				34		34	2.00		6.00																					4.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2986	002	0	1	01	01	H2986_002_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	34		90				1	2			90				34		34	5.00		15.00																					10.00																5.00				5.00		0.15						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	002	0	1	01	01	H2986_002_0	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	34		90				1	2			90				34		34	5.00		15.00																					10.00																5.00				5.00		0.15						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2986	002	0	1	01	01	H2986_002_0	6	Generic	4	01	1	2	2	1	110		01	100		1	34		90				1	2			90				34		34	15.00		45.00																					30.00																15.00				15.00		0.44						0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	002	0	1	01	01	H2986_002_0	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	34		90				1	2			90				34		34	47.00		141.00																					94.00																47.00				47.00		1.38						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	002	0	1	01	01	H2986_002_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	34		90				1	2			90				34		34	100.00		300.00																					200.00																100.00				100.00		2.94						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	002	0	1	01	01	H2986_002_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		34				200.00	28																																					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	002	0	1	01	01	H2986_002_0	6	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	34		90				1	2			90				34		34	2.00		6.00																					4.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	002	0	1	01	01	H2986_002_0	6	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	34		90				1	2			90				34		34	2.00		6.00																					4.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2986	004	0	1	01	01	H2986_004_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	34		90				1	2			90				34		34	5.00		15.00																					10.00																5.00				5.00		0.15						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	004	0	1	01	01	H2986_004_0	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	34		90				1	2			90				34		34	5.00		15.00																					10.00																5.00				5.00		0.15						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2986	004	0	1	01	01	H2986_004_0	6	Generic	4	01	1	2	2	1	110		01	100		1	34		90				1	2			90				34		34	15.00		45.00																					30.00																15.00				15.00		0.44						0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	004	0	1	01	01	H2986_004_0	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	34		90				1	2			90				34		34	47.00		141.00																					94.00																47.00				47.00		1.38						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	004	0	1	01	01	H2986_004_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	34		90				1	2			90				34		34	100.00		300.00																					200.00																100.00				100.00		2.94						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	004	0	1	01	01	H2986_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		34				200.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	004	0	1	01	01	H2986_004_0	6	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	34		90				1	2			90				34		34	2.00		6.00																					4.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	004	0	1	01	01	H2986_004_0	6	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	34		90				1	2			90				34		34	2.00		6.00																					4.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2986	005	0	1	01	01	H2986_005_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	34		90				1	2			90				34		34	5.00		15.00																					10.00																5.00				5.00		0.15						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	005	0	1	01	01	H2986_005_0	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	34		90				1	2			90				34		34	5.00		15.00																					10.00																5.00				5.00		0.15						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H2986	005	0	1	01	01	H2986_005_0	6	Generic	4	01	1	2	2	1	110		01	100		1	34		90				1	2			90				34		34	15.00		45.00																					30.00																15.00				15.00		0.44						0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	005	0	1	01	01	H2986_005_0	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	34		90				1	2			90				34		34	47.00		141.00																					94.00																47.00				47.00		1.38						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	005	0	1	01	01	H2986_005_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	34		90				1	2			90				34		34	100.00		300.00																					200.00																100.00				100.00		2.94						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	005	0	1	01	01	H2986_005_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		34				200.00	28																																					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	005	0	1	01	01	H2986_005_0	6	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	34		90				1	2			90				34		34	2.00		6.00																					4.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H2986	005	0	1	01	01	H2986_005_0	6	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	34		90				1	2			90				34		34	2.00		6.00																					4.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3018	001	0	1	48	05	H3018_001_0	5	Generic Drugs	4	01			1	1	110		01	100		1	30		90				2	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3018	001	0	1	48	05	H3018_001_0	5	Brand Drugs	4	10			2	1	110		01	100		1	30		90				2	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3018	001	0	1	48	05	H3018_001_0	5	Non-Medicare Rx Drugs	4	11			3	1	110		01	100		1	30		90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3018	001	0	1	48	05	H3018_001_0	5	Non-Medicare OTC Drugs	4	11			4	1	110		01	100		1	30		90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3054	001	0	1	01	01	H3054_001_0	7	Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	9.00	18.00	27.00																					15.00																9.00				9.00		0.30						0.29	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3054	001	0	1	01	01	H3054_001_0	7	Preferred Brand	2	10	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3054	001	0	1	01	01	H3054_001_0	7	Non-Preferred Brand	2	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3054	001	0	1	01	01	H3054_001_0	7	Specialty Tier	2	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				780.55	25	25	25																				25															25			25								1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3054	003	0	1	01	01	H3054_003_0	7	Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	9.25	18.50	27.75																					27.75																9.25				9.25		0.31						0.30	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3054	003	0	1	01	01	H3054_003_0	7	Preferred Brand	2	10	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3054	003	0	1	01	01	H3054_003_0	7	Non-Preferred Brand	2	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3054	003	0	1	01	01	H3054_003_0	7	Specialty Tier	2	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				780.55	25	25	25																				25															25			25								1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3054	004	0	1	01	01	H3054_004_0	8	Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	9.50	19.00	28.50																					28.50																9.50				9.50		0.32						0.31	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3054	004	0	1	01	01	H3054_004_0	8	Preferred Brand	2	10	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3054	004	0	1	01	01	H3054_004_0	8	Non-Preferred Brand	2	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3054	004	0	1	01	01	H3054_004_0	8	Specialty Tier	2	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				780.55	25	25	25																				25															25			25								1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3071	002	0	1	01	01	H3071_002_0	5	Preferred Generic	4	11	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	3.00	1.00	1.00																									9.00	3.00	3.00				3.00	0.00	0.00				3.00				3.00		0.10				0.30	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3071	002	0	1	01	01	H3071_002_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									30.00	60.00	90.00				10.00	20.00	30.00				10.00				10.00		0.33				1.00	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3071	002	0	1	01	01	H3071_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									141.00	282.00	423.00				47.00	94.00	141.00				47.00				47.00		1.57				4.70	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3071	002	0	1	01	01	H3071_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				76.72	50	50	50																								50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3071	002	0	1	01	01	H3071_002_0	5	Specialty Tier	4	11	1	1	5	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				628.83	33	33	33																								33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3113	008	0	1	01	01	H3113_008_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3113	008	0	1	01	01	H3113_008_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3113	008	0	1	01	01	H3113_008_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3113	008	0	1	01	01	H3113_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3113	008	0	1	01	01	H3113_008_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				743.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3132	001	0	1	01	01	H3132_001_0	4	Generic	2	01	1	1	1	1	110		10			1	30		90				1	2								29	34				8.84	25		25																																				25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3132	001	0	1	01	01	H3132_001_0	4	Preferred Brand	2	11	1	1	2	1	110		10			1	30		90				1	2								29	34				70.78	25		25																																				25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3132	001	0	1	01	01	H3132_001_0	4	Non-Preferred Brand	2	10	1	1	3	1	010		10			1	30															29	34				90.54	25																																						25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3132	001	0	1	01	01	H3132_001_0	4	Specialty Tier	2	10	1	1	4	1	010		10			1	30															29	34				348.23	25																																						25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3152	022	0	1	01	01	H3152_022_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	022	0	1	01	01	H3152_022_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	022	0	1	01	01	H3152_022_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	022	0	1	01	01	H3152_022_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	022	0	1	01	01	H3152_022_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	022	0	1	01	01	H3152_022_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	022	0	1	01	01	H3152_022_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	048	0	1	01	01	H3152_048_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	048	0	1	01	01	H3152_048_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	048	0	1	01	01	H3152_048_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	048	0	1	01	01	H3152_048_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	048	0	1	01	01	H3152_048_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	048	0	1	01	01	H3152_048_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	048	0	1	01	01	H3152_048_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	080	0	1	01	01	H3152_080_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	080	0	1	01	01	H3152_080_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	080	0	1	01	01	H3152_080_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	080	0	1	01	01	H3152_080_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	080	0	1	01	01	H3152_080_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	080	0	1	01	01	H3152_080_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	080	0	1	01	01	H3152_080_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	082	0	1	01	01	H3152_082_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	082	0	1	01	01	H3152_082_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	082	0	1	01	01	H3152_082_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	082	0	1	01	01	H3152_082_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	082	0	1	01	01	H3152_082_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	082	0	1	01	01	H3152_082_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	082	0	1	01	01	H3152_082_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	084	0	1	01	01	H3152_084_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	084	0	1	01	01	H3152_084_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	084	0	1	01	01	H3152_084_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	084	0	1	01	01	H3152_084_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	084	0	1	01	01	H3152_084_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	084	0	1	01	01	H3152_084_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	084	0	1	01	01	H3152_084_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	085	0	1	01	01	H3152_085_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	085	0	1	01	01	H3152_085_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	085	0	1	01	01	H3152_085_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	085	0	1	01	01	H3152_085_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	085	0	1	01	01	H3152_085_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	085	0	1	01	01	H3152_085_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	085	0	1	01	01	H3152_085_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	086	0	1	01	01	H3152_086_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	086	0	1	01	01	H3152_086_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	086	0	1	01	01	H3152_086_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	086	0	1	01	01	H3152_086_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3152	086	0	1	01	01	H3152_086_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	086	0	1	01	01	H3152_086_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3152	086	0	1	01	01	H3152_086_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3154	004	0	1	01	01	H3154_004_0	6	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	004	0	1	01	01	H3154_004_0	6	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					4.50	9.00	13.50																16.00				16.00			0.53	0.30	0.15			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	004	0	1	01	01	H3154_004_0	6	Preferred Brand	2	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								37.00	74.00	111.00					30.00	60.00	90.00					30.00	60.00	90.00																37.00				37.00			1.23	1.00	1.00			1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	004	0	1	01	01	H3154_004_0	6	Non-Preferred Brand	2	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								70.00	140.00	210.00					60.00	120.00	180.00					60.00	120.00	180.00																70.00				70.00			2.33	2.00	2.00			2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	004	0	1	01	01	H3154_004_0	6	Specialty Tier	2	11	1	1	5	1		010	01			1				30											30		31											955.15	25						955.15	25																							25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	022	0	1	01	01	H3154_022_0	6	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	022	0	1	01	01	H3154_022_0	6	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					4.50	9.00	13.50																16.00				16.00			0.53	0.30	0.15			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	022	0	1	01	01	H3154_022_0	6	Preferred Brand	2	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								37.00	74.00	111.00					30.00	60.00	90.00					30.00	60.00	90.00																37.00				37.00			1.23	1.00	1.00			1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	022	0	1	01	01	H3154_022_0	6	Non-Preferred Brand	2	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								70.00	140.00	210.00					60.00	120.00	180.00					60.00	120.00	180.00																70.00				70.00			2.33	2.00	2.00			2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	022	0	1	01	01	H3154_022_0	6	Specialty Tier	2	11	1	1	5	1		010	01			1				30											30		31											955.15	25						955.15	25																							25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	029	0	1	01	01	H3154_029_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	029	0	1	01	01	H3154_029_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					4.50	9.00	13.50																16.00				16.00			0.53	0.30	0.15			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	029	0	1	01	01	H3154_029_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	029	0	1	01	01	H3154_029_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								70.00	140.00	210.00					60.00	120.00	180.00					60.00	120.00	180.00																70.00				70.00			2.33	2.00	2.00			2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	029	0	1	01	01	H3154_029_0	5	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											993.97	27						993.97	27																							27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	030	0	1	01	01	H3154_030_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	030	0	1	01	01	H3154_030_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					4.50	9.00	13.50																16.00				16.00			0.53	0.30	0.15			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	030	0	1	01	01	H3154_030_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	030	0	1	01	01	H3154_030_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								70.00	140.00	210.00					60.00	120.00	180.00					60.00	120.00	180.00																70.00				70.00			2.33	2.00	2.00			2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	030	0	1	01	01	H3154_030_0	5	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											993.97	27						993.97	27																							27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	031	0	1	01	01	H3154_031_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	031	0	1	01	01	H3154_031_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					4.50	9.00	13.50																16.00				16.00			0.53	0.30	0.15			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	031	0	1	01	01	H3154_031_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	031	0	1	01	01	H3154_031_0	6	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								70.00	140.00	210.00					60.00	120.00	180.00					60.00	120.00	180.00																70.00				70.00			2.33	2.00	2.00			2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	031	0	1	01	01	H3154_031_0	6	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											957.15	26						957.15	26																							26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	032	0	1	01	01	H3154_032_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	032	0	1	01	01	H3154_032_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					4.50	9.00	13.50																16.00				16.00			0.53	0.30	0.15			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	032	0	1	01	01	H3154_032_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	032	0	1	01	01	H3154_032_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								70.00	140.00	210.00					60.00	120.00	180.00					60.00	120.00	180.00																70.00				70.00			2.33	2.00	2.00			2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3154	032	0	1	01	01	H3154_032_0	5	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1214.85	33						1214.85	33																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3170	001	0	1	01	01	H3170_001_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					4.00	8.00	12.00					4.00	8.00	12.00																14.00				4.00			0.47	0.13	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3170	001	0	1	01	01	H3170_001_0	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					8.00	16.00	24.00					8.00	16.00	24.00																18.00				8.00			0.60	0.27	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3170	001	0	1	01	01	H3170_001_0	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				37.00			1.57	1.23	1.23			1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3170	001	0	1	01	01	H3170_001_0	9	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				90.00			3.33	3.00	3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3170	001	0	1	01	01	H3170_001_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	25						1.00	25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3170	002	0	1	02	01	H3170_002_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					2.00	4.00	6.00					2.00	4.00	6.00																12.00				2.00			0.40	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3170	002	0	1	02	01	H3170_002_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					8.00	16.00	24.00					8.00	16.00	24.00																18.00				8.00			0.60	0.27	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3170	002	0	1	02	01	H3170_002_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				37.00			1.57	1.23	1.23			1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3170	002	0	1	02	01	H3170_002_0	8	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				90.00			3.33	3.00	3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3170	002	0	1	02	01	H3170_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	28						1.00	28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3204	001	0	1	01	01	H3204_001_0	5	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3204	001	0	1	01	01	H3204_001_0	5	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3204	001	0	1	01	01	H3204_001_0	5	Preferred Brand	4	10	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3204	001	0	1	01	01	H3204_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3204	001	0	1	01	01	H3204_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3204	007	0	1	01	01	H3204_007_0	6	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3204	007	0	1	01	01	H3204_007_0	6	Preferred Generic	4	01	1	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3204	007	0	1	01	01	H3204_007_0	6	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3204	007	0	1	01	01	H3204_007_0	6	Generic	4	01	1	2	2	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3204	007	0	1	01	01	H3204_007_0	6	Preferred Brand	4	10	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3204	007	0	1	01	01	H3204_007_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3204	007	0	1	01	01	H3204_007_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3206	001	0	1	04	01	H3206_001_0	7	Preferred Generic	3	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3206	001	0	1	04	01	H3206_001_0	7	Generic	3	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3206	001	0	1	04	01	H3206_001_0	7	Preferred Brand	3	10	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3206	001	0	1	04	01	H3206_001_0	7	Non-Preferred Drug	3	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3206	001	0	1	04	01	H3206_001_0	7	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3233	001	0	1	01	01	H3233_001_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	001	0	1	01	01	H3233_001_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3233	001	0	1	01	01	H3233_001_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	001	0	1	01	01	H3233_001_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	001	0	1	01	01	H3233_001_0	6	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	001	0	1	01	01	H3233_001_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	001	0	1	01	01	H3233_001_0	6	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	001	0	1	01	01	H3233_001_0	6	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3233	003	0	1	02	01	H3233_003_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	003	0	1	02	01	H3233_003_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3233	003	0	1	02	01	H3233_003_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	003	0	1	02	01	H3233_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	003	0	1	02	01	H3233_003_0	5	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	003	0	1	02	01	H3233_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	003	0	1	02	01	H3233_003_0	5	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3233	003	0	1	02	01	H3233_003_0	5	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3237	001	0	1	48	05	H3237_001_0	5	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	3.35	0.00	3.35	0.00	3.35	0.00	3.35			
H3237	001	0	1	48	05	H3237_001_0	5	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	8.35	0.00	8.35	0.00	8.35	0.00	8.35			
H3237	001	0	1	48	05	H3237_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3237	002	0	1	48	05	H3237_002_0	5	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	3.35	0.00	3.35	0.00	3.35	0.00	3.35			
H3237	002	0	1	48	05	H3237_002_0	5	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	8.35	0.00	8.35	0.00	8.35	0.00	8.35			
H3237	002	0	1	48	05	H3237_002_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3240	013	0	1	01	01	H3240_013_0	8	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	013	0	1	01	01	H3240_013_0	8	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								12.00	24.00	36.00					12.00	24.00	36.00					12.00	36.00	36.00																12.00				12.00			0.40	0.40	0.40			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	013	0	1	01	01	H3240_013_0	8	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	013	0	1	01	01	H3240_013_0	8	Non-Preferred Drug	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	013	0	1	01	01	H3240_013_0	8	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	013	0	1	01	01	H3240_013_0	8	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	016	0	1	01	01	H3240_016_0	8	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	016	0	1	01	01	H3240_016_0	8	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					11.00	22.00	33.00					11.00	33.00	33.00																11.00				11.00			0.37	0.37	0.37			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	016	0	1	01	01	H3240_016_0	8	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	016	0	1	01	01	H3240_016_0	8	Non-Preferred Drug	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	016	0	1	01	01	H3240_016_0	8	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	016	0	1	01	01	H3240_016_0	8	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	017	0	1	02	01	H3240_017_0	8	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	017	0	1	02	01	H3240_017_0	8	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	017	0	1	02	01	H3240_017_0	8	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	017	0	1	02	01	H3240_017_0	8	Non-Preferred Drug	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	017	0	1	02	01	H3240_017_0	8	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	017	0	1	02	01	H3240_017_0	8	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	021	0	1	01	01	H3240_021_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	021	0	1	01	01	H3240_021_0	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	021	0	1	01	01	H3240_021_0	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	021	0	1	01	01	H3240_021_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	021	0	1	01	01	H3240_021_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	021	0	1	01	01	H3240_021_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3240	021	0	1	01	01	H3240_021_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3251	002	0	1	01	01	H3251_002_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3251	002	0	1	01	01	H3251_002_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3251	002	0	1	01	01	H3251_002_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3251	002	0	1	01	01	H3251_002_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3251	002	0	1	01	01	H3251_002_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3251	002	0	1	01	01	H3251_002_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3251	002	0	1	01	01	H3251_002_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											537.93	25		25				557.42	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3251	021	0	1	02	01	H3251_021_0	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3251	021	0	1	02	01	H3251_021_0	10	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3251	021	0	1	02	01	H3251_021_0	10	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3251	021	0	1	02	01	H3251_021_0	10	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3251	021	0	1	02	01	H3251_021_0	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3251	021	0	1	02	01	H3251_021_0	10	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3251	021	0	1	02	01	H3251_021_0	10	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											426.30	25		25				451.55	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3262	001	0	1	01	01	H3262_001_0	5	Preferred Generic	4	01	1	2	1	1	110		10	100		1	31		90				1	2			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3262	001	0	1	01	01	H3262_001_0	5	Generic	4	01	1	1	2	1	110		10	100		1	31		90				1	2			90					10	31				12.79	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3262	001	0	1	01	01	H3262_001_0	5	Preferred Brand	4	10	1	1	3	1	110		10	100		1	31		90				1	2			90					10	31				142.62	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3262	001	0	1	01	01	H3262_001_0	5	Non-Preferred Brand	4	10	1	1	4	1	110		10	100		1	31		90				1	2			90					10	31				56.16	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3262	001	0	1	01	01	H3262_001_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	31								30							10	31				1.00	25																				25																		25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3305	015	0	1	02	01	H3305_015_0	8	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	015	0	1	02	01	H3305_015_0	8	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3305	015	0	1	02	01	H3305_015_0	8	Generic	4	01	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	015	0	1	02	01	H3305_015_0	8	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	015	0	1	02	01	H3305_015_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				82.03	36		36																								36		36				36		36			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	015	0	1	02	01	H3305_015_0	8	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				888.31	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	021	0	1	02	01	H3305_021_0	8	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	021	0	1	02	01	H3305_021_0	8	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3305	021	0	1	02	01	H3305_021_0	8	Generic	4	01	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	021	0	1	02	01	H3305_021_0	8	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	021	0	1	02	01	H3305_021_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				91.80	36		36																								36		36				36		36			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	021	0	1	02	01	H3305_021_0	8	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				843.00	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	022	0	1	02	01	H3305_022_0	7	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	022	0	1	02	01	H3305_022_0	7	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3305	022	0	1	02	01	H3305_022_0	7	Generic	4	01	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		30.00				15.00				15.00		0.50				0.50	0.50	0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	022	0	1	02	01	H3305_022_0	7	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.50				1.50	1.50	1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	022	0	1	02	01	H3305_022_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				91.00	36		36																								36		36				36		36			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	022	0	1	02	01	H3305_022_0	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				655.99	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	030	0	1	02	01	H3305_030_0	7	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		2.00				1.00				1.00		0.03				0.03	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	030	0	1	02	01	H3305_030_0	7	Generic	4	01	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		24.00				12.00				12.00		0.40				0.40	0.40	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	030	0	1	02	01	H3305_030_0	7	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	030	0	1	02	01	H3305_030_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				90.38	36		36																								36		36				36		36			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3305	030	0	1	02	01	H3305_030_0	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				818.32	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	002	0	1	01	01	H3307_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	002	0	1	01	01	H3307_002_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	002	0	1	01	01	H3307_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	002	0	1	01	01	H3307_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	002	0	1	01	01	H3307_002_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				757.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	012	0	1	01	01	H3307_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	012	0	1	01	01	H3307_012_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	012	0	1	01	01	H3307_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	012	0	1	01	01	H3307_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	012	0	1	01	01	H3307_012_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				740.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	015	0	1	01	01	H3307_015_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	015	0	1	01	01	H3307_015_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	015	0	1	01	01	H3307_015_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	015	0	1	01	01	H3307_015_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	015	0	1	01	01	H3307_015_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				546.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	023	0	1	01	01	H3307_023_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	023	0	1	01	01	H3307_023_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	023	0	1	01	01	H3307_023_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	023	0	1	01	01	H3307_023_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	023	0	1	01	01	H3307_023_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				520.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	024	0	1	01	01	H3307_024_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	024	0	1	01	01	H3307_024_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	024	0	1	01	01	H3307_024_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	024	0	1	01	01	H3307_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	024	0	1	01	01	H3307_024_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				756.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	025	0	1	01	01	H3307_025_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	025	0	1	01	01	H3307_025_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	025	0	1	01	01	H3307_025_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	025	0	1	01	01	H3307_025_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3307	025	0	1	01	01	H3307_025_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				703.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	002	0	1	01	01	H3312_002_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	002	0	1	01	01	H3312_002_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3312	002	0	1	01	01	H3312_002_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	002	0	1	01	01	H3312_002_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3312	002	0	1	01	01	H3312_002_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	002	0	1	01	01	H3312_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	002	0	1	01	01	H3312_002_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	018	0	1	01	01	H3312_018_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	018	0	1	01	01	H3312_018_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3312	018	0	1	01	01	H3312_018_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	018	0	1	01	01	H3312_018_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3312	018	0	1	01	01	H3312_018_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	018	0	1	01	01	H3312_018_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	018	0	1	01	01	H3312_018_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	048	0	1	01	01	H3312_048_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	048	0	1	01	01	H3312_048_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3312	048	0	1	01	01	H3312_048_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	048	0	1	01	01	H3312_048_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3312	048	0	1	01	01	H3312_048_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	048	0	1	01	01	H3312_048_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	048	0	1	01	01	H3312_048_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	062	0	1	01	01	H3312_062_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	062	0	1	01	01	H3312_062_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3312	062	0	1	01	01	H3312_062_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	062	0	1	01	01	H3312_062_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3312	062	0	1	01	01	H3312_062_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	062	0	1	01	01	H3312_062_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	062	0	1	01	01	H3312_062_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	063	0	1	01	01	H3312_063_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	063	0	1	01	01	H3312_063_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3312	063	0	1	01	01	H3312_063_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	063	0	1	01	01	H3312_063_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3312	063	0	1	01	01	H3312_063_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	063	0	1	01	01	H3312_063_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3312	063	0	1	01	01	H3312_063_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	002	0	1	01	01	H3328_002_0	7	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	002	0	1	01	01	H3328_002_0	7	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	002	0	1	01	01	H3328_002_0	7	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	002	0	1	01	01	H3328_002_0	7	Non-Preferred Drug	3	11	1	2	4	1	110		01	100		1	30		90				1	1			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	002	0	1	01	01	H3328_002_0	7	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				1017.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	003	0	1	02	01	H3328_003_0	6	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	003	0	1	02	01	H3328_003_0	6	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	15.00		45.00																					30.00																15.00				15.00		0.50						0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	003	0	1	02	01	H3328_003_0	6	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	35.00		105.00																					70.00																35.00				35.00		1.17						1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	003	0	1	02	01	H3328_003_0	6	Non-Preferred Drug	3	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	003	0	1	02	01	H3328_003_0	6	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				1494.00	28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	016	0	1	01	01	H3328_016_0	7	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	1.00		3.00																					2.00																1.00				1.00		0.03						0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	016	0	1	01	01	H3328_016_0	7	Generic	2	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	016	0	1	01	01	H3328_016_0	7	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	016	0	1	01	01	H3328_016_0	7	Non-Preferred Drug	2	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	016	0	1	01	01	H3328_016_0	7	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		34				857.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	017	0	1	01	01	H3328_017_0	6	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	017	0	1	01	01	H3328_017_0	6	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	017	0	1	01	01	H3328_017_0	6	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	017	0	1	01	01	H3328_017_0	6	Non-Preferred Drug	3	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	017	0	1	01	01	H3328_017_0	6	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				1153.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	020	1	1	01	01	H3328_020_1	7	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	020	1	1	01	01	H3328_020_1	7	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	020	1	1	01	01	H3328_020_1	7	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	020	1	1	01	01	H3328_020_1	7	Non-Preferred Drug	3	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	020	1	1	01	01	H3328_020_1	7	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				1150.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	020	2	1	01	01	H3328_020_2	6	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	020	2	1	01	01	H3328_020_2	6	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	020	2	1	01	01	H3328_020_2	6	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	020	2	1	01	01	H3328_020_2	6	Non-Preferred Drug	3	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3328	020	2	1	01	01	H3328_020_2	6	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				1150.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	1	1	01	01	H3330_021_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								3.00	6.00	9.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	1	1	01	01	H3330_021_1	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	30.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	1	1	01	01	H3330_021_1	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	1	1	01	01	H3330_021_1	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	1	1	01	01	H3330_021_1	7	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											624.59	29	29	29				624.59	29	29	29				29	29	29															29			29								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	2	1	01	01	H3330_021_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								3.00	6.00	9.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	2	1	01	01	H3330_021_2	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	30.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	2	1	01	01	H3330_021_2	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	2	1	01	01	H3330_021_2	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	2	1	01	01	H3330_021_2	7	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											624.59	29	29	29				624.59	29	29	29				29	29	29															29			29								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	3	1	01	01	H3330_021_3	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								3.00	6.00	9.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	3	1	01	01	H3330_021_3	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	30.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	3	1	01	01	H3330_021_3	8	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	3	1	01	01	H3330_021_3	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	3	1	01	01	H3330_021_3	8	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											624.59	29	29	29				624.59	29	29	29				29	29	29															29			29								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	4	1	01	01	H3330_021_4	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								3.00	6.00	9.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	4	1	01	01	H3330_021_4	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	30.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	4	1	01	01	H3330_021_4	8	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	4	1	01	01	H3330_021_4	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	021	4	1	01	01	H3330_021_4	8	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											624.59	29	29	29				624.59	29	29	29				29	29	29															29			29								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	1	1	01	01	H3330_032_1	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	1	1	01	01	H3330_032_1	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	1	1	01	01	H3330_032_1	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	1	1	01	01	H3330_032_1	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	1	1	01	01	H3330_032_1	6	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											659.74	28	28	28				659.74	28	28	28				28	28	28															28			28								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	2	1	01	01	H3330_032_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	2	1	01	01	H3330_032_2	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	2	1	01	01	H3330_032_2	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	2	1	01	01	H3330_032_2	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	2	1	01	01	H3330_032_2	7	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											659.74	28	28	28				659.74	28	28	28				28	28	28															28			28								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	3	1	01	01	H3330_032_3	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	3	1	01	01	H3330_032_3	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	3	1	01	01	H3330_032_3	8	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	3	1	01	01	H3330_032_3	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	3	1	01	01	H3330_032_3	8	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											659.74	28	28	28				659.74	28	28	28				28	28	28															28			28								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	4	1	01	01	H3330_032_4	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	4	1	01	01	H3330_032_4	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	4	1	01	01	H3330_032_4	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	4	1	01	01	H3330_032_4	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	032	4	1	01	01	H3330_032_4	6	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											659.74	28	28	28				659.74	28	28	28				28	28	28															28			28								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	036	0	1	01	01	H3330_036_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	036	0	1	01	01	H3330_036_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	036	0	1	01	01	H3330_036_0	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	036	0	1	01	01	H3330_036_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	036	0	1	01	01	H3330_036_0	7	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											737.64	28	28	28				737.64	28	28	28				28	28	28															28			28								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	038	0	1	01	01	H3330_038_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								3.00	6.00	9.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	038	0	1	01	01	H3330_038_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	30.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	038	0	1	01	01	H3330_038_0	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	038	0	1	01	01	H3330_038_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3330	038	0	1	01	01	H3330_038_0	6	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											423.92	29	29	29				423.92	29	29	29				29	29	29															29			29								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	005	0	1	04	01	H3335_005_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	005	0	1	04	01	H3335_005_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	005	0	1	04	01	H3335_005_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	005	0	1	04	01	H3335_005_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	005	0	1	04	01	H3335_005_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	006	0	1	04	01	H3335_006_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	006	0	1	04	01	H3335_006_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	006	0	1	04	01	H3335_006_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	006	0	1	04	01	H3335_006_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	006	0	1	04	01	H3335_006_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	014	0	1	04	01	H3335_014_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	014	0	1	04	01	H3335_014_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	014	0	1	04	01	H3335_014_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	014	0	1	04	01	H3335_014_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	014	0	1	04	01	H3335_014_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	015	0	1	04	01	H3335_015_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	015	0	1	04	01	H3335_015_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	015	0	1	04	01	H3335_015_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	015	0	1	04	01	H3335_015_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	015	0	1	04	01	H3335_015_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	018	0	1	04	01	H3335_018_0	5	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	018	0	1	04	01	H3335_018_0	5	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					50.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	018	0	1	04	01	H3335_018_0	5	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	018	0	1	04	01	H3335_018_0	5	Non-Preferred Drug	3	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	018	0	1	04	01	H3335_018_0	5	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	038	0	1	04	01	H3335_038_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	038	0	1	04	01	H3335_038_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	038	0	1	04	01	H3335_038_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	038	0	1	04	01	H3335_038_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	038	0	1	04	01	H3335_038_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	051	0	1	04	01	H3335_051_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	051	0	1	04	01	H3335_051_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	051	0	1	04	01	H3335_051_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	051	0	1	04	01	H3335_051_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	051	0	1	04	01	H3335_051_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	053	0	1	04	01	H3335_053_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	053	0	1	04	01	H3335_053_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		35.00																					35.00																14.00				14.00		0.47						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	053	0	1	04	01	H3335_053_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	053	0	1	04	01	H3335_053_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	053	0	1	04	01	H3335_053_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	054	0	1	04	01	H3335_054_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	054	0	1	04	01	H3335_054_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		35.00																					35.00																14.00				14.00		0.47						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	054	0	1	04	01	H3335_054_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	054	0	1	04	01	H3335_054_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3335	054	0	1	04	01	H3335_054_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3342	019	0	1	04	01	H3342_019_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3342	019	0	1	04	01	H3342_019_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3342	019	0	1	04	01	H3342_019_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								43.00	86.00	129.00					38.00	76.00	114.00					38.00	114.00	114.00																43.00				43.00			1.43	1.27	1.27			1.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3342	019	0	1	04	01	H3342_019_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								93.00	186.00	279.00					88.00	176.00	264.00					88.00	264.00	264.00																93.00				93.00			3.10	2.93	2.93			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3342	019	0	1	04	01	H3342_019_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3342	019	0	1	04	01	H3342_019_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3342	019	0	1	04	01	H3342_019_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3344	005	0	1	04	01	H3344_005_0	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3344	005	0	1	04	01	H3344_005_0	9	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		34	20.00		50.00																					50.00																20.00				20.00		0.67						0.59	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3344	005	0	1	04	01	H3344_005_0	9	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3344	005	0	1	04	01	H3344_005_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				79.69	50		50																				50															50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3344	005	0	1	04	01	H3344_005_0	9	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				845.96	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	002	0	1	02	01	H3351_002_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	002	0	1	02	01	H3351_002_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	002	0	1	02	01	H3351_002_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	002	0	1	02	01	H3351_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	002	0	1	02	01	H3351_002_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	006	0	1	02	01	H3351_006_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	006	0	1	02	01	H3351_006_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					30.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	006	0	1	02	01	H3351_006_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	006	0	1	02	01	H3351_006_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	006	0	1	02	01	H3351_006_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	010	0	1	01	01	H3351_010_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	010	0	1	01	01	H3351_010_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	010	0	1	01	01	H3351_010_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	010	0	1	01	01	H3351_010_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	010	0	1	01	01	H3351_010_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	011	0	1	01	01	H3351_011_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	011	0	1	01	01	H3351_011_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	011	0	1	01	01	H3351_011_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	011	0	1	01	01	H3351_011_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	011	0	1	01	01	H3351_011_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	28		28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	012	0	1	02	01	H3351_012_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	012	0	1	02	01	H3351_012_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	012	0	1	02	01	H3351_012_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	012	0	1	02	01	H3351_012_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	012	0	1	02	01	H3351_012_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	013	0	1	01	01	H3351_013_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	013	0	1	01	01	H3351_013_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	013	0	1	01	01	H3351_013_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	013	0	1	01	01	H3351_013_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	013	0	1	01	01	H3351_013_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	015	0	1	02	01	H3351_015_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	015	0	1	02	01	H3351_015_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	015	0	1	02	01	H3351_015_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	015	0	1	02	01	H3351_015_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	015	0	1	02	01	H3351_015_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	016	0	1	02	01	H3351_016_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	016	0	1	02	01	H3351_016_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	016	0	1	02	01	H3351_016_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	016	0	1	02	01	H3351_016_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	016	0	1	02	01	H3351_016_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	017	0	1	01	01	H3351_017_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	017	0	1	01	01	H3351_017_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		35.00																					35.00																14.00				14.00		0.47						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	017	0	1	01	01	H3351_017_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	017	0	1	01	01	H3351_017_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3351	017	0	1	01	01	H3351_017_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3359	001	0	1	01	01	H3359_001_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3359	001	0	1	01	01	H3359_001_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3359	001	0	1	01	01	H3359_001_0	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3359	001	0	1	01	01	H3359_001_0	5	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	238.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3359	001	0	1	01	01	H3359_001_0	5	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3359	036	0	1	01	01	H3359_036_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3359	036	0	1	01	01	H3359_036_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3359	036	0	1	01	01	H3359_036_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3359	036	0	1	01	01	H3359_036_0	7	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	238.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3359	036	0	1	01	01	H3359_036_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	043	0	1	01	01	H3361_043_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	043	0	1	01	01	H3361_043_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	043	0	1	01	01	H3361_043_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	043	0	1	01	01	H3361_043_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				89.38	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	043	0	1	01	01	H3361_043_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				458.33	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	065	0	1	01	01	H3361_065_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	065	0	1	01	01	H3361_065_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	065	0	1	01	01	H3361_065_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	065	0	1	01	01	H3361_065_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.76	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	065	0	1	01	01	H3361_065_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				428.53	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	109	0	1	01	01	H3361_109_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	109	0	1	01	01	H3361_109_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	109	0	1	01	01	H3361_109_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	109	0	1	01	01	H3361_109_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				99.59	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	109	0	1	01	01	H3361_109_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				440.98	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	130	0	1	01	01	H3361_130_0	3	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	130	0	1	01	01	H3361_130_0	3	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		42.50				17.00				17.00		0.57				0.57	0.57	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	130	0	1	01	01	H3361_130_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	130	0	1	01	01	H3361_130_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.83	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	130	0	1	01	01	H3361_130_0	3	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				511.53	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	132	0	1	01	01	H3361_132_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	132	0	1	01	01	H3361_132_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	132	0	1	01	01	H3361_132_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	132	0	1	01	01	H3361_132_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				74.78	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	132	0	1	01	01	H3361_132_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				580.60	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	133	0	1	01	01	H3361_133_0	2	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	133	0	1	01	01	H3361_133_0	2	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	133	0	1	01	01	H3361_133_0	2	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	133	0	1	01	01	H3361_133_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.41	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	133	0	1	01	01	H3361_133_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				667.31	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	134	0	1	01	01	H3361_134_0	2	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	134	0	1	01	01	H3361_134_0	2	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	134	0	1	01	01	H3361_134_0	2	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	134	0	1	01	01	H3361_134_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				68.17	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	134	0	1	01	01	H3361_134_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				608.22	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	135	0	1	02	01	H3361_135_0	2	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	135	0	1	02	01	H3361_135_0	2	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	135	0	1	02	01	H3361_135_0	2	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	135	0	1	02	01	H3361_135_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				72.28	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	135	0	1	02	01	H3361_135_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				782.47	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	136	1	1	01	01	H3361_136_1	2	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	136	1	1	01	01	H3361_136_1	2	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	136	1	1	01	01	H3361_136_1	2	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	136	1	1	01	01	H3361_136_1	2	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				66.39	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	136	1	1	01	01	H3361_136_1	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				609.66	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	136	2	1	01	01	H3361_136_2	2	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	136	2	1	01	01	H3361_136_2	2	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	136	2	1	01	01	H3361_136_2	2	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	136	2	1	01	01	H3361_136_2	2	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				66.39	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	136	2	1	01	01	H3361_136_2	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				609.66	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	137	1	1	02	01	H3361_137_1	2	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	137	1	1	02	01	H3361_137_1	2	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	137	1	1	02	01	H3361_137_1	2	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	137	1	1	02	01	H3361_137_1	2	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				68.14	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	137	1	1	02	01	H3361_137_1	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				757.16	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	137	2	1	02	01	H3361_137_2	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	137	2	1	02	01	H3361_137_2	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	137	2	1	02	01	H3361_137_2	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	137	2	1	02	01	H3361_137_2	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				68.14	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	137	2	1	02	01	H3361_137_2	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				757.16	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	138	0	1	01	01	H3361_138_0	2	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	138	0	1	01	01	H3361_138_0	2	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	138	0	1	01	01	H3361_138_0	2	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	138	0	1	01	01	H3361_138_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				68.17	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3361	138	0	1	01	01	H3361_138_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				608.20	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	017	0	1	01	01	H3362_017_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	017	0	1	01	01	H3362_017_0	12	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		34	10.00		25.00																					25.00																10.00				10.00		0.33						0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	017	0	1	01	01	H3362_017_0	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	017	0	1	01	01	H3362_017_0	12	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				73.76	50		50																				50															50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	017	0	1	01	01	H3362_017_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				843.73	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	020	0	1	01	01	H3362_020_0	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		34	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	020	0	1	01	01	H3362_020_0	9	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		34	15.00		37.50																					37.50																15.00				15.00		0.50						0.44	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	020	0	1	01	01	H3362_020_0	9	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		34				53.47	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	020	0	1	01	01	H3362_020_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				22.00	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	020	0	1	01	01	H3362_020_0	9	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				447.84	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	033	0	1	01	01	H3362_033_0	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	033	0	1	01	01	H3362_033_0	9	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		34	20.00		50.00																					50.00																20.00				20.00		0.67						0.59	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	033	0	1	01	01	H3362_033_0	9	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	033	0	1	01	01	H3362_033_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				75.06	50		50																				50															50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3362	033	0	1	01	01	H3362_033_0	9	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				798.77	29																																					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	001	0	1	01	01	H3379_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	001	0	1	01	01	H3379_001_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	001	0	1	01	01	H3379_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	001	0	1	01	01	H3379_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	001	0	1	01	01	H3379_001_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				740.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	039	0	1	01	01	H3379_039_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	039	0	1	01	01	H3379_039_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	039	0	1	01	01	H3379_039_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	039	0	1	01	01	H3379_039_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	039	0	1	01	01	H3379_039_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				652.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	040	0	1	01	01	H3379_040_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	040	0	1	01	01	H3379_040_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	040	0	1	01	01	H3379_040_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	040	0	1	01	01	H3379_040_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	040	0	1	01	01	H3379_040_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				652.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	041	0	1	01	01	H3379_041_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	041	0	1	01	01	H3379_041_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	041	0	1	01	01	H3379_041_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	041	0	1	01	01	H3379_041_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3379	041	0	1	01	01	H3379_041_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				652.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	013	0	1	01	01	H3384_013_0	4	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					4.00		12.00					4.00		10.00																9.00				9.00			0.30	0.13	0.13			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	013	0	1	01	01	H3384_013_0	4	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					4.00		12.00					4.00		10.00																9.00				9.00			0.30	0.13	0.13			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3384	013	0	1	01	01	H3384_013_0	4	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	013	0	1	01	01	H3384_013_0	4	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	013	0	1	01	01	H3384_013_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											89.88	50		50				89.88	50		50				50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	013	0	1	01	01	H3384_013_0	4	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	019	0	1	01	01	H3384_019_0	3	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					4.00		12.00					4.00		10.00																9.00				9.00			0.30	0.13	0.13			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	019	0	1	01	01	H3384_019_0	3	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					4.00		12.00					4.00		10.00																9.00				9.00			0.30	0.13	0.13			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3384	019	0	1	01	01	H3384_019_0	3	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	019	0	1	01	01	H3384_019_0	3	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	019	0	1	01	01	H3384_019_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	019	0	1	01	01	H3384_019_0	3	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	058	0	1	01	01	H3384_058_0	4	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		5.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	058	0	1	01	01	H3384_058_0	4	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	058	0	1	01	01	H3384_058_0	4	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	058	0	1	01	01	H3384_058_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	058	0	1	01	01	H3384_058_0	4	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												29		29					29		29				29		29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	059	0	1	02	01	H3384_059_0	3	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		24.00					3.00		9.00					3.00		7.50																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	059	0	1	02	01	H3384_059_0	3	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		24.00					3.00		9.00					3.00		7.50																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3384	059	0	1	02	01	H3384_059_0	3	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					15.00		45.00					15.00		37.50																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	059	0	1	02	01	H3384_059_0	3	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	059	0	1	02	01	H3384_059_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	059	0	1	02	01	H3384_059_0	3	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	062	0	1	01	01	H3384_062_0	3	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		5.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	062	0	1	01	01	H3384_062_0	3	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		51.00					12.00		36.00					12.00		30.00																17.00				17.00			0.57	0.40	0.40			0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	062	0	1	01	01	H3384_062_0	3	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	062	0	1	01	01	H3384_062_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								90.00		270.00					85.00		255.00					85.00		212.50																90.00				90.00			3.00	2.83	2.83			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	062	0	1	01	01	H3384_062_0	3	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												27		27					27		27				27		27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	063	0	1	01	01	H3384_063_0	3	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		5.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	063	0	1	01	01	H3384_063_0	3	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		51.00					12.00		36.00					12.00		30.00																17.00				17.00			0.57	0.40	0.40			0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	063	0	1	01	01	H3384_063_0	3	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	063	0	1	01	01	H3384_063_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								90.00		270.00					85.00		255.00					85.00		212.50																90.00				90.00			3.00	2.83	2.83			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3384	063	0	1	01	01	H3384_063_0	3	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												27		27					27		27				27		27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	002	0	1	01	01	H3388_002_0	9	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	002	0	1	01	01	H3388_002_0	9	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		22.00				11.00				11.00		0.37				0.37	0.37	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	002	0	1	01	01	H3388_002_0	9	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	002	0	1	01	01	H3388_002_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		225.00				90.00				90.00		3.00				3.00	3.00	2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	002	0	1	01	01	H3388_002_0	9	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				947.17	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	004	0	1	01	01	H3388_004_0	9	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	004	0	1	01	01	H3388_004_0	9	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		26.00				13.00				13.00		0.43				0.43	0.43	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	004	0	1	01	01	H3388_004_0	9	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		84.00				42.00				42.00		1.40				1.40	1.40	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	004	0	1	01	01	H3388_004_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	93.00		279.00																									93.00		279.00				93.00		232.50				93.00				93.00		3.10				3.10	3.10	3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	004	0	1	01	01	H3388_004_0	9	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				871.79	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	013	0	1	01	01	H3388_013_0	9	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		6.00				3.00				3.00		0.10				0.10	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	013	0	1	01	01	H3388_013_0	9	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		30.00				15.00				15.00		0.50				0.50	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	013	0	1	01	01	H3388_013_0	9	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.50				1.50	1.50	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	013	0	1	01	01	H3388_013_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		242.50				97.00				97.00		3.23				3.23	3.23	3.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	013	0	1	01	01	H3388_013_0	9	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				998.33	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	014	0	1	01	01	H3388_014_0	13	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		6.00				3.00				3.00		0.10				0.10	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	014	0	1	01	01	H3388_014_0	13	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		34.00				17.00				17.00		0.57				0.57	0.57	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	014	0	1	01	01	H3388_014_0	13	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	014	0	1	01	01	H3388_014_0	13	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3388	014	0	1	01	01	H3388_014_0	13	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				817.21	27																										27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3404	003	1	1	04	01	H3404_003_1	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	1	1	04	01	H3404_003_1	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	1	1	04	01	H3404_003_1	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	1	1	04	01	H3404_003_1	7	Non-Preferred Brand	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.20	50	50	50				63.20	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	1	1	04	01	H3404_003_1	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1056.48	33						1056.48	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	1	1	04	01	H3404_003_1	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	1	1	04	01	H3404_003_1	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3404	003	2	1	04	01	H3404_003_2	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	2	1	04	01	H3404_003_2	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	2	1	04	01	H3404_003_2	8	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	2	1	04	01	H3404_003_2	8	Non-Preferred Brand	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.20	50	50	50				63.20	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	2	1	04	01	H3404_003_2	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1056.48	33						1056.48	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	2	1	04	01	H3404_003_2	8	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3404	003	2	1	04	01	H3404_003_2	8	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3416	001	4	1	04	01	H3416_001_4	7	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	001	4	1	04	01	H3416_001_4	7	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		18.00				9.00				9.00		0.30				0.30	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	001	4	1	04	01	H3416_001_4	7	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	001	4	1	04	01	H3416_001_4	7	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	001	4	1	04	01	H3416_001_4	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	001	5	1	04	01	H3416_001_5	7	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	001	5	1	04	01	H3416_001_5	7	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		18.00				9.00				9.00		0.30				0.30	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	001	5	1	04	01	H3416_001_5	7	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	001	5	1	04	01	H3416_001_5	7	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	001	5	1	04	01	H3416_001_5	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	002	2	1	04	01	H3416_002_2	7	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	002	2	1	04	01	H3416_002_2	7	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3416	002	2	1	04	01	H3416_002_2	7	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		18.00				9.00				9.00		0.30				0.30	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	002	2	1	04	01	H3416_002_2	7	Generic	4	01	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		18.00				9.00				9.00		0.30				0.30	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3416	002	2	1	04	01	H3416_002_2	7	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	002	2	1	04	01	H3416_002_2	7	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	002	2	1	04	01	H3416_002_2	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	002	3	1	04	01	H3416_002_3	7	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	002	3	1	04	01	H3416_002_3	7	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3416	002	3	1	04	01	H3416_002_3	7	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		18.00				9.00				9.00		0.30				0.30	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	002	3	1	04	01	H3416_002_3	7	Generic	4	01	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		18.00				9.00				9.00		0.30				0.30	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3416	002	3	1	04	01	H3416_002_3	7	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	002	3	1	04	01	H3416_002_3	7	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3416	002	3	1	04	01	H3416_002_3	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3447	001	0	1	01	01	H3447_001_0	7	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	001	0	1	01	01	H3447_001_0	7	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3447	001	0	1	01	01	H3447_001_0	7	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	001	0	1	01	01	H3447_001_0	7	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3447	001	0	1	01	01	H3447_001_0	7	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	001	0	1	01	01	H3447_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	001	0	1	01	01	H3447_001_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	001	0	1	01	01	H3447_001_0	7	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	001	0	1	01	01	H3447_001_0	7	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H3447	003	0	1	01	01	H3447_003_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	003	0	1	01	01	H3447_003_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3447	003	0	1	01	01	H3447_003_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	003	0	1	01	01	H3447_003_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							19.00																14.50				14.50			0.48	0.32				0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3447	003	0	1	01	01	H3447_003_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	003	0	1	01	01	H3447_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	003	0	1	01	01	H3447_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	003	0	1	01	01	H3447_003_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	003	0	1	01	01	H3447_003_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H3447	004	0	1	01	01	H3447_004_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	004	0	1	01	01	H3447_004_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3447	004	0	1	01	01	H3447_004_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	004	0	1	01	01	H3447_004_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3447	004	0	1	01	01	H3447_004_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	004	0	1	01	01	H3447_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	004	0	1	01	01	H3447_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	004	0	1	01	01	H3447_004_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	004	0	1	01	01	H3447_004_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H3447	005	0	1	01	01	H3447_005_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		15.00							10.00																10.00				10.00			0.33	0.17				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	005	0	1	01	01	H3447_005_0	6	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								17.50		52.50					12.50		37.50							25.00																17.50				17.50			0.58	0.42				0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	005	0	1	01	01	H3447_005_0	6	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	005	0	1	01	01	H3447_005_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					90.00		270.00							180.00																95.00				95.00			3.17	3.00				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	005	0	1	01	01	H3447_005_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	005	0	1	01	01	H3447_005_0	6	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					10.00		30.00							20.00																10.00				10.00			0.33	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	010	0	1	01	01	H3447_010_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	010	0	1	01	01	H3447_010_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3447	010	0	1	01	01	H3447_010_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		0.25						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	010	0	1	01	01	H3447_010_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		0.25						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3447	010	0	1	01	01	H3447_010_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	010	0	1	01	01	H3447_010_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	010	0	1	01	01	H3447_010_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	010	0	1	01	01	H3447_010_0	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	010	0	1	01	01	H3447_010_0	5	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H3447	011	0	1	01	01	H3447_011_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								2.00	4.00	6.00					2.00	4.00	6.00					2.00	6.00	6.00																2.00				2.00			0.07	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	011	0	1	01	01	H3447_011_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								16.00	32.00	48.00					16.00	32.00	48.00					16.00	48.00	48.00																16.00				16.00			0.53	0.53	0.53			0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	011	0	1	01	01	H3447_011_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	011	0	1	01	01	H3447_011_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	011	0	1	01	01	H3447_011_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	011	0	1	01	01	H3447_011_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	011	0	1	01	01	H3447_011_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3447	012	0	1	01	01	H3447_012_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								2.00	4.00	6.00					2.00	4.00	6.00					2.00	6.00	6.00																2.00				2.00			0.07	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	012	0	1	01	01	H3447_012_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					18.00	36.00	54.00					18.00	54.00	54.00																18.00				18.00			0.60	0.60	0.60			0.53		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	012	0	1	01	01	H3447_012_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	012	0	1	01	01	H3447_012_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	012	0	1	01	01	H3447_012_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	012	0	1	01	01	H3447_012_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	012	0	1	01	01	H3447_012_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3447	013	0	1	01	01	H3447_013_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	013	0	1	01	01	H3447_013_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	013	0	1	01	01	H3447_013_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	013	0	1	01	01	H3447_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	013	0	1	01	01	H3447_013_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	013	0	1	01	01	H3447_013_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	014	0	1	01	01	H3447_014_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	014	0	1	01	01	H3447_014_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	014	0	1	01	01	H3447_014_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	014	0	1	01	01	H3447_014_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	014	0	1	01	01	H3447_014_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3447	014	0	1	01	01	H3447_014_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3449	005	0	1	01	01	H3449_005_0	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	005	0	1	01	01	H3449_005_0	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	005	0	1	01	01	H3449_005_0	8	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	005	0	1	01	01	H3449_005_0	8	Non-Preferred Brand	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											61.80	50	50	50				61.80	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	005	0	1	01	01	H3449_005_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1046.30	33						1046.30	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	005	0	1	01	01	H3449_005_0	8	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	005	0	1	01	01	H3449_005_0	8	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3449	023	1	1	01	01	H3449_023_1	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	1	1	01	01	H3449_023_1	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	1	1	01	01	H3449_023_1	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	1	1	01	01	H3449_023_1	7	Non-Preferred Brand	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.52	50	50	50				82.52	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	1	1	01	01	H3449_023_1	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											668.94	25						668.94	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	1	1	01	01	H3449_023_1	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	1	1	01	01	H3449_023_1	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3449	023	2	1	01	01	H3449_023_2	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	2	1	01	01	H3449_023_2	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	2	1	01	01	H3449_023_2	8	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	2	1	01	01	H3449_023_2	8	Non-Preferred Brand	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.52	50	50	50				82.52	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	2	1	01	01	H3449_023_2	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											668.94	25						668.94	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	2	1	01	01	H3449_023_2	8	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3449	023	2	1	01	01	H3449_023_2	8	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3464	001	0	1	01	01	H3464_001_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	001	0	1	01	01	H3464_001_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	001	0	1	01	01	H3464_001_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	001	0	1	01	01	H3464_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	001	0	1	01	01	H3464_001_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				723.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	002	0	1	01	01	H3464_002_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	002	0	1	01	01	H3464_002_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	002	0	1	01	01	H3464_002_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	002	0	1	01	01	H3464_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	002	0	1	01	01	H3464_002_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	003	0	1	01	01	H3464_003_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	003	0	1	01	01	H3464_003_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	003	0	1	01	01	H3464_003_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	003	0	1	01	01	H3464_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	003	0	1	01	01	H3464_003_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				716.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	004	0	1	01	01	H3464_004_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	004	0	1	01	01	H3464_004_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	004	0	1	01	01	H3464_004_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	004	0	1	01	01	H3464_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	004	0	1	01	01	H3464_004_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	005	0	1	01	01	H3464_005_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	005	0	1	01	01	H3464_005_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	005	0	1	01	01	H3464_005_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	005	0	1	01	01	H3464_005_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	005	0	1	01	01	H3464_005_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				716.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	006	0	1	01	01	H3464_006_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	006	0	1	01	01	H3464_006_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	006	0	1	01	01	H3464_006_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	006	0	1	01	01	H3464_006_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3464	006	0	1	01	01	H3464_006_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	001	0	1	01	01	H3471_001_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	001	0	1	01	01	H3471_001_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	001	0	1	01	01	H3471_001_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	001	0	1	01	01	H3471_001_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											53.45	50	50	50				53.45	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	001	0	1	01	01	H3471_001_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											1057.50	33	33	33				1057.50	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	002	0	1	01	01	H3471_002_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	002	0	1	01	01	H3471_002_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	002	0	1	01	01	H3471_002_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	002	0	1	01	01	H3471_002_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											47.49	50	50	50				47.49	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	002	0	1	01	01	H3471_002_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											532.00	33	33	33				532.00	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	004	0	1	01	01	H3471_004_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	004	0	1	01	01	H3471_004_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	004	0	1	01	01	H3471_004_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	004	0	1	01	01	H3471_004_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											69.01	50	50	50				69.01	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	004	0	1	01	01	H3471_004_0	5	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											1023.41	33	33	33				1023.41	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	005	0	1	01	01	H3471_005_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	005	0	1	01	01	H3471_005_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	005	0	1	01	01	H3471_005_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	005	0	1	01	01	H3471_005_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											72.30	50	50	50				72.30	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	005	0	1	01	01	H3471_005_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											1555.48	33	33	33				1555.48	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	007	0	1	01	01	H3471_007_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	007	0	1	01	01	H3471_007_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	007	0	1	01	01	H3471_007_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	007	0	1	01	01	H3471_007_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											56.84	50	50	50				56.84	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	007	0	1	01	01	H3471_007_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											965.94	33	33	33				965.94	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	008	0	1	01	01	H3471_008_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	008	0	1	01	01	H3471_008_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	008	0	1	01	01	H3471_008_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	008	0	1	01	01	H3471_008_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											49.95	50	50	50				49.95	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	008	0	1	01	01	H3471_008_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											922.53	33	33	33				922.53	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	010	0	1	01	01	H3471_010_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	010	0	1	01	01	H3471_010_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	010	0	1	01	01	H3471_010_0	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	010	0	1	01	01	H3471_010_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.32	50	50	50				62.32	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	010	0	1	01	01	H3471_010_0	4	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											876.47	33	33	33				876.47	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	012	0	1	01	01	H3471_012_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	012	0	1	01	01	H3471_012_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	012	0	1	01	01	H3471_012_0	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	012	0	1	01	01	H3471_012_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											67.26	50	50	50				67.26	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	012	0	1	01	01	H3471_012_0	4	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											953.40	33	33	33				953.40	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	013	0	1	02	01	H3471_013_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	013	0	1	02	01	H3471_013_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	013	0	1	02	01	H3471_013_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	013	0	1	02	01	H3471_013_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.93	50	50	50				62.93	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	013	0	1	02	01	H3471_013_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											1016.53	33	33	33				1016.53	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	014	0	1	02	01	H3471_014_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	014	0	1	02	01	H3471_014_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	014	0	1	02	01	H3471_014_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	014	0	1	02	01	H3471_014_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											40.51	50	50	50				40.51	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3471	014	0	1	02	01	H3471_014_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											1021.32	33	33	33				1021.32	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3499	001	0	1	01	01	H3499_001_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	001	0	1	01	01	H3499_001_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	001	0	1	01	01	H3499_001_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	001	0	1	01	01	H3499_001_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	001	0	1	01	01	H3499_001_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	001	0	1	01	01	H3499_001_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	002	0	1	01	01	H3499_002_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	002	0	1	01	01	H3499_002_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	002	0	1	01	01	H3499_002_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	002	0	1	01	01	H3499_002_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	002	0	1	01	01	H3499_002_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	002	0	1	01	01	H3499_002_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	003	0	1	01	01	H3499_003_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	003	0	1	01	01	H3499_003_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	003	0	1	01	01	H3499_003_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	003	0	1	01	01	H3499_003_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	003	0	1	01	01	H3499_003_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3499	003	0	1	01	01	H3499_003_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3528	006	0	1	02	01	H3528_006_0	10	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	006	0	1	02	01	H3528_006_0	10	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3528	006	0	1	02	01	H3528_006_0	10	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	006	0	1	02	01	H3528_006_0	10	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3528	006	0	1	02	01	H3528_006_0	10	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	006	0	1	02	01	H3528_006_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	238.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	006	0	1	02	01	H3528_006_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	010	0	1	01	01	H3528_010_0	10	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	010	0	1	01	01	H3528_010_0	10	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	010	0	1	01	01	H3528_010_0	10	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	010	0	1	01	01	H3528_010_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	238.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	010	0	1	01	01	H3528_010_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	011	1	1	02	01	H3528_011_1	11	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	011	1	1	02	01	H3528_011_1	11	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	011	1	1	02	01	H3528_011_1	11	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	011	1	1	02	01	H3528_011_1	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	238.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	011	1	1	02	01	H3528_011_1	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	011	2	1	02	01	H3528_011_2	11	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	011	2	1	02	01	H3528_011_2	11	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	011	2	1	02	01	H3528_011_2	11	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	011	2	1	02	01	H3528_011_2	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	238.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	011	2	1	02	01	H3528_011_2	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	012	1	1	02	01	H3528_012_1	11	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	012	1	1	02	01	H3528_012_1	11	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	012	1	1	02	01	H3528_012_1	11	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	012	1	1	02	01	H3528_012_1	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	238.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	012	1	1	02	01	H3528_012_1	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	012	2	1	02	01	H3528_012_2	11	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	012	2	1	02	01	H3528_012_2	11	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	012	2	1	02	01	H3528_012_2	11	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	012	2	1	02	01	H3528_012_2	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	238.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	012	2	1	02	01	H3528_012_2	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	013	1	1	01	01	H3528_013_1	12	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	013	1	1	01	01	H3528_013_1	12	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3528	013	1	1	01	01	H3528_013_1	12	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	013	1	1	01	01	H3528_013_1	12	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3528	013	1	1	01	01	H3528_013_1	12	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	013	1	1	01	01	H3528_013_1	12	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	238.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	013	1	1	01	01	H3528_013_1	12	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	013	2	1	01	01	H3528_013_2	12	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	013	2	1	01	01	H3528_013_2	12	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3528	013	2	1	01	01	H3528_013_2	12	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	013	2	1	01	01	H3528_013_2	12	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3528	013	2	1	01	01	H3528_013_2	12	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	013	2	1	01	01	H3528_013_2	12	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	238.00																100.00				100.00			3.33	3.17	3.17			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3528	013	2	1	01	01	H3528_013_2	12	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	001	0	1	01	01	H3533_001_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	001	0	1	01	01	H3533_001_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	001	0	1	01	01	H3533_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	001	0	1	01	01	H3533_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	001	0	1	01	01	H3533_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	002	0	1	01	01	H3533_002_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	002	0	1	01	01	H3533_002_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	002	0	1	01	01	H3533_002_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	002	0	1	01	01	H3533_002_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	002	0	1	01	01	H3533_002_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	004	0	1	01	01	H3533_004_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	004	0	1	01	01	H3533_004_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	004	0	1	01	01	H3533_004_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	004	0	1	01	01	H3533_004_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	004	0	1	01	01	H3533_004_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	006	0	1	01	01	H3533_006_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	006	0	1	01	01	H3533_006_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	006	0	1	01	01	H3533_006_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	006	0	1	01	01	H3533_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	006	0	1	01	01	H3533_006_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	010	0	1	01	01	H3533_010_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	010	0	1	01	01	H3533_010_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	010	0	1	01	01	H3533_010_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	010	0	1	01	01	H3533_010_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	010	0	1	01	01	H3533_010_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	013	0	1	01	01	H3533_013_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	013	0	1	01	01	H3533_013_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	013	0	1	01	01	H3533_013_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	013	0	1	01	01	H3533_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	013	0	1	01	01	H3533_013_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	020	0	1	01	01	H3533_020_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	020	0	1	01	01	H3533_020_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	020	0	1	01	01	H3533_020_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	020	0	1	01	01	H3533_020_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	020	0	1	01	01	H3533_020_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	021	0	1	01	01	H3533_021_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	021	0	1	01	01	H3533_021_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	021	0	1	01	01	H3533_021_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	021	0	1	01	01	H3533_021_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	021	0	1	01	01	H3533_021_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	023	0	1	01	01	H3533_023_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	023	0	1	01	01	H3533_023_0	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	023	0	1	01	01	H3533_023_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	023	0	1	01	01	H3533_023_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	023	0	1	01	01	H3533_023_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	027	0	1	01	01	H3533_027_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	027	0	1	01	01	H3533_027_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	027	0	1	01	01	H3533_027_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	027	0	1	01	01	H3533_027_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3533	027	0	1	01	01	H3533_027_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3536	002	0	1	01	01	H3536_002_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	002	0	1	01	01	H3536_002_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	002	0	1	01	01	H3536_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	002	0	1	01	01	H3536_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	002	0	1	01	01	H3536_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	002	0	1	01	01	H3536_002_0	6	Select Care Drugs	4	10	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	002	0	1	01	01	H3536_002_0	6	Select Care Drugs	4	10	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3536	003	0	1	01	01	H3536_003_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	003	0	1	01	01	H3536_003_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	003	0	1	01	01	H3536_003_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	003	0	1	01	01	H3536_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	003	0	1	01	01	H3536_003_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	003	0	1	01	01	H3536_003_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	003	0	1	01	01	H3536_003_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3536	004	0	1	01	01	H3536_004_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	004	0	1	01	01	H3536_004_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					17.00	34.00	51.00					17.00	51.00	51.00																17.00				17.00			0.57	0.57	0.57			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	004	0	1	01	01	H3536_004_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	004	0	1	01	01	H3536_004_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	004	0	1	01	01	H3536_004_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	004	0	1	01	01	H3536_004_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3536	004	0	1	01	01	H3536_004_0	8	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3561	001	0	1	01	01	H3561_001_0	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	001	0	1	01	01	H3561_001_0	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	001	0	1	01	01	H3561_001_0	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	001	0	1	01	01	H3561_001_0	4	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	001	0	1	01	01	H3561_001_0	4	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					28	28	28																		28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	001	0	1	01	01	H3561_001_0	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	002	0	1	01	01	H3561_002_0	3	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	002	0	1	01	01	H3561_002_0	3	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	002	0	1	01	01	H3561_002_0	3	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	002	0	1	01	01	H3561_002_0	3	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	002	0	1	01	01	H3561_002_0	3	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					31	31	31																		31	31	31															31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	002	0	1	01	01	H3561_002_0	3	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	004	0	1	01	01	H3561_004_0	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	004	0	1	01	01	H3561_004_0	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	004	0	1	01	01	H3561_004_0	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	004	0	1	01	01	H3561_004_0	4	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	004	0	1	01	01	H3561_004_0	4	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					30	30	30																		30	30	30															30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3561	004	0	1	01	01	H3561_004_0	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3572	001	0	1	01	01	H3572_001_0	4	Generic	2	01	1	1	1	1	110		10			1	30		90				1	2								29	34				8.84	25		25																																				25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3572	001	0	1	01	01	H3572_001_0	4	Preferred Brand	2	11	1	1	2	1	110		10			1	30		90				1	2								29	34				70.78	25		25																																				25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3572	001	0	1	01	01	H3572_001_0	4	Non-Preferred Brand	2	10	1	1	3	1	010		10			1	30															29	34				90.54	25																																						25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3572	001	0	1	01	01	H3572_001_0	4	Specialty Tier	2	10	1	1	4	1	010		10			1	30															29	34				348.23	25																																						25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3597	001	0	1	01	01	H3597_001_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	001	0	1	01	01	H3597_001_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3597	001	0	1	01	01	H3597_001_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	001	0	1	01	01	H3597_001_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3597	001	0	1	01	01	H3597_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	001	0	1	01	01	H3597_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	001	0	1	01	01	H3597_001_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	005	0	1	01	01	H3597_005_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	005	0	1	01	01	H3597_005_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3597	005	0	1	01	01	H3597_005_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	005	0	1	01	01	H3597_005_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3597	005	0	1	01	01	H3597_005_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	005	0	1	01	01	H3597_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	005	0	1	01	01	H3597_005_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	007	0	1	01	01	H3597_007_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	007	0	1	01	01	H3597_007_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3597	007	0	1	01	01	H3597_007_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	007	0	1	01	01	H3597_007_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3597	007	0	1	01	01	H3597_007_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	007	0	1	01	01	H3597_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	007	0	1	01	01	H3597_007_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	009	0	1	01	01	H3597_009_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	009	0	1	01	01	H3597_009_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3597	009	0	1	01	01	H3597_009_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	009	0	1	01	01	H3597_009_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3597	009	0	1	01	01	H3597_009_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	009	0	1	01	01	H3597_009_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3597	009	0	1	01	01	H3597_009_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3653	004	0	1	01	01	H3653_004_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.06			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3653	004	0	1	01	01	H3653_004_0	6	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3653	004	0	1	01	01	H3653_004_0	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3653	004	0	1	01	01	H3653_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3653	004	0	1	01	01	H3653_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				688.36	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3653	015	0	1	01	01	H3653_015_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3653	015	0	1	01	01	H3653_015_0	6	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3653	015	0	1	01	01	H3653_015_0	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3653	015	0	1	01	01	H3653_015_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3653	015	0	1	01	01	H3653_015_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				677.71	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3655	032	0	1	01	01	H3655_032_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	032	0	1	01	01	H3655_032_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	032	0	1	01	01	H3655_032_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	032	0	1	01	01	H3655_032_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	032	0	1	01	01	H3655_032_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	032	0	1	01	01	H3655_032_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	032	0	1	01	01	H3655_032_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3655	033	0	1	01	01	H3655_033_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	033	0	1	01	01	H3655_033_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	033	0	1	01	01	H3655_033_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	033	0	1	01	01	H3655_033_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	033	0	1	01	01	H3655_033_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	033	0	1	01	01	H3655_033_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	033	0	1	01	01	H3655_033_0	8	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3655	034	0	1	01	01	H3655_034_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	034	0	1	01	01	H3655_034_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	034	0	1	01	01	H3655_034_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	034	0	1	01	01	H3655_034_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	034	0	1	01	01	H3655_034_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	034	0	1	01	01	H3655_034_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	034	0	1	01	01	H3655_034_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3655	038	0	1	01	01	H3655_038_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	038	0	1	01	01	H3655_038_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	038	0	1	01	01	H3655_038_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	038	0	1	01	01	H3655_038_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	038	0	1	01	01	H3655_038_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	038	0	1	01	01	H3655_038_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3655	038	0	1	01	01	H3655_038_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3660	028	0	1	02	01	H3660_028_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	028	0	1	02	01	H3660_028_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	028	0	1	02	01	H3660_028_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	028	0	1	02	01	H3660_028_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	028	0	1	02	01	H3660_028_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	028	0	1	02	01	H3660_028_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	028	0	1	02	01	H3660_028_0	5	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	028	0	1	02	01	H3660_028_0	5	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	029	0	1	02	01	H3660_029_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	029	0	1	02	01	H3660_029_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	029	0	1	02	01	H3660_029_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	029	0	1	02	01	H3660_029_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	029	0	1	02	01	H3660_029_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	029	0	1	02	01	H3660_029_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	029	0	1	02	01	H3660_029_0	5	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	029	0	1	02	01	H3660_029_0	5	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	044	0	1	01	01	H3660_044_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	044	0	1	01	01	H3660_044_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	044	0	1	01	01	H3660_044_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	044	0	1	01	01	H3660_044_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	044	0	1	01	01	H3660_044_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	044	0	1	01	01	H3660_044_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	044	0	1	01	01	H3660_044_0	5	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	044	0	1	01	01	H3660_044_0	5	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	047	0	1	01	01	H3660_047_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	047	0	1	01	01	H3660_047_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	047	0	1	01	01	H3660_047_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	047	0	1	01	01	H3660_047_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	047	0	1	01	01	H3660_047_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	047	0	1	01	01	H3660_047_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	047	0	1	01	01	H3660_047_0	5	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	047	0	1	01	01	H3660_047_0	5	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	048	0	1	02	01	H3660_048_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	048	0	1	02	01	H3660_048_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	048	0	1	02	01	H3660_048_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	048	0	1	02	01	H3660_048_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	048	0	1	02	01	H3660_048_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	048	0	1	02	01	H3660_048_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	048	0	1	02	01	H3660_048_0	5	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	048	0	1	02	01	H3660_048_0	5	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	049	0	1	01	01	H3660_049_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	049	0	1	01	01	H3660_049_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	049	0	1	01	01	H3660_049_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	049	0	1	01	01	H3660_049_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	049	0	1	01	01	H3660_049_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	049	0	1	01	01	H3660_049_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	049	0	1	01	01	H3660_049_0	5	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	049	0	1	01	01	H3660_049_0	5	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	050	0	1	01	01	H3660_050_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	050	0	1	01	01	H3660_050_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3660	050	0	1	01	01	H3660_050_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	050	0	1	01	01	H3660_050_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	050	0	1	01	01	H3660_050_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	050	0	1	01	01	H3660_050_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	050	0	1	01	01	H3660_050_0	5	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H3660	050	0	1	01	01	H3660_050_0	5	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H3664	017	0	1	02	01	H3664_017_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	017	0	1	02	01	H3664_017_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	017	0	1	02	01	H3664_017_0	3	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	017	0	1	02	01	H3664_017_0	3	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	017	0	1	02	01	H3664_017_0	3	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				902.58	31	31	31																		31	31	31															31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	020	0	1	02	01	H3664_020_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	020	0	1	02	01	H3664_020_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	020	0	1	02	01	H3664_020_0	3	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	020	0	1	02	01	H3664_020_0	3	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	020	0	1	02	01	H3664_020_0	3	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1077.42	30	30	30																		30	30	30															30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	021	0	1	02	01	H3664_021_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	021	0	1	02	01	H3664_021_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	021	0	1	02	01	H3664_021_0	3	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	021	0	1	02	01	H3664_021_0	3	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3664	021	0	1	02	01	H3664_021_0	3	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1180.55	29	29	29																		29	29	29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3668	005	0	1	01	01	H3668_005_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	005	0	1	01	01	H3668_005_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3668	005	0	1	01	01	H3668_005_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	005	0	1	01	01	H3668_005_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	005	0	1	01	01	H3668_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	005	0	1	01	01	H3668_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	011	0	1	01	01	H3668_011_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	011	0	1	01	01	H3668_011_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3668	011	0	1	01	01	H3668_011_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	011	0	1	01	01	H3668_011_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	011	0	1	01	01	H3668_011_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	011	0	1	01	01	H3668_011_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	014	0	1	01	01	H3668_014_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	014	0	1	01	01	H3668_014_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3668	014	0	1	01	01	H3668_014_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	014	0	1	01	01	H3668_014_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	014	0	1	01	01	H3668_014_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	014	0	1	01	01	H3668_014_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	015	0	1	01	01	H3668_015_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	015	0	1	01	01	H3668_015_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3668	015	0	1	01	01	H3668_015_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	015	0	1	01	01	H3668_015_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	015	0	1	01	01	H3668_015_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	015	0	1	01	01	H3668_015_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	016	0	1	01	01	H3668_016_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	016	0	1	01	01	H3668_016_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3668	016	0	1	01	01	H3668_016_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	016	0	1	01	01	H3668_016_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	016	0	1	01	01	H3668_016_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	016	0	1	01	01	H3668_016_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	017	0	1	01	01	H3668_017_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	017	0	1	01	01	H3668_017_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3668	017	0	1	01	01	H3668_017_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	017	0	1	01	01	H3668_017_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	017	0	1	01	01	H3668_017_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3668	017	0	1	01	01	H3668_017_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	013	0	1	01	01	H3672_013_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	013	0	1	01	01	H3672_013_0	6	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	013	0	1	01	01	H3672_013_0	6	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	013	0	1	01	01	H3672_013_0	6	Non-Preferred Drug	4	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	013	0	1	01	01	H3672_013_0	6	Specialty Tier	4	10	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	018	0	1	01	01	H3672_018_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								15.00		45.00					5.00		15.00							0.00																15.00				15.00			0.50	0.17				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	018	0	1	01	01	H3672_018_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	018	0	1	01	01	H3672_018_0	5	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	018	0	1	01	01	H3672_018_0	5	Non-Preferred Drug	4	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	018	0	1	01	01	H3672_018_0	5	Specialty Tier	4	10	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	29						1000.00	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	020	0	1	01	01	H3672_020_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	020	0	1	01	01	H3672_020_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	020	0	1	01	01	H3672_020_0	5	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	020	0	1	01	01	H3672_020_0	5	Non-Preferred Drug	4	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	020	0	1	01	01	H3672_020_0	5	Specialty Tier	4	10	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	023	0	1	01	01	H3672_023_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	023	0	1	01	01	H3672_023_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	023	0	1	01	01	H3672_023_0	5	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	023	0	1	01	01	H3672_023_0	5	Non-Preferred Drug	4	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3672	023	0	1	01	01	H3672_023_0	5	Specialty Tier	4	10	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3706	001	0	1	01	01	H3706_001_0	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3706	001	0	1	01	01	H3706_001_0	6	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3706	001	0	1	01	01	H3706_001_0	6	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	1				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3706	001	0	1	01	01	H3706_001_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	1				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3706	001	0	1	01	01	H3706_001_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	1				30		90	30		31											59.23	50		50				46.34	40		40										50		50				30		30			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3706	001	0	1	01	01	H3706_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3706	018	0	1	01	01	H3706_018_0	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3706	018	0	1	01	01	H3706_018_0	6	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3706	018	0	1	01	01	H3706_018_0	6	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	1				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3706	018	0	1	01	01	H3706_018_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	1				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3706	018	0	1	01	01	H3706_018_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	1				30		90	30		31											61.75	50		50				47.75	40		40										50		50				30		30			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3706	018	0	1	01	01	H3706_018_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	001	0	1	01	01	H3749_001_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	001	0	1	01	01	H3749_001_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	001	0	1	01	01	H3749_001_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	001	0	1	01	01	H3749_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	001	0	1	01	01	H3749_001_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				762.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	017	0	1	01	01	H3749_017_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	017	0	1	01	01	H3749_017_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	017	0	1	01	01	H3749_017_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	017	0	1	01	01	H3749_017_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	017	0	1	01	01	H3749_017_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				718.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	018	0	1	01	01	H3749_018_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	018	0	1	01	01	H3749_018_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	018	0	1	01	01	H3749_018_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	018	0	1	01	01	H3749_018_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	018	0	1	01	01	H3749_018_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				600.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	020	0	1	01	01	H3749_020_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	020	0	1	01	01	H3749_020_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	020	0	1	01	01	H3749_020_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	020	0	1	01	01	H3749_020_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3749	020	0	1	01	01	H3749_020_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				686.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3755	001	0	1	01	01	H3755_001_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	001	0	1	01	01	H3755_001_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	001	0	1	01	01	H3755_001_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	001	0	1	01	01	H3755_001_0	7	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	001	0	1	01	01	H3755_001_0	7	Injectable Drugs	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				70.29	33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	001	0	1	01	01	H3755_001_0	7	Specialty Tier	4	11	1	1	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	004	0	1	01	01	H3755_004_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	004	0	1	01	01	H3755_004_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	004	0	1	01	01	H3755_004_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	004	0	1	01	01	H3755_004_0	7	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	004	0	1	01	01	H3755_004_0	7	Injectable Drugs	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				79.98	33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	004	0	1	01	01	H3755_004_0	7	Specialty Tier	4	11	1	1	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	005	0	1	01	01	H3755_005_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	005	0	1	01	01	H3755_005_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	13.00	26.00	39.00																			13.00	26.00	26.00																13.00				13.00		0.43			0.43			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	005	0	1	01	01	H3755_005_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	005	0	1	01	01	H3755_005_0	7	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	180.00																90.00				90.00		3.00			3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	005	0	1	01	01	H3755_005_0	7	Injectable Drugs	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.85	33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3755	005	0	1	01	01	H3755_005_0	7	Specialty Tier	4	11	1	1	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H3765	001	0	1	01	01	H3765_001_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	2.00	4.00	5.00																					5.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3765	001	0	1	01	01	H3765_001_0	4	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	12.00	24.00	30.00																					30.00																12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3765	001	0	1	01	01	H3765_001_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3765	001	0	1	01	01	H3765_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				54.98	50	50	50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3765	001	0	1	01	01	H3765_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	001	0	1	01	01	H3805_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	001	0	1	01	01	H3805_001_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	001	0	1	01	01	H3805_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	001	0	1	01	01	H3805_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	001	0	1	01	01	H3805_001_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				840.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	007	0	1	01	01	H3805_007_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	007	0	1	01	01	H3805_007_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	007	0	1	01	01	H3805_007_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	007	0	1	01	01	H3805_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	007	0	1	01	01	H3805_007_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				717.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	012	0	1	01	01	H3805_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	012	0	1	01	01	H3805_012_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	012	0	1	01	01	H3805_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	012	0	1	01	01	H3805_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	012	0	1	01	01	H3805_012_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				609.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	013	0	1	01	01	H3805_013_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	013	0	1	01	01	H3805_013_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	013	0	1	01	01	H3805_013_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	013	0	1	01	01	H3805_013_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	013	0	1	01	01	H3805_013_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				738.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	014	0	1	01	01	H3805_014_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	014	0	1	01	01	H3805_014_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	014	0	1	01	01	H3805_014_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	014	0	1	01	01	H3805_014_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	014	0	1	01	01	H3805_014_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				542.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	015	0	1	01	01	H3805_015_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	015	0	1	01	01	H3805_015_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	015	0	1	01	01	H3805_015_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	015	0	1	01	01	H3805_015_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	015	0	1	01	01	H3805_015_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				662.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	016	0	1	01	01	H3805_016_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	016	0	1	01	01	H3805_016_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	016	0	1	01	01	H3805_016_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	016	0	1	01	01	H3805_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	016	0	1	01	01	H3805_016_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				827.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	017	0	1	01	01	H3805_017_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	017	0	1	01	01	H3805_017_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	017	0	1	01	01	H3805_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	017	0	1	01	01	H3805_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	017	0	1	01	01	H3805_017_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				617.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	018	0	1	01	01	H3805_018_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	018	0	1	01	01	H3805_018_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	018	0	1	01	01	H3805_018_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	018	0	1	01	01	H3805_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	018	0	1	01	01	H3805_018_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				429.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	019	0	1	01	01	H3805_019_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	019	0	1	01	01	H3805_019_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	019	0	1	01	01	H3805_019_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	019	0	1	01	01	H3805_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	019	0	1	01	01	H3805_019_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				832.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	020	0	1	01	01	H3805_020_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	020	0	1	01	01	H3805_020_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	020	0	1	01	01	H3805_020_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	020	0	1	01	01	H3805_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	020	0	1	01	01	H3805_020_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				601.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	021	0	1	01	01	H3805_021_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	021	0	1	01	01	H3805_021_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	021	0	1	01	01	H3805_021_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	021	0	1	01	01	H3805_021_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3805	021	0	1	01	01	H3805_021_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				594.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3810	003	0	1	01	01	H3810_003_0	12	Preferred Generic	4	01	1	2	1	1	111		01		100	1	30	60	90				1	2						90	30		31	5.00	10.00	0.00																											15.00						0.00				5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3810	003	0	1	01	01	H3810_003_0	12	Preferred Generic	4	01	1	2	1	3	111		01		100	1	30	60	90				1	2						90	30		31	10.00	20.00	20.00																											30.00						20.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3810	003	0	1	01	01	H3810_003_0	12	Generic	4	01	1	2	2	1	111		01		100	1	30	60	90				1	2						90	30		31	15.00	30.00	30.00																											45.00						30.00				15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3810	003	0	1	01	01	H3810_003_0	12	Preferred Brand	4	10	1	2	3	1	111		01		100	1	30	60	90				1	2						90	30		31	45.00	90.00	90.00																											135.00						90.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3810	003	0	1	01	01	H3810_003_0	12	Non-Preferred Brand	4	10	1	2	4	1	111		01		100	1	30	60	90				1	2						90	30		31	95.00	190.00	190.00																											285.00						190.00				95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3810	003	0	1	01	01	H3810_003_0	12	Specialty Tier	4	11	1	1	5	1	111		01		100	1	30	60	90				1	2						90	30		31				0.00	25	25	25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3811	002	0	1	01	01	H3811_002_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.09						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3811	002	0	1	01	01	H3811_002_0	5	Generic	4	01	1	2	2	1	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3811	002	0	1	01	01	H3811_002_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	34	60	90				1	2			90				34		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.38						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3811	002	0	1	01	01	H3811_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	34	60	90				1	2			90				34		31				62.00	50	50	50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3811	002	0	1	01	01	H3811_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		31				563.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3811	009	0	1	01	01	H3811_009_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.09						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3811	009	0	1	01	01	H3811_009_0	5	Preferred Generic	4	01	1	2	1	3	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.09						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3811	009	0	1	01	01	H3811_009_0	5	Generic	4	01	1	2	2	1	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3811	009	0	1	01	01	H3811_009_0	5	Generic	4	01	1	2	2	3	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3811	009	0	1	01	01	H3811_009_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	34	60	90				1	2			90				34		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.38						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3811	009	0	1	01	01	H3811_009_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	34	60	90				1	2			90				34		31				62.00	50	50	50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3811	009	0	1	01	01	H3811_009_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		31				563.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3813	006	0	1	04	01	H3813_006_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	2.00	4.00	6.00																					6.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3813	006	0	1	04	01	H3813_006_0	9	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.65						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3813	006	0	1	04	01	H3813_006_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.45						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3813	006	0	1	04	01	H3813_006_0	9	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	31	62	93				1	2			93				31		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.23						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3813	006	0	1	04	01	H3813_006_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				300.00	30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3815	001	0	1	01	01	H3815_001_0	5	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								8.00	9.00	10.00					1.00	2.00	3.00					1.00	2.00	2.50																	8.00			1.00			0.27	0.03	0.03			0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	001	0	1	01	01	H3815_001_0	5	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								8.00	9.00	10.00					1.00	2.00	3.00					1.00	2.00	2.50																	8.00			1.00			0.27	0.03	0.03			0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3815	001	0	1	01	01	H3815_001_0	5	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	001	0	1	01	01	H3815_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37.00	67.00	97.00					30.00	60.00	90.00					30.00	60.00	75.00																	37.00			30.00			1.23	1.00	1.00			0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	001	0	1	01	01	H3815_001_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82.00	157.00	232.00					75.00	150.00	225.00					75.00	150.00	187.50																	82.00			75.00			2.73	2.50	2.50			2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	001	0	1	01	01	H3815_001_0	5	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	001	0	1	01	01	H3815_001_0	5	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	001	0	1	01	01	H3815_001_0	5	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3815	006	0	1	02	01	H3815_006_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	006	0	1	02	01	H3815_006_0	4	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17.00	27.00	37.00					10.00	20.00	30.00					10.00	20.00	25.00																	17.00			10.00			0.57	0.33	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	006	0	1	02	01	H3815_006_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	100.00																	47.00			40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	006	0	1	02	01	H3815_006_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	232.50																	100.00			93.00			3.33	3.10	3.10			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	006	0	1	02	01	H3815_006_0	4	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	006	0	1	02	01	H3815_006_0	4	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	006	0	1	02	01	H3815_006_0	4	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3815	007	0	1	01	01	H3815_007_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	007	0	1	01	01	H3815_007_0	4	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	007	0	1	01	01	H3815_007_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	100.00																	47.00			40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	007	0	1	01	01	H3815_007_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	232.50																	100.00			93.00			3.33	3.10	3.10			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	007	0	1	01	01	H3815_007_0	4	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	007	0	1	01	01	H3815_007_0	4	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	007	0	1	01	01	H3815_007_0	4	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3815	008	0	1	01	01	H3815_008_0	5	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	008	0	1	01	01	H3815_008_0	5	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3815	008	0	1	01	01	H3815_008_0	5	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	7.50																	10.00			3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	008	0	1	01	01	H3815_008_0	5	Generic	4	01	1	2	2	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	7.50																	10.00			3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3815	008	0	1	01	01	H3815_008_0	5	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37.00	67.00	97.00					30.00	60.00	90.00					30.00	60.00	75.00																	37.00			30.00			1.23	1.00	1.00			0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	008	0	1	01	01	H3815_008_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82.00	157.00	232.00					75.00	150.00	225.00					75.00	150.00	187.50																	82.00			75.00			2.73	2.50	2.50			2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	008	0	1	01	01	H3815_008_0	5	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	008	0	1	01	01	H3815_008_0	5	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	008	0	1	01	01	H3815_008_0	5	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3815	009	0	1	01	01	H3815_009_0	4	Preferred Generic	2	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	009	0	1	01	01	H3815_009_0	4	Generic	2	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17.00	27.00	37.00					10.00	20.00	30.00					10.00	20.00	25.00																	17.00			10.00			0.57	0.33	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	009	0	1	01	01	H3815_009_0	4	Preferred Brand	2	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	100.00																	47.00			40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	009	0	1	01	01	H3815_009_0	4	Non-Preferred Brand	2	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	232.50																	100.00			93.00			3.33	3.10	3.10			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	009	0	1	01	01	H3815_009_0	4	Specialty Tier	2	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	25						999.00	25						25																		25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	009	0	1	01	01	H3815_009_0	4	Select Care Drugs	2	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	010	0	1	01	01	H3815_010_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	010	0	1	01	01	H3815_010_0	4	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3815	010	0	1	01	01	H3815_010_0	4	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	010	0	1	01	01	H3815_010_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37.00	67.00	97.00					30.00	60.00	90.00					30.00	60.00	75.00																	37.00			30.00			1.23	1.00	1.00			0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	010	0	1	01	01	H3815_010_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82.00	157.00	232.00					75.00	150.00	225.00					75.00	150.00	187.50																	82.00			75.00			2.73	2.50	2.50			2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	010	0	1	01	01	H3815_010_0	4	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	010	0	1	01	01	H3815_010_0	4	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	010	0	1	01	01	H3815_010_0	4	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3815	011	0	1	01	01	H3815_011_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	011	0	1	01	01	H3815_011_0	4	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17.00	27.00	37.00					10.00	20.00	30.00					10.00	20.00	25.00																	17.00			10.00			0.57	0.33	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	011	0	1	01	01	H3815_011_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	100.00																	47.00			40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	011	0	1	01	01	H3815_011_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	232.50																	100.00			93.00			3.33	3.10	3.10			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	011	0	1	01	01	H3815_011_0	4	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	011	0	1	01	01	H3815_011_0	4	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	011	0	1	01	01	H3815_011_0	4	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3815	013	0	1	01	01	H3815_013_0	3	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	013	0	1	01	01	H3815_013_0	3	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3815	013	0	1	01	01	H3815_013_0	3	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17.00	27.00	37.00					10.00	20.00	30.00					10.00	20.00	25.00																	17.00			10.00			0.57	0.33	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	013	0	1	01	01	H3815_013_0	3	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37.00	67.00	97.00					30.00	60.00	90.00					30.00	60.00	75.00																	37.00			30.00			1.23	1.00	1.00			0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	013	0	1	01	01	H3815_013_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82.00	157.00	232.00					75.00	150.00	225.00					75.00	150.00	187.50																	82.00			75.00			2.73	2.50	2.50			2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	013	0	1	01	01	H3815_013_0	3	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											999.00	33						999.00	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	013	0	1	01	01	H3815_013_0	3	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H3815	013	0	1	01	01	H3815_013_0	3	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H3817	008	1	1	04	01	H3817_008_1	9	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	008	1	1	04	01	H3817_008_1	9	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	008	1	1	04	01	H3817_008_1	9	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	008	1	1	04	01	H3817_008_1	9	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	008	1	1	04	01	H3817_008_1	9	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1238.22	27						1238.22	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	008	1	1	04	01	H3817_008_1	9	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	008	2	1	04	01	H3817_008_2	9	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	008	2	1	04	01	H3817_008_2	9	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	008	2	1	04	01	H3817_008_2	9	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	008	2	1	04	01	H3817_008_2	9	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	008	2	1	04	01	H3817_008_2	9	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1238.22	27						1238.22	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	008	2	1	04	01	H3817_008_2	9	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	1	1	04	01	H3817_009_1	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					3.00	6.00	6.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	1	1	04	01	H3817_009_1	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	1	1	04	01	H3817_009_1	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	1	1	04	01	H3817_009_1	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	1	1	04	01	H3817_009_1	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1513.38	33						1513.38	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	1	1	04	01	H3817_009_1	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	2	1	04	01	H3817_009_2	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					3.00	6.00	6.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	2	1	04	01	H3817_009_2	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	2	1	04	01	H3817_009_2	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	2	1	04	01	H3817_009_2	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	2	1	04	01	H3817_009_2	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1513.38	33						1513.38	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3817	009	2	1	04	01	H3817_009_2	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3818	002	0	1	01	01	H3818_002_0	6	Preferred Generic	4	01	1	1	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31				0.00	0	0	0																		0	0	0																0		0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3818	002	0	1	01	01	H3818_002_0	6	Preferred Generic	4	01	1	1	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31				0.00	0	0	0																		0	0	0																0		0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3818	002	0	1	01	01	H3818_002_0	6	Generic	4	01	1	1	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31				4.49	25	25	25																		25	25	25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3818	002	0	1	01	01	H3818_002_0	6	Preferred Brand	4	11	1	1	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31				22.41	25	25	25																		25	25	25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3818	002	0	1	01	01	H3818_002_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31				49.04	25	25	25																		25	25	25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3818	002	0	1	01	01	H3818_002_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				444.74	25																				25																		25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3818	003	0	1	01	01	H3818_003_0	7	Preferred Generic	4	01	1	2	1	1	111		10		111	1	30	60	90				1	2				30	60	90		10	31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00					0.00			0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3818	003	0	1	01	01	H3818_003_0	7	Preferred Generic	4	01	1	2	1	3	111		10		111	1	30	60	90				1	2				30	60	90		10	31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00					0.00			0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3818	003	0	1	01	01	H3818_003_0	7	Generic	4	01	1	2	2	1	111		10		111	1	30	60	90				1	2				30	60	90		10	31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	20.00	20.00					20.00			20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3818	003	0	1	01	01	H3818_003_0	7	Preferred Brand	4	11	1	2	3	1	111		10		111	1	30	60	90				1	2				30	60	90		10	31	35.00	70.00	105.00																									35.00	70.00	105.00				35.00	35.00	35.00					35.00			35.00		1.17				1.17	1.17	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3818	003	0	1	01	01	H3818_003_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10		111	1	30	60	90				1	2				30	60	90		10	31	90.00	180.00	270.00																									90.00	180.00	270.00				90.00	90.00	90.00					90.00			90.00		3.00				3.00	3.00	2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3818	003	0	1	01	01	H3818_003_0	7	Specialty Tier	4	11	1	1	5	1	010		10		010	1	30											30				10	31					28																										28						28						28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3822	001	0	1	01	01	H3822_001_0	7	Preferred Generic	4	11	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	001	0	1	01	01	H3822_001_0	7	Preferred Generic	4	11	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	001	0	1	01	01	H3822_001_0	7	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	001	0	1	01	01	H3822_001_0	7	Generic	4	01	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	001	0	1	01	01	H3822_001_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	001	0	1	01	01	H3822_001_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	001	0	1	01	01	H3822_001_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											341.45	33		33				356.15	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	002	0	1	01	01	H3822_002_0	7	Preferred Generic	4	11	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	002	0	1	01	01	H3822_002_0	7	Preferred Generic	4	11	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	002	0	1	01	01	H3822_002_0	7	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	002	0	1	01	01	H3822_002_0	7	Generic	4	01	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	002	0	1	01	01	H3822_002_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	002	0	1	01	01	H3822_002_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	002	0	1	01	01	H3822_002_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											391.14	33		33				426.40	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	003	0	1	01	01	H3822_003_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	003	0	1	01	01	H3822_003_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	003	0	1	01	01	H3822_003_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	003	0	1	01	01	H3822_003_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	003	0	1	01	01	H3822_003_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	003	0	1	01	01	H3822_003_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	003	0	1	01	01	H3822_003_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											636.65	33		33				607.49	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	007	0	1	02	01	H3822_007_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	007	0	1	02	01	H3822_007_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	007	0	1	02	01	H3822_007_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	007	0	1	02	01	H3822_007_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	007	0	1	02	01	H3822_007_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	007	0	1	02	01	H3822_007_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	007	0	1	02	01	H3822_007_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											517.11	33		33				559.56	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	008	0	1	02	01	H3822_008_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	008	0	1	02	01	H3822_008_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	008	0	1	02	01	H3822_008_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	008	0	1	02	01	H3822_008_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	008	0	1	02	01	H3822_008_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	008	0	1	02	01	H3822_008_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	008	0	1	02	01	H3822_008_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											596.78	33		33				590.37	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	009	0	1	01	01	H3822_009_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	009	0	1	01	01	H3822_009_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	009	0	1	01	01	H3822_009_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	009	0	1	01	01	H3822_009_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	009	0	1	01	01	H3822_009_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	009	0	1	01	01	H3822_009_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	009	0	1	01	01	H3822_009_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											656.61	33		33				729.78	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	010	0	1	02	01	H3822_010_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	010	0	1	02	01	H3822_010_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	010	0	1	02	01	H3822_010_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	010	0	1	02	01	H3822_010_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3822	010	0	1	02	01	H3822_010_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	010	0	1	02	01	H3822_010_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3822	010	0	1	02	01	H3822_010_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											569.23	33		33				588.25	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3832	007	0	1	04	01	H3832_007_0	11	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	5.00	5.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	007	0	1	04	01	H3832_007_0	11	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	20.00	20.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	007	0	1	04	01	H3832_007_0	11	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			94.00	94.00	94.00																47.00				47.00		1.57			3.13			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	007	0	1	04	01	H3832_007_0	11	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			200.00	200.00	200.00																100.00				100.00		3.33			6.67			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	007	0	1	04	01	H3832_007_0	11	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	008	0	1	04	01	H3832_008_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	008	0	1	04	01	H3832_008_0	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3832	008	0	1	04	01	H3832_008_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	11.00	11.00																11.00				11.00		0.37			0.37			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	008	0	1	04	01	H3832_008_0	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			90.00	90.00	90.00																45.00				45.00		1.50			3.00			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	008	0	1	04	01	H3832_008_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			190.00	190.00	190.00																95.00				95.00		3.17			6.33			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	008	0	1	04	01	H3832_008_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	009	0	1	04	01	H3832_009_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.50	9.00	13.50																			4.50	4.50	4.50																4.50				4.50		0.15			0.15			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	009	0	1	04	01	H3832_009_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	12.00	12.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	009	0	1	04	01	H3832_009_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			94.00	94.00	94.00																47.00				47.00		1.57			3.13			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	009	0	1	04	01	H3832_009_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			200.00	200.00	200.00																100.00				100.00		3.33			6.67			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	009	0	1	04	01	H3832_009_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	010	0	1	04	01	H3832_010_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	010	0	1	04	01	H3832_010_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3832	010	0	1	04	01	H3832_010_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	11.00	11.00																11.00				11.00		0.37			0.37			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	010	0	1	04	01	H3832_010_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			90.00	90.00	90.00																45.00				45.00		1.50			3.00			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	010	0	1	04	01	H3832_010_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			190.00	190.00	190.00																95.00				95.00		3.17			6.33			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3832	010	0	1	04	01	H3832_010_0	6	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3864	006	0	1	01	01	H3864_006_0	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	006	0	1	01	01	H3864_006_0	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	006	0	1	01	01	H3864_006_0	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	006	0	1	01	01	H3864_006_0	8	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H3864	006	0	1	01	01	H3864_006_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.97	33	33	33				82.02	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	006	0	1	01	01	H3864_006_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	006	0	1	01	01	H3864_006_0	8	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	006	0	1	01	01	H3864_006_0	8	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3864	014	0	1	02	01	H3864_014_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	014	0	1	02	01	H3864_014_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	014	0	1	02	01	H3864_014_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	014	0	1	02	01	H3864_014_0	7	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H3864	014	0	1	02	01	H3864_014_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.18	33	33	33				80.37	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	014	0	1	02	01	H3864_014_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	014	0	1	02	01	H3864_014_0	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	014	0	1	02	01	H3864_014_0	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3864	021	0	1	01	01	H3864_021_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	021	0	1	01	01	H3864_021_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	021	0	1	01	01	H3864_021_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	021	0	1	01	01	H3864_021_0	7	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H3864	021	0	1	01	01	H3864_021_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.59	33	33	33				84.25	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	021	0	1	01	01	H3864_021_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	021	0	1	01	01	H3864_021_0	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	021	0	1	01	01	H3864_021_0	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3864	024	0	1	02	01	H3864_024_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	024	0	1	02	01	H3864_024_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	024	0	1	02	01	H3864_024_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	024	0	1	02	01	H3864_024_0	7	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H3864	024	0	1	02	01	H3864_024_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											93.22	33	33	33				84.95	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	024	0	1	02	01	H3864_024_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	024	0	1	02	01	H3864_024_0	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	024	0	1	02	01	H3864_024_0	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3864	026	1	1	01	01	H3864_026_1	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	1	1	01	01	H3864_026_1	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	1	1	01	01	H3864_026_1	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	1	1	01	01	H3864_026_1	7	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H3864	026	1	1	01	01	H3864_026_1	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.63	33	33	33				83.47	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	1	1	01	01	H3864_026_1	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	1	1	01	01	H3864_026_1	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	1	1	01	01	H3864_026_1	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3864	026	2	1	01	01	H3864_026_2	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	2	1	01	01	H3864_026_2	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	2	1	01	01	H3864_026_2	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	2	1	01	01	H3864_026_2	7	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H3864	026	2	1	01	01	H3864_026_2	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.63	33	33	33				83.47	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	2	1	01	01	H3864_026_2	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	2	1	01	01	H3864_026_2	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	026	2	1	01	01	H3864_026_2	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3864	027	0	1	01	01	H3864_027_0	6	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	027	0	1	01	01	H3864_027_0	6	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					11.00	22.00	33.00											16.00	32.00	48.00				11.00	22.00	33.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	027	0	1	01	01	H3864_027_0	6	Preferred Brand	3	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	027	0	1	01	01	H3864_027_0	6	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.95	33	33	33				89.49	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	027	0	1	01	01	H3864_027_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	027	0	1	01	01	H3864_027_0	6	Select Care Drugs	3	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	1	1	01	01	H3864_028_1	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	1	1	01	01	H3864_028_1	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	1	1	01	01	H3864_028_1	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	1	1	01	01	H3864_028_1	8	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H3864	028	1	1	01	01	H3864_028_1	8	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.23	33	33	33				78.62	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	1	1	01	01	H3864_028_1	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	1	1	01	01	H3864_028_1	8	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	1	1	01	01	H3864_028_1	8	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3864	028	2	1	01	01	H3864_028_2	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	2	1	01	01	H3864_028_2	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	2	1	01	01	H3864_028_2	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	2	1	01	01	H3864_028_2	8	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H3864	028	2	1	01	01	H3864_028_2	8	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.23	33	33	33				78.62	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	2	1	01	01	H3864_028_2	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	2	1	01	01	H3864_028_2	8	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	028	2	1	01	01	H3864_028_2	8	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3864	029	0	1	01	01	H3864_029_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	029	0	1	01	01	H3864_029_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	029	0	1	01	01	H3864_029_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	029	0	1	01	01	H3864_029_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.86	33	33	33				84.62	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	029	0	1	01	01	H3864_029_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	029	0	1	01	01	H3864_029_0	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	1	1	01	01	H3864_031_1	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	1	1	01	01	H3864_031_1	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	1	1	01	01	H3864_031_1	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	1	1	01	01	H3864_031_1	8	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H3864	031	1	1	01	01	H3864_031_1	8	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.38	33	33	33				86.92	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	1	1	01	01	H3864_031_1	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	1	1	01	01	H3864_031_1	8	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	1	1	01	01	H3864_031_1	8	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3864	031	2	1	01	01	H3864_031_2	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	2	1	01	01	H3864_031_2	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	2	1	01	01	H3864_031_2	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	2	1	01	01	H3864_031_2	8	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H3864	031	2	1	01	01	H3864_031_2	8	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.38	33	33	33				86.92	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	2	1	01	01	H3864_031_2	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	2	1	01	01	H3864_031_2	8	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	031	2	1	01	01	H3864_031_2	8	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3864	032	0	1	01	01	H3864_032_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	032	0	1	01	01	H3864_032_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	032	0	1	01	01	H3864_032_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	032	0	1	01	01	H3864_032_0	7	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H3864	032	0	1	01	01	H3864_032_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.96	33	33	33				82.98	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	032	0	1	01	01	H3864_032_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	032	0	1	01	01	H3864_032_0	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H3864	032	0	1	01	01	H3864_032_0	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H3890	001	0	1	04	01	H3890_001_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	10.50	14.00																			7.00	10.50	14.00																7.00				7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3890	001	0	1	04	01	H3890_001_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	22.50	30.00																			15.00	22.50	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3890	001	0	1	04	01	H3890_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	67.50	90.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3890	001	0	1	04	01	H3890_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	142.50	190.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3890	001	0	1	04	01	H3890_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3890	002	0	1	04	01	H3890_002_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	6.00	8.00																			4.00	6.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3890	002	0	1	04	01	H3890_002_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3890	002	0	1	04	01	H3890_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	63.00	84.00																42.00				42.00		1.40			1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3890	002	0	1	04	01	H3890_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	92.00	184.00	276.00																			92.00	138.00	184.00																92.00				92.00		3.07			3.07			2.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3890	002	0	1	04	01	H3890_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	006	0	1	01	01	H3907_006_0	3	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	006	0	1	01	01	H3907_006_0	3	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	006	0	1	01	01	H3907_006_0	3	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	006	0	1	01	01	H3907_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	006	0	1	01	01	H3907_006_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											906.26	33						238.26	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	029	0	1	01	01	H3907_029_0	4	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	029	0	1	01	01	H3907_029_0	4	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	029	0	1	01	01	H3907_029_0	4	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	029	0	1	01	01	H3907_029_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	029	0	1	01	01	H3907_029_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1044.88	33						312.49	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	037	0	1	01	01	H3907_037_0	3	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	037	0	1	01	01	H3907_037_0	3	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	037	0	1	01	01	H3907_037_0	3	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	037	0	1	01	01	H3907_037_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	037	0	1	01	01	H3907_037_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											981.05	33						320.12	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	039	0	1	01	01	H3907_039_0	7	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	039	0	1	01	01	H3907_039_0	7	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	039	0	1	01	01	H3907_039_0	7	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	039	0	1	01	01	H3907_039_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	039	0	1	01	01	H3907_039_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											952.74	33						330.59	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	040	0	1	01	01	H3907_040_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	040	0	1	01	01	H3907_040_0	6	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	040	0	1	01	01	H3907_040_0	6	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	040	0	1	01	01	H3907_040_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	040	0	1	01	01	H3907_040_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1044.86	33						312.47	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	042	0	1	01	01	H3907_042_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	042	0	1	01	01	H3907_042_0	6	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	042	0	1	01	01	H3907_042_0	6	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	042	0	1	01	01	H3907_042_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	042	0	1	01	01	H3907_042_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1044.86	33						312.47	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	043	0	1	01	01	H3907_043_0	7	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	043	0	1	01	01	H3907_043_0	7	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	043	0	1	01	01	H3907_043_0	7	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	043	0	1	01	01	H3907_043_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	043	0	1	01	01	H3907_043_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											981.02	33						320.13	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	044	0	1	01	01	H3907_044_0	7	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	044	0	1	01	01	H3907_044_0	7	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	044	0	1	01	01	H3907_044_0	7	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	044	0	1	01	01	H3907_044_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	044	0	1	01	01	H3907_044_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											981.02	33						320.13	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	045	0	1	01	01	H3907_045_0	9	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	045	0	1	01	01	H3907_045_0	9	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	045	0	1	01	01	H3907_045_0	9	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	045	0	1	01	01	H3907_045_0	9	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											55.60	50		50				37.97	45		45						45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	045	0	1	01	01	H3907_045_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											773.89	33						271.72	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	046	0	1	01	01	H3907_046_0	8	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	046	0	1	01	01	H3907_046_0	8	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	046	0	1	01	01	H3907_046_0	8	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	046	0	1	01	01	H3907_046_0	8	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											55.60	50		50				37.97	45		45						45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	046	0	1	01	01	H3907_046_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											773.89	33						271.72	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	047	0	1	01	01	H3907_047_0	7	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	047	0	1	01	01	H3907_047_0	7	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	047	0	1	01	01	H3907_047_0	7	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	047	0	1	01	01	H3907_047_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	047	0	1	01	01	H3907_047_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1044.86	33						312.47	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	048	0	1	01	01	H3907_048_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	048	0	1	01	01	H3907_048_0	6	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	048	0	1	01	01	H3907_048_0	6	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	048	0	1	01	01	H3907_048_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3907	048	0	1	01	01	H3907_048_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1044.86	33						312.47	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3909	001	0	1	04	01	H3909_001_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					3.00	6.00	9.00					3.00	6.00	6.00																9.00				9.00			0.30	0.10	0.10			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3909	001	0	1	04	01	H3909_001_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	36.00					12.00	24.00	24.00																18.00				18.00			0.60	0.40	0.40			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3909	001	0	1	04	01	H3909_001_0	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3909	001	0	1	04	01	H3909_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3909	001	0	1	04	01	H3909_001_0	4	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												25	25	25					25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3909	009	0	1	04	01	H3909_009_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					3.00	6.00	9.00					3.00	6.00	6.00																9.00				9.00			0.30	0.10	0.10			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3909	009	0	1	04	01	H3909_009_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	36.00					12.00	24.00	24.00																18.00				18.00			0.60	0.40	0.40			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3909	009	0	1	04	01	H3909_009_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3909	009	0	1	04	01	H3909_009_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3909	009	0	1	04	01	H3909_009_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												25	25	25					25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	001	0	1	04	01	H3916_001_0	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	001	0	1	04	01	H3916_001_0	10	Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3916	001	0	1	04	01	H3916_001_0	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	001	0	1	04	01	H3916_001_0	10	Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3916	001	0	1	04	01	H3916_001_0	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	001	0	1	04	01	H3916_001_0	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	001	0	1	04	01	H3916_001_0	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1571.21	33						1571.21	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	002	0	1	04	01	H3916_002_0	11	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	002	0	1	04	01	H3916_002_0	11	Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3916	002	0	1	04	01	H3916_002_0	11	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	002	0	1	04	01	H3916_002_0	11	Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3916	002	0	1	04	01	H3916_002_0	11	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	002	0	1	04	01	H3916_002_0	11	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	002	0	1	04	01	H3916_002_0	11	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1561.22	33						1561.22	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	005	0	1	04	01	H3916_005_0	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	005	0	1	04	01	H3916_005_0	10	Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3916	005	0	1	04	01	H3916_005_0	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	005	0	1	04	01	H3916_005_0	10	Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3916	005	0	1	04	01	H3916_005_0	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	005	0	1	04	01	H3916_005_0	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	005	0	1	04	01	H3916_005_0	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1750.30	33						1750.30	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	015	0	1	04	01	H3916_015_0	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	015	0	1	04	01	H3916_015_0	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	015	0	1	04	01	H3916_015_0	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	015	0	1	04	01	H3916_015_0	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	015	0	1	04	01	H3916_015_0	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1880.36	33						1880.36	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	018	0	1	04	01	H3916_018_0	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	018	0	1	04	01	H3916_018_0	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	018	0	1	04	01	H3916_018_0	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	018	0	1	04	01	H3916_018_0	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	018	0	1	04	01	H3916_018_0	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1066.69	33						1066.69	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	022	0	1	04	01	H3916_022_0	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	022	0	1	04	01	H3916_022_0	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	022	0	1	04	01	H3916_022_0	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	022	0	1	04	01	H3916_022_0	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	022	0	1	04	01	H3916_022_0	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1622.31	33						1622.31	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	024	0	1	04	01	H3916_024_0	11	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	024	0	1	04	01	H3916_024_0	11	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	024	0	1	04	01	H3916_024_0	11	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	024	0	1	04	01	H3916_024_0	11	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	024	0	1	04	01	H3916_024_0	11	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1732.81	33						1732.81	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	032	0	1	04	01	H3916_032_0	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	032	0	1	04	01	H3916_032_0	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	032	0	1	04	01	H3916_032_0	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	032	0	1	04	01	H3916_032_0	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	032	0	1	04	01	H3916_032_0	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1010.47	33						1010.47	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	033	0	1	04	01	H3916_033_0	11	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	033	0	1	04	01	H3916_033_0	11	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	033	0	1	04	01	H3916_033_0	11	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	033	0	1	04	01	H3916_033_0	11	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	033	0	1	04	01	H3916_033_0	11	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1207.25	33						1207.25	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	1	1	04	01	H3916_034_1	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	1	1	04	01	H3916_034_1	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	1	1	04	01	H3916_034_1	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	1	1	04	01	H3916_034_1	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	1	1	04	01	H3916_034_1	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1100.91	33						1100.91	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	3	1	04	01	H3916_034_3	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	3	1	04	01	H3916_034_3	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	3	1	04	01	H3916_034_3	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	3	1	04	01	H3916_034_3	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	3	1	04	01	H3916_034_3	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1100.91	33						1100.91	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	4	1	04	01	H3916_034_4	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	4	1	04	01	H3916_034_4	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	4	1	04	01	H3916_034_4	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	4	1	04	01	H3916_034_4	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	034	4	1	04	01	H3916_034_4	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1100.91	33						1100.91	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	035	1	1	04	01	H3916_035_1	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	035	1	1	04	01	H3916_035_1	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	035	1	1	04	01	H3916_035_1	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	035	1	1	04	01	H3916_035_1	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	035	1	1	04	01	H3916_035_1	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											912.71	33						912.71	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	035	2	1	04	01	H3916_035_2	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	035	2	1	04	01	H3916_035_2	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	035	2	1	04	01	H3916_035_2	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	035	2	1	04	01	H3916_035_2	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	035	2	1	04	01	H3916_035_2	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											912.71	33						912.71	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	036	0	1	04	01	H3916_036_0	11	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	036	0	1	04	01	H3916_036_0	11	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	036	0	1	04	01	H3916_036_0	11	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	036	0	1	04	01	H3916_036_0	11	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3916	036	0	1	04	01	H3916_036_0	11	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											754.28	33						754.28	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3923	013	0	1	04	01	H3923_013_0	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3923	013	0	1	04	01	H3923_013_0	7	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3923	013	0	1	04	01	H3923_013_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3923	013	0	1	04	01	H3923_013_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3923	013	0	1	04	01	H3923_013_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											720.17	33						720.17	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3923	017	0	1	04	01	H3923_017_0	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3923	017	0	1	04	01	H3923_017_0	7	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3923	017	0	1	04	01	H3923_017_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3923	017	0	1	04	01	H3923_017_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3923	017	0	1	04	01	H3923_017_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											578.70	33						578.70	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	3	1	04	01	H3924_059_3	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	3	1	04	01	H3924_059_3	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	059	3	1	04	01	H3924_059_3	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	3	1	04	01	H3924_059_3	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	3	1	04	01	H3924_059_3	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	3	1	04	01	H3924_059_3	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	4	1	04	01	H3924_059_4	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	4	1	04	01	H3924_059_4	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	059	4	1	04	01	H3924_059_4	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	4	1	04	01	H3924_059_4	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	4	1	04	01	H3924_059_4	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	4	1	04	01	H3924_059_4	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	6	1	04	01	H3924_059_6	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	6	1	04	01	H3924_059_6	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	059	6	1	04	01	H3924_059_6	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	6	1	04	01	H3924_059_6	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	6	1	04	01	H3924_059_6	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	6	1	04	01	H3924_059_6	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	7	1	04	01	H3924_059_7	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	7	1	04	01	H3924_059_7	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	059	7	1	04	01	H3924_059_7	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	7	1	04	01	H3924_059_7	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	7	1	04	01	H3924_059_7	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	7	1	04	01	H3924_059_7	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	8	1	04	01	H3924_059_8	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	8	1	04	01	H3924_059_8	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	059	8	1	04	01	H3924_059_8	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	8	1	04	01	H3924_059_8	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	8	1	04	01	H3924_059_8	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	8	1	04	01	H3924_059_8	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	9	1	04	01	H3924_059_9	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	9	1	04	01	H3924_059_9	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	059	9	1	04	01	H3924_059_9	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	9	1	04	01	H3924_059_9	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	9	1	04	01	H3924_059_9	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	059	9	1	04	01	H3924_059_9	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	3	1	04	01	H3924_060_3	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	3	1	04	01	H3924_060_3	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	060	3	1	04	01	H3924_060_3	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	3	1	04	01	H3924_060_3	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	3	1	04	01	H3924_060_3	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	3	1	04	01	H3924_060_3	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	4	1	04	01	H3924_060_4	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	4	1	04	01	H3924_060_4	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	060	4	1	04	01	H3924_060_4	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	4	1	04	01	H3924_060_4	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	4	1	04	01	H3924_060_4	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	4	1	04	01	H3924_060_4	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	6	1	04	01	H3924_060_6	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	6	1	04	01	H3924_060_6	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	060	6	1	04	01	H3924_060_6	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	6	1	04	01	H3924_060_6	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	6	1	04	01	H3924_060_6	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	6	1	04	01	H3924_060_6	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	7	1	04	01	H3924_060_7	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	7	1	04	01	H3924_060_7	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	060	7	1	04	01	H3924_060_7	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	7	1	04	01	H3924_060_7	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	7	1	04	01	H3924_060_7	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	7	1	04	01	H3924_060_7	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	8	1	04	01	H3924_060_8	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	8	1	04	01	H3924_060_8	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	060	8	1	04	01	H3924_060_8	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	8	1	04	01	H3924_060_8	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	8	1	04	01	H3924_060_8	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	8	1	04	01	H3924_060_8	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	9	1	04	01	H3924_060_9	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	9	1	04	01	H3924_060_9	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3924	060	9	1	04	01	H3924_060_9	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	9	1	04	01	H3924_060_9	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	9	1	04	01	H3924_060_9	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3924	060	9	1	04	01	H3924_060_9	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3928	001	0	1	01	01	H3928_001_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3928	001	0	1	01	01	H3928_001_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3928	001	0	1	01	01	H3928_001_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3928	001	0	1	01	01	H3928_001_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3928	001	0	1	01	01	H3928_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3928	001	0	1	01	01	H3928_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3928	001	0	1	01	01	H3928_001_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3928	002	0	1	01	01	H3928_002_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3928	002	0	1	01	01	H3928_002_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3928	002	0	1	01	01	H3928_002_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3928	002	0	1	01	01	H3928_002_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3928	002	0	1	01	01	H3928_002_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3928	002	0	1	01	01	H3928_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3928	002	0	1	01	01	H3928_002_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3930	001	0	1	01	01	H3930_001_0	2	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H3930	001	0	1	01	01	H3930_001_0	2	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H3930	002	0	1	01	01	H3930_002_0	3	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H3930	002	0	1	01	01	H3930_002_0	3	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H3930	003	0	1	01	01	H3930_003_0	4	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H3930	003	0	1	01	01	H3930_003_0	4	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H3931	004	0	1	01	01	H3931_004_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	004	0	1	01	01	H3931_004_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	004	0	1	01	01	H3931_004_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	004	0	1	01	01	H3931_004_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	004	0	1	01	01	H3931_004_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	004	0	1	01	01	H3931_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	004	0	1	01	01	H3931_004_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	064	0	1	01	01	H3931_064_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	064	0	1	01	01	H3931_064_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	064	0	1	01	01	H3931_064_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	064	0	1	01	01	H3931_064_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	064	0	1	01	01	H3931_064_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	064	0	1	01	01	H3931_064_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	064	0	1	01	01	H3931_064_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	065	0	1	01	01	H3931_065_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	065	0	1	01	01	H3931_065_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	065	0	1	01	01	H3931_065_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	065	0	1	01	01	H3931_065_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	065	0	1	01	01	H3931_065_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	065	0	1	01	01	H3931_065_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	065	0	1	01	01	H3931_065_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	070	0	1	01	01	H3931_070_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	070	0	1	01	01	H3931_070_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	070	0	1	01	01	H3931_070_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	070	0	1	01	01	H3931_070_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	070	0	1	01	01	H3931_070_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	070	0	1	01	01	H3931_070_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	070	0	1	01	01	H3931_070_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	081	0	1	01	01	H3931_081_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	081	0	1	01	01	H3931_081_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	081	0	1	01	01	H3931_081_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	081	0	1	01	01	H3931_081_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	081	0	1	01	01	H3931_081_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	081	0	1	01	01	H3931_081_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	081	0	1	01	01	H3931_081_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	087	0	1	01	01	H3931_087_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	087	0	1	01	01	H3931_087_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	087	0	1	01	01	H3931_087_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	087	0	1	01	01	H3931_087_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	087	0	1	01	01	H3931_087_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	087	0	1	01	01	H3931_087_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	087	0	1	01	01	H3931_087_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	091	0	1	01	01	H3931_091_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	091	0	1	01	01	H3931_091_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	091	0	1	01	01	H3931_091_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	091	0	1	01	01	H3931_091_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	091	0	1	01	01	H3931_091_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	091	0	1	01	01	H3931_091_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	091	0	1	01	01	H3931_091_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	092	0	1	01	01	H3931_092_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	092	0	1	01	01	H3931_092_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	092	0	1	01	01	H3931_092_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	092	0	1	01	01	H3931_092_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	092	0	1	01	01	H3931_092_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	092	0	1	01	01	H3931_092_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	092	0	1	01	01	H3931_092_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	093	0	1	01	01	H3931_093_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	093	0	1	01	01	H3931_093_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	093	0	1	01	01	H3931_093_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	093	0	1	01	01	H3931_093_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	093	0	1	01	01	H3931_093_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	093	0	1	01	01	H3931_093_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	093	0	1	01	01	H3931_093_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	094	0	1	01	01	H3931_094_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	094	0	1	01	01	H3931_094_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	094	0	1	01	01	H3931_094_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	094	0	1	01	01	H3931_094_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	094	0	1	01	01	H3931_094_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	094	0	1	01	01	H3931_094_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	094	0	1	01	01	H3931_094_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	095	0	1	01	01	H3931_095_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	095	0	1	01	01	H3931_095_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	095	0	1	01	01	H3931_095_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	095	0	1	01	01	H3931_095_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	095	0	1	01	01	H3931_095_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	095	0	1	01	01	H3931_095_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	095	0	1	01	01	H3931_095_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	096	0	1	01	01	H3931_096_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	096	0	1	01	01	H3931_096_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	096	0	1	01	01	H3931_096_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	096	0	1	01	01	H3931_096_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	096	0	1	01	01	H3931_096_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	096	0	1	01	01	H3931_096_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	096	0	1	01	01	H3931_096_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	097	0	1	01	01	H3931_097_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	097	0	1	01	01	H3931_097_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	097	0	1	01	01	H3931_097_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	097	0	1	01	01	H3931_097_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	097	0	1	01	01	H3931_097_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	097	0	1	01	01	H3931_097_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	097	0	1	01	01	H3931_097_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	098	0	1	01	01	H3931_098_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	098	0	1	01	01	H3931_098_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	098	0	1	01	01	H3931_098_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	098	0	1	01	01	H3931_098_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	098	0	1	01	01	H3931_098_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	098	0	1	01	01	H3931_098_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	098	0	1	01	01	H3931_098_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	099	0	1	01	01	H3931_099_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	099	0	1	01	01	H3931_099_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	099	0	1	01	01	H3931_099_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	099	0	1	01	01	H3931_099_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	099	0	1	01	01	H3931_099_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	099	0	1	01	01	H3931_099_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	099	0	1	01	01	H3931_099_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	100	0	1	01	01	H3931_100_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	100	0	1	01	01	H3931_100_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	100	0	1	01	01	H3931_100_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	100	0	1	01	01	H3931_100_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	100	0	1	01	01	H3931_100_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	100	0	1	01	01	H3931_100_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	100	0	1	01	01	H3931_100_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	101	0	1	01	01	H3931_101_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	101	0	1	01	01	H3931_101_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	101	0	1	01	01	H3931_101_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	101	0	1	01	01	H3931_101_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	101	0	1	01	01	H3931_101_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	101	0	1	01	01	H3931_101_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	101	0	1	01	01	H3931_101_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	102	0	1	01	01	H3931_102_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	102	0	1	01	01	H3931_102_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	102	0	1	01	01	H3931_102_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	102	0	1	01	01	H3931_102_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	102	0	1	01	01	H3931_102_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	102	0	1	01	01	H3931_102_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	102	0	1	01	01	H3931_102_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	104	0	1	01	01	H3931_104_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	104	0	1	01	01	H3931_104_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	104	0	1	01	01	H3931_104_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	104	0	1	01	01	H3931_104_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	104	0	1	01	01	H3931_104_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	104	0	1	01	01	H3931_104_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	104	0	1	01	01	H3931_104_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	105	0	1	01	01	H3931_105_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	105	0	1	01	01	H3931_105_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	105	0	1	01	01	H3931_105_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	105	0	1	01	01	H3931_105_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	105	0	1	01	01	H3931_105_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	105	0	1	01	01	H3931_105_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	105	0	1	01	01	H3931_105_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	106	0	1	01	01	H3931_106_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	106	0	1	01	01	H3931_106_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	106	0	1	01	01	H3931_106_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	106	0	1	01	01	H3931_106_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	106	0	1	01	01	H3931_106_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	106	0	1	01	01	H3931_106_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	106	0	1	01	01	H3931_106_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	107	0	1	01	01	H3931_107_0	8	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	107	0	1	01	01	H3931_107_0	8	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	107	0	1	01	01	H3931_107_0	8	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	107	0	1	01	01	H3931_107_0	8	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	107	0	1	01	01	H3931_107_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	107	0	1	01	01	H3931_107_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	107	0	1	01	01	H3931_107_0	8	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	108	0	1	01	01	H3931_108_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	108	0	1	01	01	H3931_108_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	108	0	1	01	01	H3931_108_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	108	0	1	01	01	H3931_108_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	108	0	1	01	01	H3931_108_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	108	0	1	01	01	H3931_108_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	108	0	1	01	01	H3931_108_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	109	0	1	01	01	H3931_109_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	109	0	1	01	01	H3931_109_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	109	0	1	01	01	H3931_109_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	109	0	1	01	01	H3931_109_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	109	0	1	01	01	H3931_109_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	109	0	1	01	01	H3931_109_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	109	0	1	01	01	H3931_109_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	110	0	1	01	01	H3931_110_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	110	0	1	01	01	H3931_110_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	110	0	1	01	01	H3931_110_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	110	0	1	01	01	H3931_110_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	110	0	1	01	01	H3931_110_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	110	0	1	01	01	H3931_110_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	110	0	1	01	01	H3931_110_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	112	0	1	01	01	H3931_112_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	112	0	1	01	01	H3931_112_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	112	0	1	01	01	H3931_112_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	112	0	1	01	01	H3931_112_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	112	0	1	01	01	H3931_112_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	112	0	1	01	01	H3931_112_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	112	0	1	01	01	H3931_112_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	115	0	1	01	01	H3931_115_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	115	0	1	01	01	H3931_115_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	115	0	1	01	01	H3931_115_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	115	0	1	01	01	H3931_115_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	115	0	1	01	01	H3931_115_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	115	0	1	01	01	H3931_115_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	115	0	1	01	01	H3931_115_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	116	0	1	01	01	H3931_116_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	116	0	1	01	01	H3931_116_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	116	0	1	01	01	H3931_116_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	116	0	1	01	01	H3931_116_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	116	0	1	01	01	H3931_116_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	116	0	1	01	01	H3931_116_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	116	0	1	01	01	H3931_116_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	118	0	1	01	01	H3931_118_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	118	0	1	01	01	H3931_118_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	118	0	1	01	01	H3931_118_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	118	0	1	01	01	H3931_118_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	118	0	1	01	01	H3931_118_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	118	0	1	01	01	H3931_118_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	118	0	1	01	01	H3931_118_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	119	0	1	01	01	H3931_119_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	119	0	1	01	01	H3931_119_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	119	0	1	01	01	H3931_119_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	119	0	1	01	01	H3931_119_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	119	0	1	01	01	H3931_119_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	119	0	1	01	01	H3931_119_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	119	0	1	01	01	H3931_119_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	120	0	1	01	01	H3931_120_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	120	0	1	01	01	H3931_120_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	120	0	1	01	01	H3931_120_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	120	0	1	01	01	H3931_120_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	120	0	1	01	01	H3931_120_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	120	0	1	01	01	H3931_120_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	120	0	1	01	01	H3931_120_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	122	0	1	01	01	H3931_122_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	122	0	1	01	01	H3931_122_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	122	0	1	01	01	H3931_122_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	122	0	1	01	01	H3931_122_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	122	0	1	01	01	H3931_122_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	122	0	1	01	01	H3931_122_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	122	0	1	01	01	H3931_122_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	123	0	1	01	01	H3931_123_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	123	0	1	01	01	H3931_123_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	123	0	1	01	01	H3931_123_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	123	0	1	01	01	H3931_123_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	123	0	1	01	01	H3931_123_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	123	0	1	01	01	H3931_123_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	123	0	1	01	01	H3931_123_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	124	0	1	01	01	H3931_124_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	124	0	1	01	01	H3931_124_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	124	0	1	01	01	H3931_124_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	124	0	1	01	01	H3931_124_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	124	0	1	01	01	H3931_124_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	124	0	1	01	01	H3931_124_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	124	0	1	01	01	H3931_124_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	125	0	1	01	01	H3931_125_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	125	0	1	01	01	H3931_125_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	125	0	1	01	01	H3931_125_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	125	0	1	01	01	H3931_125_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	125	0	1	01	01	H3931_125_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	125	0	1	01	01	H3931_125_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	125	0	1	01	01	H3931_125_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	126	0	1	01	01	H3931_126_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	126	0	1	01	01	H3931_126_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	126	0	1	01	01	H3931_126_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	126	0	1	01	01	H3931_126_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	126	0	1	01	01	H3931_126_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	126	0	1	01	01	H3931_126_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	126	0	1	01	01	H3931_126_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	127	0	1	01	01	H3931_127_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	127	0	1	01	01	H3931_127_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	127	0	1	01	01	H3931_127_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	127	0	1	01	01	H3931_127_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	127	0	1	01	01	H3931_127_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	127	0	1	01	01	H3931_127_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	127	0	1	01	01	H3931_127_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	129	0	1	01	01	H3931_129_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	129	0	1	01	01	H3931_129_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	129	0	1	01	01	H3931_129_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	129	0	1	01	01	H3931_129_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	129	0	1	01	01	H3931_129_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	129	0	1	01	01	H3931_129_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	129	0	1	01	01	H3931_129_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	130	0	1	01	01	H3931_130_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	130	0	1	01	01	H3931_130_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	130	0	1	01	01	H3931_130_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	130	0	1	01	01	H3931_130_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3931	130	0	1	01	01	H3931_130_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	130	0	1	01	01	H3931_130_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3931	130	0	1	01	01	H3931_130_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	013	0	1	01	01	H3949_013_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	12.00					1.00	2.00	2.00					6.00	12.00	12.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	013	0	1	01	01	H3949_013_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	26.00					8.00	16.00	16.00					13.00	26.00	26.00																13.00				13.00			0.43	0.27	0.43			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	013	0	1	01	01	H3949_013_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	013	0	1	01	01	H3949_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	285.00																95.00				95.00			3.17	3.00	3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	013	0	1	01	01	H3949_013_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											365.21	27						266.00	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	024	0	1	01	01	H3949_024_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	12.00					1.00	2.00	2.00					6.00	12.00	12.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H3949	024	0	1	01	01	H3949_024_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					10.00	20.00	20.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H3949	024	0	1	01	01	H3949_024_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H3949	024	0	1	01	01	H3949_024_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	285.00																95.00				95.00			3.17	3.00	3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H3949	024	0	1	01	01	H3949_024_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											303.98	27						295.93	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H3949	024	0	1	01	01	H3949_024_0	5	Select Diabetic Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	12.00					5.00	10.00	10.00					6.00	12.00	12.00																6.00				6.00			0.20	0.17	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H3949	028	0	1	01	01	H3949_028_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	12.00					1.00	2.00	2.00					6.00	12.00	12.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	028	0	1	01	01	H3949_028_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					10.00	20.00	20.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	028	0	1	01	01	H3949_028_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	028	0	1	01	01	H3949_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	285.00																95.00				95.00			3.17	3.00	3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	028	0	1	01	01	H3949_028_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											405.09	26						269.67	26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	030	0	1	01	01	H3949_030_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	12.00					1.00	2.00	2.00					6.00	12.00	12.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	030	0	1	01	01	H3949_030_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					10.00	20.00	20.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	030	0	1	01	01	H3949_030_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	030	0	1	01	01	H3949_030_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	285.00																95.00				95.00			3.17	3.00	3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3949	030	0	1	01	01	H3949_030_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											356.13	27						274.73	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	020	0	1	01	01	H3952_020_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	020	0	1	01	01	H3952_020_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					10.00	20.00	30.00					10.00	20.00	20.00																16.00				16.00			0.53	0.33	0.33			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	020	0	1	01	01	H3952_020_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	020	0	1	01	01	H3952_020_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	020	0	1	01	01	H3952_020_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	045	0	1	01	01	H3952_045_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	045	0	1	01	01	H3952_045_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					10.00	20.00	30.00					10.00	20.00	20.00																16.00				16.00			0.53	0.33	0.33			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	045	0	1	01	01	H3952_045_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	045	0	1	01	01	H3952_045_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	045	0	1	01	01	H3952_045_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	049	0	1	01	01	H3952_049_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					3.00	6.00	9.00					3.00	6.00	6.00																9.00				9.00			0.30	0.10	0.10			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	049	0	1	01	01	H3952_049_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	36.00					12.00	24.00	24.00																18.00				18.00			0.60	0.40	0.40			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	049	0	1	01	01	H3952_049_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	049	0	1	01	01	H3952_049_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	049	0	1	01	01	H3952_049_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	051	0	1	01	01	H3952_051_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					3.00	6.00	9.00					3.00	6.00	6.00																9.00				9.00			0.30	0.10	0.10			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	051	0	1	01	01	H3952_051_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	36.00					12.00	24.00	24.00																18.00				18.00			0.60	0.40	0.40			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	051	0	1	01	01	H3952_051_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	051	0	1	01	01	H3952_051_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	051	0	1	01	01	H3952_051_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	053	0	1	01	01	H3952_053_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	053	0	1	01	01	H3952_053_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	053	0	1	01	01	H3952_053_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	053	0	1	01	01	H3952_053_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	053	0	1	01	01	H3952_053_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												29	29	29					29	29	29				29	29	29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	054	0	1	01	01	H3952_054_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	054	0	1	01	01	H3952_054_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	054	0	1	01	01	H3952_054_0	3	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	054	0	1	01	01	H3952_054_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	054	0	1	01	01	H3952_054_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												29	29	29					29	29	29				29	29	29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	055	0	1	01	01	H3952_055_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					3.00	6.00	9.00					3.00	6.00	6.00																9.00				9.00			0.30	0.10	0.10			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	055	0	1	01	01	H3952_055_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	36.00					12.00	24.00	24.00																18.00				18.00			0.60	0.40	0.40			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	055	0	1	01	01	H3952_055_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	055	0	1	01	01	H3952_055_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	055	0	1	01	01	H3952_055_0	5	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												27	27	27					27	27	27				27	27	27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	056	0	1	01	01	H3952_056_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					3.00	6.00	9.00					3.00	6.00	6.00																9.00				9.00			0.30	0.10	0.10			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	056	0	1	01	01	H3952_056_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	36.00					12.00	24.00	24.00																18.00				18.00			0.60	0.40	0.40			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	056	0	1	01	01	H3952_056_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	056	0	1	01	01	H3952_056_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3952	056	0	1	01	01	H3952_056_0	5	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												27	27	27					27	27	27				27	27	27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	1	1	01	01	H3954_157_1	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	1	1	01	01	H3954_157_1	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	157	1	1	01	01	H3954_157_1	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	1	1	01	01	H3954_157_1	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	1	1	01	01	H3954_157_1	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	1	1	01	01	H3954_157_1	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	2	1	01	01	H3954_157_2	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	2	1	01	01	H3954_157_2	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	157	2	1	01	01	H3954_157_2	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	2	1	01	01	H3954_157_2	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	2	1	01	01	H3954_157_2	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	2	1	01	01	H3954_157_2	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	3	1	01	01	H3954_157_3	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	3	1	01	01	H3954_157_3	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	157	3	1	01	01	H3954_157_3	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	3	1	01	01	H3954_157_3	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	3	1	01	01	H3954_157_3	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	3	1	01	01	H3954_157_3	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	4	1	01	01	H3954_157_4	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	4	1	01	01	H3954_157_4	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	157	4	1	01	01	H3954_157_4	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	4	1	01	01	H3954_157_4	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	4	1	01	01	H3954_157_4	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	4	1	01	01	H3954_157_4	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	5	1	01	01	H3954_157_5	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	5	1	01	01	H3954_157_5	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	157	5	1	01	01	H3954_157_5	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	5	1	01	01	H3954_157_5	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	5	1	01	01	H3954_157_5	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	5	1	01	01	H3954_157_5	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	6	1	01	01	H3954_157_6	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	6	1	01	01	H3954_157_6	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	157	6	1	01	01	H3954_157_6	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	6	1	01	01	H3954_157_6	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	6	1	01	01	H3954_157_6	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	157	6	1	01	01	H3954_157_6	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	1	1	01	01	H3954_158_1	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	1	1	01	01	H3954_158_1	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	158	1	1	01	01	H3954_158_1	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	1	1	01	01	H3954_158_1	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	1	1	01	01	H3954_158_1	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	1	1	01	01	H3954_158_1	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	2	1	01	01	H3954_158_2	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	2	1	01	01	H3954_158_2	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	158	2	1	01	01	H3954_158_2	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	2	1	01	01	H3954_158_2	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	2	1	01	01	H3954_158_2	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	2	1	01	01	H3954_158_2	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	3	1	01	01	H3954_158_3	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	3	1	01	01	H3954_158_3	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	158	3	1	01	01	H3954_158_3	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	3	1	01	01	H3954_158_3	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	3	1	01	01	H3954_158_3	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	3	1	01	01	H3954_158_3	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	4	1	01	01	H3954_158_4	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	4	1	01	01	H3954_158_4	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	158	4	1	01	01	H3954_158_4	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	4	1	01	01	H3954_158_4	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	4	1	01	01	H3954_158_4	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	4	1	01	01	H3954_158_4	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	5	1	01	01	H3954_158_5	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	5	1	01	01	H3954_158_5	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	158	5	1	01	01	H3954_158_5	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	5	1	01	01	H3954_158_5	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	5	1	01	01	H3954_158_5	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	5	1	01	01	H3954_158_5	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	6	1	01	01	H3954_158_6	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	6	1	01	01	H3954_158_6	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	158	6	1	01	01	H3954_158_6	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	6	1	01	01	H3954_158_6	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	6	1	01	01	H3954_158_6	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	158	6	1	01	01	H3954_158_6	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	1	1	01	01	H3954_159_1	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	1	1	01	01	H3954_159_1	4	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	159	1	1	01	01	H3954_159_1	4	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	1	1	01	01	H3954_159_1	4	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	1	1	01	01	H3954_159_1	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	1	1	01	01	H3954_159_1	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	2	1	01	01	H3954_159_2	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	2	1	01	01	H3954_159_2	4	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	159	2	1	01	01	H3954_159_2	4	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	2	1	01	01	H3954_159_2	4	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	2	1	01	01	H3954_159_2	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	2	1	01	01	H3954_159_2	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	3	1	01	01	H3954_159_3	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	3	1	01	01	H3954_159_3	4	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	159	3	1	01	01	H3954_159_3	4	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	3	1	01	01	H3954_159_3	4	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	3	1	01	01	H3954_159_3	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	3	1	01	01	H3954_159_3	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	4	1	01	01	H3954_159_4	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	4	1	01	01	H3954_159_4	4	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	159	4	1	01	01	H3954_159_4	4	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	4	1	01	01	H3954_159_4	4	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	4	1	01	01	H3954_159_4	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	4	1	01	01	H3954_159_4	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	5	1	01	01	H3954_159_5	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	5	1	01	01	H3954_159_5	4	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	159	5	1	01	01	H3954_159_5	4	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	5	1	01	01	H3954_159_5	4	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	5	1	01	01	H3954_159_5	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	5	1	01	01	H3954_159_5	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	6	1	01	01	H3954_159_6	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	6	1	01	01	H3954_159_6	4	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					4.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3954	159	6	1	01	01	H3954_159_6	4	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		50.00																					30.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	6	1	01	01	H3954_159_6	4	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		117.50																					70.50																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	6	1	01	01	H3954_159_6	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		250.00																					150.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3954	159	6	1	01	01	H3954_159_6	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	003	0	1	01	01	H3957_003_0	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	003	0	1	01	01	H3957_003_0	9	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	003	0	1	01	01	H3957_003_0	9	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	003	0	1	01	01	H3957_003_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	003	0	1	01	01	H3957_003_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1382.06	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	006	0	1	01	01	H3957_006_0	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	006	0	1	01	01	H3957_006_0	9	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	006	0	1	01	01	H3957_006_0	9	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	006	0	1	01	01	H3957_006_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	006	0	1	01	01	H3957_006_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1202.58	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	020	0	1	01	01	H3957_020_0	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	020	0	1	01	01	H3957_020_0	9	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3957	020	0	1	01	01	H3957_020_0	9	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	020	0	1	01	01	H3957_020_0	9	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3957	020	0	1	01	01	H3957_020_0	9	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	020	0	1	01	01	H3957_020_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	020	0	1	01	01	H3957_020_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1671.32	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	021	0	1	01	01	H3957_021_0	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	021	0	1	01	01	H3957_021_0	9	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3957	021	0	1	01	01	H3957_021_0	9	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	021	0	1	01	01	H3957_021_0	9	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3957	021	0	1	01	01	H3957_021_0	9	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	021	0	1	01	01	H3957_021_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	021	0	1	01	01	H3957_021_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1905.43	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	031	0	1	01	01	H3957_031_0	9	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	031	0	1	01	01	H3957_031_0	9	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	031	0	1	01	01	H3957_031_0	9	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	031	0	1	01	01	H3957_031_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	031	0	1	01	01	H3957_031_0	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1127.17	33						1127.17	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	032	0	1	01	01	H3957_032_0	9	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	032	0	1	01	01	H3957_032_0	9	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	032	0	1	01	01	H3957_032_0	9	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	032	0	1	01	01	H3957_032_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	032	0	1	01	01	H3957_032_0	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1044.72	33						1044.72	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	038	0	1	01	01	H3957_038_0	9	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	038	0	1	01	01	H3957_038_0	9	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	038	0	1	01	01	H3957_038_0	9	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	038	0	1	01	01	H3957_038_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	038	0	1	01	01	H3957_038_0	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											932.28	33						932.28	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	039	0	1	01	01	H3957_039_0	9	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	039	0	1	01	01	H3957_039_0	9	Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3957	039	0	1	01	01	H3957_039_0	9	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	039	0	1	01	01	H3957_039_0	9	Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3957	039	0	1	01	01	H3957_039_0	9	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	039	0	1	01	01	H3957_039_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	039	0	1	01	01	H3957_039_0	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1483.43	33						1483.43	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	1	1	01	01	H3957_042_1	9	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	1	1	01	01	H3957_042_1	9	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	1	1	01	01	H3957_042_1	9	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	1	1	01	01	H3957_042_1	9	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	1	1	01	01	H3957_042_1	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1083.41	33						1083.41	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	2	1	01	01	H3957_042_2	9	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	2	1	01	01	H3957_042_2	9	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	2	1	01	01	H3957_042_2	9	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	2	1	01	01	H3957_042_2	9	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	2	1	01	01	H3957_042_2	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1083.41	33						1083.41	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	4	1	01	01	H3957_042_4	9	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	4	1	01	01	H3957_042_4	9	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	4	1	01	01	H3957_042_4	9	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	4	1	01	01	H3957_042_4	9	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3957	042	4	1	01	01	H3957_042_4	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1083.41	33						1083.41	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	001	0	1	01	01	H3959_001_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	001	0	1	01	01	H3959_001_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	001	0	1	01	01	H3959_001_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	001	0	1	01	01	H3959_001_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	001	0	1	01	01	H3959_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	001	0	1	01	01	H3959_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	001	0	1	01	01	H3959_001_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	002	0	1	01	01	H3959_002_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	002	0	1	01	01	H3959_002_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	002	0	1	01	01	H3959_002_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	002	0	1	01	01	H3959_002_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	002	0	1	01	01	H3959_002_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	002	0	1	01	01	H3959_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	002	0	1	01	01	H3959_002_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	010	0	1	01	01	H3959_010_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	010	0	1	01	01	H3959_010_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	010	0	1	01	01	H3959_010_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	010	0	1	01	01	H3959_010_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	010	0	1	01	01	H3959_010_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	010	0	1	01	01	H3959_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	010	0	1	01	01	H3959_010_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	011	0	1	01	01	H3959_011_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	011	0	1	01	01	H3959_011_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	011	0	1	01	01	H3959_011_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	011	0	1	01	01	H3959_011_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	011	0	1	01	01	H3959_011_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	011	0	1	01	01	H3959_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	011	0	1	01	01	H3959_011_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	031	0	1	01	01	H3959_031_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	031	0	1	01	01	H3959_031_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	031	0	1	01	01	H3959_031_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	031	0	1	01	01	H3959_031_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	031	0	1	01	01	H3959_031_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	031	0	1	01	01	H3959_031_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	031	0	1	01	01	H3959_031_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	032	0	1	01	01	H3959_032_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	032	0	1	01	01	H3959_032_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	032	0	1	01	01	H3959_032_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	032	0	1	01	01	H3959_032_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	032	0	1	01	01	H3959_032_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	032	0	1	01	01	H3959_032_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	032	0	1	01	01	H3959_032_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	033	0	1	01	01	H3959_033_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	033	0	1	01	01	H3959_033_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	033	0	1	01	01	H3959_033_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	033	0	1	01	01	H3959_033_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	033	0	1	01	01	H3959_033_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	033	0	1	01	01	H3959_033_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	033	0	1	01	01	H3959_033_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	035	0	1	01	01	H3959_035_0	4	Preferred Generic	3	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	10.00	20.00	30.00																			10.00	20.00	0.00																	10.00			10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	035	0	1	01	01	H3959_035_0	4	Generic	3	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	40.00																	15.00			15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	035	0	1	01	01	H3959_035_0	4	Preferred Brand	3	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	035	0	1	01	01	H3959_035_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	035	0	1	01	01	H3959_035_0	4	Specialty Tier	3	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	30																				30																		30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	036	0	1	01	01	H3959_036_0	5	Preferred Generic	3	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	9.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	036	0	1	01	01	H3959_036_0	5	Generic	3	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	036	0	1	01	01	H3959_036_0	5	Preferred Brand	3	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	036	0	1	01	01	H3959_036_0	5	Non-Preferred Drug	3	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	036	0	1	01	01	H3959_036_0	5	Specialty Tier	3	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	30																				30																		30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	037	0	1	01	01	H3959_037_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	037	0	1	01	01	H3959_037_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	037	0	1	01	01	H3959_037_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	037	0	1	01	01	H3959_037_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	037	0	1	01	01	H3959_037_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	037	0	1	01	01	H3959_037_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	037	0	1	01	01	H3959_037_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	039	0	1	01	01	H3959_039_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	039	0	1	01	01	H3959_039_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	039	0	1	01	01	H3959_039_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	039	0	1	01	01	H3959_039_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	039	0	1	01	01	H3959_039_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	039	0	1	01	01	H3959_039_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	039	0	1	01	01	H3959_039_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	043	0	1	01	01	H3959_043_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	043	0	1	01	01	H3959_043_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	043	0	1	01	01	H3959_043_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	043	0	1	01	01	H3959_043_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	043	0	1	01	01	H3959_043_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	043	0	1	01	01	H3959_043_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	043	0	1	01	01	H3959_043_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	044	0	1	01	01	H3959_044_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	044	0	1	01	01	H3959_044_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	044	0	1	01	01	H3959_044_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	044	0	1	01	01	H3959_044_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	044	0	1	01	01	H3959_044_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	044	0	1	01	01	H3959_044_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	044	0	1	01	01	H3959_044_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	045	0	1	01	01	H3959_045_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	045	0	1	01	01	H3959_045_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	045	0	1	01	01	H3959_045_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	045	0	1	01	01	H3959_045_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	045	0	1	01	01	H3959_045_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	045	0	1	01	01	H3959_045_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	045	0	1	01	01	H3959_045_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	046	0	1	01	01	H3959_046_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	046	0	1	01	01	H3959_046_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	046	0	1	01	01	H3959_046_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	046	0	1	01	01	H3959_046_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	046	0	1	01	01	H3959_046_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	046	0	1	01	01	H3959_046_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	046	0	1	01	01	H3959_046_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	047	0	1	01	01	H3959_047_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	047	0	1	01	01	H3959_047_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	047	0	1	01	01	H3959_047_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	047	0	1	01	01	H3959_047_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	047	0	1	01	01	H3959_047_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	047	0	1	01	01	H3959_047_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	047	0	1	01	01	H3959_047_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	048	0	1	01	01	H3959_048_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	048	0	1	01	01	H3959_048_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	048	0	1	01	01	H3959_048_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	048	0	1	01	01	H3959_048_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	048	0	1	01	01	H3959_048_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	048	0	1	01	01	H3959_048_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	048	0	1	01	01	H3959_048_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	049	0	1	01	01	H3959_049_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	049	0	1	01	01	H3959_049_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	049	0	1	01	01	H3959_049_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	049	0	1	01	01	H3959_049_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	049	0	1	01	01	H3959_049_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	049	0	1	01	01	H3959_049_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	049	0	1	01	01	H3959_049_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	050	0	1	01	01	H3959_050_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	050	0	1	01	01	H3959_050_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	050	0	1	01	01	H3959_050_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	050	0	1	01	01	H3959_050_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	050	0	1	01	01	H3959_050_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	050	0	1	01	01	H3959_050_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	050	0	1	01	01	H3959_050_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	051	0	1	01	01	H3959_051_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	051	0	1	01	01	H3959_051_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	051	0	1	01	01	H3959_051_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	051	0	1	01	01	H3959_051_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3959	051	0	1	01	01	H3959_051_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	051	0	1	01	01	H3959_051_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3959	051	0	1	01	01	H3959_051_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	001	0	1	01	01	H3962_001_0	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	001	0	1	01	01	H3962_001_0	6	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3962	001	0	1	01	01	H3962_001_0	6	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		30.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	001	0	1	01	01	H3962_001_0	6	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		30.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H3962	001	0	1	01	01	H3962_001_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	001	0	1	01	01	H3962_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	001	0	1	01	01	H3962_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											539.21	33						539.21	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	004	0	1	01	01	H3962_004_0	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		12.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	004	0	1	01	01	H3962_004_0	6	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	004	0	1	01	01	H3962_004_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	004	0	1	01	01	H3962_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	004	0	1	01	01	H3962_004_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1005.56	33						1005.56	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	007	0	1	01	01	H3962_007_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	007	0	1	01	01	H3962_007_0	8	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	007	0	1	01	01	H3962_007_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	007	0	1	01	01	H3962_007_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	007	0	1	01	01	H3962_007_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											775.69	33						775.69	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	018	0	1	01	01	H3962_018_0	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	018	0	1	01	01	H3962_018_0	6	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	018	0	1	01	01	H3962_018_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	018	0	1	01	01	H3962_018_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	018	0	1	01	01	H3962_018_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											599.70	33						599.70	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	019	0	1	01	01	H3962_019_0	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	019	0	1	01	01	H3962_019_0	6	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		30.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	019	0	1	01	01	H3962_019_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	019	0	1	01	01	H3962_019_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3962	019	0	1	01	01	H3962_019_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											592.10	33						592.10	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H3979	001	0	1	01	01	H3979_001_0	6	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3979	001	0	1	01	01	H3979_001_0	6	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3979	001	0	1	01	01	H3979_001_0	6	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3979	001	0	1	01	01	H3979_001_0	6	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H3979	001	0	1	01	01	H3979_001_0	6	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3979	001	0	1	01	01	H3979_001_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H3979	001	0	1	01	01	H3979_001_0	6	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											698.89	33		33				683.64	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	009	0	1	01	01	H4003_009_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	3.00		6.00																					6.00																3.00				3.00		0.10						0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	009	0	1	01	01	H4003_009_0	12	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	3.00		6.00																					6.00																3.00				3.00		0.10						0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H4003	009	0	1	01	01	H4003_009_0	12	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	7.00		14.00																					14.00																7.00				7.00		0.23						0.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	009	0	1	01	01	H4003_009_0	12	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	7.00		14.00																					14.00																7.00				7.00		0.23						0.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H4003	009	0	1	01	01	H4003_009_0	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	009	0	1	01	01	H4003_009_0	12	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	009	0	1	01	01	H4003_009_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	019	0	1	01	01	H4003_019_0	14	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	019	0	1	01	01	H4003_019_0	14	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H4003	019	0	1	01	01	H4003_019_0	14	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	019	0	1	01	01	H4003_019_0	14	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H4003	019	0	1	01	01	H4003_019_0	14	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	18.00		54.00																					36.00																18.00				18.00		0.60						0.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	019	0	1	01	01	H4003_019_0	14	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	019	0	1	01	01	H4003_019_0	14	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	027	0	1	02	01	H4003_027_0	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	1.00		2.00																					2.00																1.00				1.00		0.03						0.03	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4003	027	0	1	02	01	H4003_027_0	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	1.00		2.00																					2.00																1.00				1.00		0.03						0.03	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2		
H4003	027	0	1	02	01	H4003_027_0	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4003	027	0	1	02	01	H4003_027_0	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2		
H4003	027	0	1	02	01	H4003_027_0	13	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4003	027	0	1	02	01	H4003_027_0	13	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	50.00		150.00																					100.00																50.00				50.00		1.67						1.61	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4003	027	0	1	02	01	H4003_027_0	13	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4003	034	0	1	02	01	H4003_034_0	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	034	0	1	02	01	H4003_034_0	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H4003	034	0	1	02	01	H4003_034_0	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	034	0	1	02	01	H4003_034_0	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H4003	034	0	1	02	01	H4003_034_0	13	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	034	0	1	02	01	H4003_034_0	13	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4003	034	0	1	02	01	H4003_034_0	13	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4004	056	0	1	01	01	H4004_056_0	15	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	1.00		2.00																					2.00																1.00				1.00		0.03						0.03	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4004	056	0	1	01	01	H4004_056_0	15	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	1.00		2.00																					2.00																1.00				1.00		0.03						0.03	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2		
H4004	056	0	1	01	01	H4004_056_0	15	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4004	056	0	1	01	01	H4004_056_0	15	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2		
H4004	056	0	1	01	01	H4004_056_0	15	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4004	056	0	1	01	01	H4004_056_0	15	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4004	056	0	1	01	01	H4004_056_0	15	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4005	004	0	1	04	01	H4005_004_0	6	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4005	004	0	1	04	01	H4005_004_0	6	Preferred Generic	4	01	3	2	1	3		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H4005	004	0	1	04	01	H4005_004_0	6	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4005	004	0	1	04	01	H4005_004_0	6	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H4005	004	0	1	04	01	H4005_004_0	6	Preferred Brand	4	11	3	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					25.00		50.00							50.00																45.00				25.00			1.50	0.83				0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4005	004	0	1	04	01	H4005_004_0	6	Non-Preferred Brand	4	11	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								75.00		150.00					40.00		80.00							80.00																75.00				40.00			2.50	1.33				1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4005	004	0	1	04	01	H4005_004_0	6	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				25.00	25		25						25															33			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4007	012	0	1	01	01	H4007_012_0	5	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	012	0	1	01	01	H4007_012_0	5	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	012	0	1	01	01	H4007_012_0	5	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	34.00		68.00																									34.00		102.00				34.00		68.00				34.00				34.00		1.13				1.13	1.13	1.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	012	0	1	01	01	H4007_012_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	65.00		195.00																									65.00		195.00				65.00		185.00				65.00				65.00		2.17				2.17	2.17	2.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	012	0	1	01	01	H4007_012_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	013	0	1	01	01	H4007_013_0	4	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	013	0	1	01	01	H4007_013_0	4	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	013	0	1	01	01	H4007_013_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.17				1.17	1.17	1.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	013	0	1	01	01	H4007_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	013	0	1	01	01	H4007_013_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	016	0	1	01	01	H4007_016_0	5	Preferred Generic	3	11	1	1	1	1	110		01	110		1	30		90				1	2	30		90				30		31				2.00	25		25																		25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	016	0	1	01	01	H4007_016_0	5	Generic	3	11	1	1	2	1	110		01	110		1	30		90				2	2	30		90				30		31				5.00	25		25																		25		25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	016	0	1	01	01	H4007_016_0	5	Preferred Brand	3	11	1	1	3	1	110		01	110		1	30		90				2	2	30		90				30		31				43.00	25		25																		25		25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	016	0	1	01	01	H4007_016_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				31.00	25		25																		25		25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	016	0	1	01	01	H4007_016_0	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	018	0	1	01	01	H4007_018_0	5	Preferred Generic	3	11	1	1	1	1	110		01	110		1	30		90				1	2	30		90				30		31				2.00	25		25																		25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	018	0	1	01	01	H4007_018_0	5	Generic	3	11	1	1	2	1	110		01	110		1	30		90				2	2	30		90				30		31				5.00	25		25																		25		25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	018	0	1	01	01	H4007_018_0	5	Preferred Brand	3	11	1	1	3	1	110		01	110		1	30		90				2	2	30		90				30		31				44.00	25		25																		25		25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	018	0	1	01	01	H4007_018_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				31.00	25		25																		25		25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4007	018	0	1	01	01	H4007_018_0	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4036	008	0	1	04	01	H4036_008_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	008	0	1	04	01	H4036_008_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	008	0	1	04	01	H4036_008_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	008	0	1	04	01	H4036_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	008	0	1	04	01	H4036_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	008	0	1	04	01	H4036_008_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	008	0	1	04	01	H4036_008_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4036	009	0	1	04	01	H4036_009_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	009	0	1	04	01	H4036_009_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	009	0	1	04	01	H4036_009_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	009	0	1	04	01	H4036_009_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	009	0	1	04	01	H4036_009_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	009	0	1	04	01	H4036_009_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	009	0	1	04	01	H4036_009_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4036	010	1	1	04	01	H4036_010_1	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	1	1	04	01	H4036_010_1	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	1	1	04	01	H4036_010_1	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	1	1	04	01	H4036_010_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	1	1	04	01	H4036_010_1	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	1	1	04	01	H4036_010_1	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	1	1	04	01	H4036_010_1	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4036	010	2	1	04	01	H4036_010_2	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	2	1	04	01	H4036_010_2	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	2	1	04	01	H4036_010_2	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	2	1	04	01	H4036_010_2	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	2	1	04	01	H4036_010_2	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	2	1	04	01	H4036_010_2	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	010	2	1	04	01	H4036_010_2	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4036	012	1	1	04	01	H4036_012_1	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	1	1	04	01	H4036_012_1	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	1	1	04	01	H4036_012_1	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	1	1	04	01	H4036_012_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	1	1	04	01	H4036_012_1	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	1	1	04	01	H4036_012_1	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	1	1	04	01	H4036_012_1	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4036	012	2	1	04	01	H4036_012_2	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	2	1	04	01	H4036_012_2	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	2	1	04	01	H4036_012_2	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	2	1	04	01	H4036_012_2	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	2	1	04	01	H4036_012_2	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	2	1	04	01	H4036_012_2	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4036	012	2	1	04	01	H4036_012_2	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4069	001	0	1	04	01	H4069_001_0	8	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4069	001	0	1	04	01	H4069_001_0	8	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4069	001	0	1	04	01	H4069_001_0	8	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4069	001	0	1	04	01	H4069_001_0	8	Non-Preferred Drug	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4069	001	0	1	04	01	H4069_001_0	8	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4069	001	0	1	04	01	H4069_001_0	8	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4089	001	0	1	01	01	H4089_001_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4089	001	0	1	01	01	H4089_001_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4089	001	0	1	01	01	H4089_001_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4089	001	0	1	01	01	H4089_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4089	001	0	1	01	01	H4089_001_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				695.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4089	002	0	1	01	01	H4089_002_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4089	002	0	1	01	01	H4089_002_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4089	002	0	1	01	01	H4089_002_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4089	002	0	1	01	01	H4089_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4089	002	0	1	01	01	H4089_002_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				857.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	003	0	1	01	01	H4141_003_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	003	0	1	01	01	H4141_003_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	003	0	1	01	01	H4141_003_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	003	0	1	01	01	H4141_003_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	003	0	1	01	01	H4141_003_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	004	0	1	01	01	H4141_004_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	004	0	1	01	01	H4141_004_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	004	0	1	01	01	H4141_004_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	004	0	1	01	01	H4141_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	004	0	1	01	01	H4141_004_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	015	0	1	01	01	H4141_015_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	015	0	1	01	01	H4141_015_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	015	0	1	01	01	H4141_015_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	015	0	1	01	01	H4141_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	015	0	1	01	01	H4141_015_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	017	3	1	01	01	H4141_017_3	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	017	3	1	01	01	H4141_017_3	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	017	3	1	01	01	H4141_017_3	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	017	3	1	01	01	H4141_017_3	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	017	3	1	01	01	H4141_017_3	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	017	4	1	01	01	H4141_017_4	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	017	4	1	01	01	H4141_017_4	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	017	4	1	01	01	H4141_017_4	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	017	4	1	01	01	H4141_017_4	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4141	017	4	1	01	01	H4141_017_4	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4152	005	0	1	01	01	H4152_005_0	11	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								11.00	22.00	33.00					3.00	6.00	9.00						0.00	0.00																11.00				3.00			0.37	0.10				0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	005	0	1	01	01	H4152_005_0	11	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								14.00	28.00	42.00					6.00	12.00	18.00						0.00	0.00																14.00				6.00			0.47	0.20				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	005	0	1	01	01	H4152_005_0	11	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	005	0	1	01	01	H4152_005_0	11	Non-Preferred Brand	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	005	0	1	01	01	H4152_005_0	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	007	0	1	02	01	H4152_007_0	12	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								11.00	22.00	33.00					3.00	6.00	9.00						0.00	0.00																11.00				3.00			0.37	0.10				0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	007	0	1	02	01	H4152_007_0	12	Preferred Generic	4	01	1	2	1	3		111	01	101		1				30	60	90	1	2		60	90				30		31								11.00	22.00	33.00					3.00	6.00	9.00						0.00	0.00																11.00				3.00			0.37	0.10				0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H4152	007	0	1	02	01	H4152_007_0	12	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								14.00	28.00	42.00					6.00	12.00	18.00						0.00	0.00																14.00				6.00			0.47	0.20				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	007	0	1	02	01	H4152_007_0	12	Generic	4	01	1	2	2	3		111	01	101		1				30	60	90	1	2		60	90				30		31								14.00	28.00	42.00					6.00	12.00	18.00						0.00	0.00																14.00				6.00			0.47	0.20				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H4152	007	0	1	02	01	H4152_007_0	12	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	007	0	1	02	01	H4152_007_0	12	Non-Preferred Brand	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	007	0	1	02	01	H4152_007_0	12	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	013	0	1	01	01	H4152_013_0	11	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								11.00	22.00	33.00					3.00	6.00	9.00						0.00	0.00																11.00				3.00			0.37	0.10				0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	013	0	1	01	01	H4152_013_0	11	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								15.00	30.00	45.00					7.00	14.00	21.00						0.00	0.00																15.00				7.00			0.50	0.23				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	013	0	1	01	01	H4152_013_0	11	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	013	0	1	01	01	H4152_013_0	11	Non-Preferred Brand	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	013	0	1	01	01	H4152_013_0	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	017	0	1	01	01	H4152_017_0	11	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								9.00	18.00	27.00					1.00	2.00	3.00						0.00	0.00																9.00				1.00			0.30	0.03				0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	017	0	1	01	01	H4152_017_0	11	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								16.00	32.00	48.00					8.00	16.00	24.00						0.00	0.00																16.00				8.00			0.53	0.27				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	017	0	1	01	01	H4152_017_0	11	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	017	0	1	01	01	H4152_017_0	11	Non-Preferred Brand	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	017	0	1	01	01	H4152_017_0	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	018	0	1	02	01	H4152_018_0	12	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								8.00	16.00	24.00					0.00	0.00	0.00						0.00	0.00																8.00				0.00			0.27	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	018	0	1	02	01	H4152_018_0	12	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								13.00	26.00	39.00					5.00	10.00	15.00						0.00	0.00																13.00				5.00			0.43	0.17				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	018	0	1	02	01	H4152_018_0	12	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	018	0	1	02	01	H4152_018_0	12	Non-Preferred Brand	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	018	0	1	02	01	H4152_018_0	12	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	019	1	1	02	01	H4152_019_1	12	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								9.00	18.00	27.00					1.00	2.00	3.00						0.00	0.00																9.00				1.00			0.30	0.03				0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	019	1	1	02	01	H4152_019_1	12	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								16.00	32.00	48.00					8.00	16.00	24.00						0.00	0.00																16.00				8.00			0.53	0.27				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	019	1	1	02	01	H4152_019_1	12	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	019	1	1	02	01	H4152_019_1	12	Non-Preferred Brand	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	019	1	1	02	01	H4152_019_1	12	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	019	2	1	02	01	H4152_019_2	11	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								9.00	18.00	27.00					1.00	2.00	3.00						0.00	0.00																9.00				1.00			0.30	0.03				0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	019	2	1	02	01	H4152_019_2	11	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								16.00	32.00	48.00					8.00	16.00	24.00						0.00	0.00																16.00				8.00			0.53	0.27				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	019	2	1	02	01	H4152_019_2	11	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	019	2	1	02	01	H4152_019_2	11	Non-Preferred Brand	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4152	019	2	1	02	01	H4152_019_2	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4198	003	0	1	01	01	H4198_003_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4198	003	0	1	01	01	H4198_003_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4198	003	0	1	01	01	H4198_003_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4198	003	0	1	01	01	H4198_003_0	7	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4198	003	0	1	01	01	H4198_003_0	7	Injectable Drugs	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				80.78	33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4198	003	0	1	01	01	H4198_003_0	7	Specialty Tier	4	11	1	1	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4198	005	0	1	01	01	H4198_005_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4198	005	0	1	01	01	H4198_005_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	13.00	26.00	39.00																			13.00	26.00	26.00																13.00				13.00		0.43			0.43			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4198	005	0	1	01	01	H4198_005_0	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4198	005	0	1	01	01	H4198_005_0	5	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	180.00																90.00				90.00		3.00			3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4198	005	0	1	01	01	H4198_005_0	5	Injectable Drugs	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				67.49	33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4198	005	0	1	01	01	H4198_005_0	5	Specialty Tier	4	11	1	1	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H4213	017	1	1	09	04	H4213_017_1	7	Preferred Generic	3	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	1	1	09	04	H4213_017_1	7	Generic	3	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.67	0.43	0.43			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	1	1	09	04	H4213_017_1	7	Preferred Brand	3	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					40.00		100.00					40.00		100.00																47.00				40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	1	1	09	04	H4213_017_1	7	Non-Preferred Brand	3	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					93.00		232.50					93.00		232.50																100.00				93.00			3.33	3.10	3.10			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	1	1	09	04	H4213_017_1	7	Specialty Tier	3	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	29		29				1.00	29		29				29		29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	5	1	09	04	H4213_017_5	7	Preferred Generic	3	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	5	1	09	04	H4213_017_5	7	Generic	3	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.67	0.43	0.43			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	5	1	09	04	H4213_017_5	7	Preferred Brand	3	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					40.00		100.00					40.00		100.00																47.00				40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	5	1	09	04	H4213_017_5	7	Non-Preferred Brand	3	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					93.00		232.50					93.00		232.50																100.00				93.00			3.33	3.10	3.10			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	5	1	09	04	H4213_017_5	7	Specialty Tier	3	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	29		29				1.00	29		29				29		29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	6	1	09	04	H4213_017_6	7	Preferred Generic	3	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	6	1	09	04	H4213_017_6	7	Generic	3	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.67	0.43	0.43			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	6	1	09	04	H4213_017_6	7	Preferred Brand	3	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					40.00		100.00					40.00		100.00																47.00				40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	6	1	09	04	H4213_017_6	7	Non-Preferred Brand	3	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					93.00		232.50					93.00		232.50																100.00				93.00			3.33	3.10	3.10			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4213	017	6	1	09	04	H4213_017_6	7	Specialty Tier	3	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	29		29				1.00	29		29				29		29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	001	0	1	01	01	H4227_001_0	8	Preferred Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	001	0	1	01	01	H4227_001_0	8	Generic	2	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	19.00	38.00	57.00																					57.00																19.00				19.00		0.63						0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	001	0	1	01	01	H4227_001_0	8	Preferred Brand	2	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	001	0	1	01	01	H4227_001_0	8	Non-Preferred Brand	2	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	001	0	1	01	01	H4227_001_0	8	Specialty Tier	2	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					25	25	25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	002	0	1	01	01	H4227_002_0	11	Preferred Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	19.00	38.00	57.00																					57.00																19.00				19.00		0.63						0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	002	0	1	01	01	H4227_002_0	11	Generic	2	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	002	0	1	01	01	H4227_002_0	11	Preferred Brand	2	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	002	0	1	01	01	H4227_002_0	11	Non-Preferred Brand	2	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	002	0	1	01	01	H4227_002_0	11	Specialty Tier	2	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					25	25	25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	003	0	1	01	01	H4227_003_0	9	Preferred Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	003	0	1	01	01	H4227_003_0	9	Generic	2	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	003	0	1	01	01	H4227_003_0	9	Preferred Brand	2	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	003	0	1	01	01	H4227_003_0	9	Non-Preferred Brand	2	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4227	003	0	1	01	01	H4227_003_0	9	Specialty Tier	2	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					25	25	25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4236	001	0	1	01	01	H4236_001_0	3	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4236	001	0	1	01	01	H4236_001_0	3	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4236	002	0	1	01	01	H4236_002_0	3	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4236	002	0	1	01	01	H4236_002_0	3	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4236	003	0	1	01	01	H4236_003_0	4	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4236	003	0	1	01	01	H4236_003_0	4	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4279	001	0	1	01	01	H4279_001_0	6	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	7.00		21.00																					12.00																7.00				7.00		0.23						0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4279	001	0	1	01	01	H4279_001_0	6	Generic	2	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					18.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4279	001	0	1	01	01	H4279_001_0	6	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	14.00		42.00																					33.00																14.00				14.00		0.47						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4279	001	0	1	01	01	H4279_001_0	6	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				62.81	46		46																				46															46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4279	001	0	1	01	01	H4279_001_0	6	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				475.46	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4346	001	0	1	01	01	H4346_001_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	001	0	1	01	01	H4346_001_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	001	0	1	01	01	H4346_001_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	001	0	1	01	01	H4346_001_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	001	0	1	01	01	H4346_001_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	001	0	1	01	01	H4346_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	001	0	1	01	01	H4346_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	001	0	1	01	01	H4346_001_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	001	0	1	01	01	H4346_001_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H4346	005	0	1	01	01	H4346_005_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	005	0	1	01	01	H4346_005_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	005	0	1	01	01	H4346_005_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	005	0	1	01	01	H4346_005_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	005	0	1	01	01	H4346_005_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	005	0	1	01	01	H4346_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	005	0	1	01	01	H4346_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	005	0	1	01	01	H4346_005_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	005	0	1	01	01	H4346_005_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H4346	006	0	1	01	01	H4346_006_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	006	0	1	01	01	H4346_006_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	006	0	1	01	01	H4346_006_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	006	0	1	01	01	H4346_006_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	006	0	1	01	01	H4346_006_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	006	0	1	01	01	H4346_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	006	0	1	01	01	H4346_006_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	006	0	1	01	01	H4346_006_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	006	0	1	01	01	H4346_006_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H4346	008	0	1	01	01	H4346_008_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	008	0	1	01	01	H4346_008_0	5	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	008	0	1	01	01	H4346_008_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	008	0	1	01	01	H4346_008_0	5	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							15.00																12.50				12.50			0.42	0.25				0.40		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	008	0	1	01	01	H4346_008_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	008	0	1	01	01	H4346_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	008	0	1	01	01	H4346_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	008	0	1	01	01	H4346_008_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	008	0	1	01	01	H4346_008_0	5	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H4346	009	0	1	01	01	H4346_009_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		15.00							10.00																10.00				10.00			0.33	0.17				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	009	0	1	01	01	H4346_009_0	5	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.50		46.50					10.50		31.50							21.00																15.50				15.50			0.52	0.35				0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	009	0	1	01	01	H4346_009_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							80.00																45.00				45.00			1.50	1.33				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	009	0	1	01	01	H4346_009_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					90.00		270.00							180.00																95.00				95.00			3.17	3.00				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	009	0	1	01	01	H4346_009_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											400.00	33						400.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	009	0	1	01	01	H4346_009_0	5	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					10.00		30.00							20.00																10.00				10.00			0.33	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	010	0	1	01	01	H4346_010_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	010	0	1	01	01	H4346_010_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	010	0	1	01	01	H4346_010_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		0.25						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	010	0	1	01	01	H4346_010_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					15.00																7.50				7.50		0.25						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	010	0	1	01	01	H4346_010_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	010	0	1	01	01	H4346_010_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	010	0	1	01	01	H4346_010_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				400.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	010	0	1	01	01	H4346_010_0	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	010	0	1	01	01	H4346_010_0	5	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	2	
H4346	012	0	1	01	01	H4346_012_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	012	0	1	01	01	H4346_012_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	012	0	1	01	01	H4346_012_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	012	0	1	01	01	H4346_012_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	012	0	1	01	01	H4346_012_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	012	0	1	01	01	H4346_012_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	012	0	1	01	01	H4346_012_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	013	0	1	01	01	H4346_013_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	013	0	1	01	01	H4346_013_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	013	0	1	01	01	H4346_013_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	013	0	1	01	01	H4346_013_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	013	0	1	01	01	H4346_013_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	013	0	1	01	01	H4346_013_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	013	0	1	01	01	H4346_013_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4346	014	0	1	01	01	H4346_014_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	014	0	1	01	01	H4346_014_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	014	0	1	01	01	H4346_014_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	014	0	1	01	01	H4346_014_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								98.00	196.00	294.00					93.00	186.00	279.00					93.00	279.00	279.00																98.00				98.00			3.27	3.10	3.10			2.88		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	014	0	1	01	01	H4346_014_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	014	0	1	01	01	H4346_014_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4346	014	0	1	01	01	H4346_014_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4407	025	1	1	01	01	H4407_025_1	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00	12.00	6.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4407	025	1	1	01	01	H4407_025_1	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	14.00					8.00	16.00	8.00					14.00	28.00	14.00																14.00				14.00			0.47	0.27	0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4407	025	1	1	01	01	H4407_025_1	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4407	025	1	1	01	01	H4407_025_1	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.01	50	50	50				59.65	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4407	025	1	1	01	01	H4407_025_1	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											570.65	31						538.36	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4407	025	2	1	01	01	H4407_025_2	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00	12.00	6.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4407	025	2	1	01	01	H4407_025_2	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	14.00					8.00	16.00	8.00					14.00	28.00	14.00																14.00				14.00			0.47	0.27	0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4407	025	2	1	01	01	H4407_025_2	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4407	025	2	1	01	01	H4407_025_2	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.01	50	50	50				59.65	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4407	025	2	1	01	01	H4407_025_2	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											570.65	31						538.36	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	030	0	1	02	01	H4454_030_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	6.00					10.00	20.00	30.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	030	0	1	02	01	H4454_030_0	4	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	6.00					10.00	20.00	30.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4454	030	0	1	02	01	H4454_030_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	24.00					20.00	40.00	60.00																20.00				20.00			0.67	0.40	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	030	0	1	02	01	H4454_030_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	030	0	1	02	01	H4454_030_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											80.83	50	50	50				72.79	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	030	0	1	02	01	H4454_030_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											501.61	29						391.20	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	031	0	1	01	01	H4454_031_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					8.00	16.00	16.00																8.00				8.00			0.27	0.10	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	031	0	1	01	01	H4454_031_0	4	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					8.00	16.00	16.00																8.00				8.00			0.27	0.10	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4454	031	0	1	01	01	H4454_031_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	34.00					12.00	24.00	24.00					17.00	34.00	34.00																17.00				17.00			0.57	0.40	0.57			0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	031	0	1	01	01	H4454_031_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	031	0	1	01	01	H4454_031_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	300.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	031	0	1	01	01	H4454_031_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											470.94	30						438.79	30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	033	0	1	01	01	H4454_033_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	7.50					10.00	20.00	30.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	033	0	1	01	01	H4454_033_0	4	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	7.50					10.00	20.00	30.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4454	033	0	1	01	01	H4454_033_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	37.50					20.00	40.00	60.00																20.00				20.00			0.67	0.50	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	033	0	1	01	01	H4454_033_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	033	0	1	01	01	H4454_033_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											68.27	50	50	50				63.33	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	033	0	1	01	01	H4454_033_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											460.69	28						376.48	28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	037	1	1	01	01	H4454_037_1	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	6.00					10.00	20.00	30.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	037	1	1	01	01	H4454_037_1	3	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	6.00					10.00	20.00	30.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4454	037	1	1	01	01	H4454_037_1	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	24.00					20.00	40.00	60.00																20.00				20.00			0.67	0.40	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	037	1	1	01	01	H4454_037_1	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	037	1	1	01	01	H4454_037_1	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											63.89	50	50	50				59.49	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	037	1	1	01	01	H4454_037_1	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											437.17	27						359.86	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	037	2	1	01	01	H4454_037_2	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	6.00					10.00	20.00	30.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	037	2	1	01	01	H4454_037_2	3	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	6.00					10.00	20.00	30.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4454	037	2	1	01	01	H4454_037_2	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	24.00					20.00	40.00	60.00																20.00				20.00			0.67	0.40	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	037	2	1	01	01	H4454_037_2	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	037	2	1	01	01	H4454_037_2	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											63.89	50	50	50				59.49	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4454	037	2	1	01	01	H4454_037_2	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											437.17	27						359.86	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	022	0	1	01	01	H4461_022_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	022	0	1	01	01	H4461_022_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	022	0	1	01	01	H4461_022_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	022	0	1	01	01	H4461_022_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	022	0	1	01	01	H4461_022_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	025	0	1	01	01	H4461_025_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	025	0	1	01	01	H4461_025_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	025	0	1	01	01	H4461_025_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	025	0	1	01	01	H4461_025_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	025	0	1	01	01	H4461_025_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	029	0	1	01	01	H4461_029_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	029	0	1	01	01	H4461_029_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	029	0	1	01	01	H4461_029_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	029	0	1	01	01	H4461_029_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	029	0	1	01	01	H4461_029_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	1	1	01	01	H4461_030_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	1	1	01	01	H4461_030_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	1	1	01	01	H4461_030_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	1	1	01	01	H4461_030_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	1	1	01	01	H4461_030_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	2	1	01	01	H4461_030_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	2	1	01	01	H4461_030_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	2	1	01	01	H4461_030_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	2	1	01	01	H4461_030_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	2	1	01	01	H4461_030_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	3	1	01	01	H4461_030_3	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	3	1	01	01	H4461_030_3	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	3	1	01	01	H4461_030_3	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	3	1	01	01	H4461_030_3	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	030	3	1	01	01	H4461_030_3	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	1	1	01	01	H4461_031_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	1	1	01	01	H4461_031_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	1	1	01	01	H4461_031_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	1	1	01	01	H4461_031_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	1	1	01	01	H4461_031_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	2	1	01	01	H4461_031_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	2	1	01	01	H4461_031_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	2	1	01	01	H4461_031_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	2	1	01	01	H4461_031_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	2	1	01	01	H4461_031_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	3	1	01	01	H4461_031_3	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	3	1	01	01	H4461_031_3	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	3	1	01	01	H4461_031_3	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	3	1	01	01	H4461_031_3	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	031	3	1	01	01	H4461_031_3	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	034	0	1	01	01	H4461_034_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	034	0	1	01	01	H4461_034_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	034	0	1	01	01	H4461_034_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	034	0	1	01	01	H4461_034_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4461	034	0	1	01	01	H4461_034_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	001	1	1	04	01	H4497_001_1	10	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	5.00		10.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	001	1	1	04	01	H4497_001_1	10	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	5.00		10.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	001	1	1	04	01	H4497_001_1	10	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	19.00		38.00																			19.00		38.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	001	1	1	04	01	H4497_001_1	10	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	19.00		38.00																			19.00		38.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	001	1	1	04	01	H4497_001_1	10	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	001	1	1	04	01	H4497_001_1	10	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				40.37	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	001	1	1	04	01	H4497_001_1	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				40.37	29																				29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	001	2	1	04	01	H4497_001_2	9	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	5.00		10.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	001	2	1	04	01	H4497_001_2	9	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	5.00		10.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	001	2	1	04	01	H4497_001_2	9	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	19.00		38.00																			19.00		38.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	001	2	1	04	01	H4497_001_2	9	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	19.00		38.00																			19.00		38.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	001	2	1	04	01	H4497_001_2	9	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	001	2	1	04	01	H4497_001_2	9	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				40.37	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	001	2	1	04	01	H4497_001_2	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				40.37	29																				29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	002	1	1	04	01	H4497_002_1	9	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	002	1	1	04	01	H4497_002_1	9	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	002	1	1	04	01	H4497_002_1	9	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	002	1	1	04	01	H4497_002_1	9	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	002	1	1	04	01	H4497_002_1	9	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	002	1	1	04	01	H4497_002_1	9	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				37.22	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	002	1	1	04	01	H4497_002_1	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				37.22	31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	002	2	1	04	01	H4497_002_2	9	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	002	2	1	04	01	H4497_002_2	9	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	002	2	1	04	01	H4497_002_2	9	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	002	2	1	04	01	H4497_002_2	9	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	002	2	1	04	01	H4497_002_2	9	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	002	2	1	04	01	H4497_002_2	9	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				37.22	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	002	2	1	04	01	H4497_002_2	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				37.22	31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	003	1	1	04	01	H4497_003_1	9	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	003	1	1	04	01	H4497_003_1	9	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	003	1	1	04	01	H4497_003_1	9	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	003	1	1	04	01	H4497_003_1	9	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	003	1	1	04	01	H4497_003_1	9	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	003	1	1	04	01	H4497_003_1	9	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				37.67	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	003	1	1	04	01	H4497_003_1	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				37.67	31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	003	2	1	04	01	H4497_003_2	9	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	003	2	1	04	01	H4497_003_2	9	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	003	2	1	04	01	H4497_003_2	9	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	003	2	1	04	01	H4497_003_2	9	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4497	003	2	1	04	01	H4497_003_2	9	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	003	2	1	04	01	H4497_003_2	9	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				37.67	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4497	003	2	1	04	01	H4497_003_2	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				37.67	31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4506	003	0	1	01	01	H4506_003_0	12	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		34	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4506	003	0	1	01	01	H4506_003_0	12	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		34	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4506	003	0	1	01	01	H4506_003_0	12	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		34	5.00		12.50																									5.00		12.50				5.00		5.00				5.00				5.00		0.17				0.17	0.17	0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4506	003	0	1	01	01	H4506_003_0	12	Generic	4	01	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		34	5.00		12.50																									5.00		12.50				5.00		5.00				5.00				5.00		0.17				0.17	0.17	0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4506	003	0	1	01	01	H4506_003_0	12	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		34	40.00		100.00																									40.00		100.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.18		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4506	003	0	1	01	01	H4506_003_0	12	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				1	2				30		90	30		34	20.00		50.00																									20.00		50.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H4506	003	0	1	01	01	H4506_003_0	12	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		34	80.00		200.00																									80.00		200.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4506	003	0	1	01	01	H4506_003_0	12	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		34				1.00	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4506	029	0	1	02	01	H4506_029_0	11	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		34	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4506	029	0	1	02	01	H4506_029_0	11	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		34	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4506	029	0	1	02	01	H4506_029_0	11	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		34	5.00		12.50																									5.00		12.50				5.00		5.00				5.00				5.00		0.17				0.17	0.17	0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4506	029	0	1	02	01	H4506_029_0	11	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		34	40.00		100.00																									40.00		100.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.18		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4506	029	0	1	02	01	H4506_029_0	11	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		34	80.00		200.00																									80.00		200.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4506	029	0	1	02	01	H4506_029_0	11	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		34				1.00	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	025	0	1	01	01	H4513_025_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	5.00					0.00	0.00	0.00					5.00	10.00	5.00																5.00				5.00			0.17	0.00	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	025	0	1	01	01	H4513_025_0	4	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	5.00					0.00	0.00	0.00					5.00	10.00	5.00																5.00				5.00			0.17	0.00	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4513	025	0	1	01	01	H4513_025_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	9.00					4.00	8.00	4.00					9.00	18.00	9.00																9.00				9.00			0.30	0.13	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	025	0	1	01	01	H4513_025_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	90.00					40.00	80.00	80.00					45.00	90.00	90.00																45.00				45.00			1.50	1.33	1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	025	0	1	01	01	H4513_025_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								85.00	170.00	170.00					80.00	160.00	160.00					85.00	170.00	170.00																85.00				85.00			2.83	2.67	2.83			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	025	0	1	01	01	H4513_025_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											427.87	33						374.60	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	026	0	1	01	01	H4513_026_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00	16.00	20.00																8.00				8.00			0.27	0.10	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	026	0	1	01	01	H4513_026_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	32.50					8.00	16.00	20.00					13.00	26.00	32.50																13.00				13.00			0.43	0.27	0.43			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	026	0	1	01	01	H4513_026_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								40.00	80.00	120.00					35.00	70.00	105.00					40.00	80.00	120.00																40.00				40.00			1.33	1.17	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	026	0	1	01	01	H4513_026_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								75.00	150.00	225.00					70.00	140.00	210.00					75.00	150.00	225.00																75.00				75.00			2.50	2.33	2.50			2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	026	0	1	01	01	H4513_026_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											516.28	33						467.31	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	028	0	1	01	01	H4513_028_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00	16.00	20.00																8.00				8.00			0.27	0.10	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	028	0	1	01	01	H4513_028_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	32.50					8.00	16.00	20.00					13.00	26.00	32.50																13.00				13.00			0.43	0.27	0.43			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	028	0	1	01	01	H4513_028_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								40.00	80.00	120.00					35.00	70.00	105.00					40.00	80.00	120.00																40.00				40.00			1.33	1.17	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	028	0	1	01	01	H4513_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								75.00	150.00	225.00					70.00	140.00	210.00					75.00	150.00	225.00																75.00				75.00			2.50	2.33	2.50			2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	028	0	1	01	01	H4513_028_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											526.15	33						490.24	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	030	0	1	01	01	H4513_030_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					8.00	16.00	16.00																8.00				8.00			0.27	0.10	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	030	0	1	01	01	H4513_030_0	3	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					8.00	16.00	16.00																8.00				8.00			0.27	0.10	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4513	030	0	1	01	01	H4513_030_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	34.00					12.00	24.00	24.00					17.00	34.00	34.00																17.00				17.00			0.57	0.40	0.57			0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	030	0	1	01	01	H4513_030_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	030	0	1	01	01	H4513_030_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	300.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4513	030	0	1	01	01	H4513_030_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											448.33	29						304.28	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4514	007	0	1	01	01	H4514_007_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4514	007	0	1	01	01	H4514_007_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4514	007	0	1	01	01	H4514_007_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4514	007	0	1	01	01	H4514_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4514	007	0	1	01	01	H4514_007_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				760.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	001	0	1	01	01	H4523_001_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	001	0	1	01	01	H4523_001_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4523	001	0	1	01	01	H4523_001_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	001	0	1	01	01	H4523_001_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4523	001	0	1	01	01	H4523_001_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	001	0	1	01	01	H4523_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	001	0	1	01	01	H4523_001_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	015	0	1	01	01	H4523_015_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	015	0	1	01	01	H4523_015_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4523	015	0	1	01	01	H4523_015_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	015	0	1	01	01	H4523_015_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4523	015	0	1	01	01	H4523_015_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	015	0	1	01	01	H4523_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	015	0	1	01	01	H4523_015_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	020	0	1	01	01	H4523_020_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	020	0	1	01	01	H4523_020_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4523	020	0	1	01	01	H4523_020_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	020	0	1	01	01	H4523_020_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4523	020	0	1	01	01	H4523_020_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	020	0	1	01	01	H4523_020_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	020	0	1	01	01	H4523_020_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	021	0	1	01	01	H4523_021_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	021	0	1	01	01	H4523_021_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4523	021	0	1	01	01	H4523_021_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	021	0	1	01	01	H4523_021_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4523	021	0	1	01	01	H4523_021_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	021	0	1	01	01	H4523_021_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	021	0	1	01	01	H4523_021_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	024	0	1	01	01	H4523_024_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	024	0	1	01	01	H4523_024_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4523	024	0	1	01	01	H4523_024_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	024	0	1	01	01	H4523_024_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4523	024	0	1	01	01	H4523_024_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	024	0	1	01	01	H4523_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4523	024	0	1	01	01	H4523_024_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	001	0	1	01	01	H4527_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	001	0	1	01	01	H4527_001_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	001	0	1	01	01	H4527_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	001	0	1	01	01	H4527_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	001	0	1	01	01	H4527_001_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				663.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	002	0	1	01	01	H4527_002_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	002	0	1	01	01	H4527_002_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	002	0	1	01	01	H4527_002_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	002	0	1	01	01	H4527_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	002	0	1	01	01	H4527_002_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				712.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	005	0	1	01	01	H4527_005_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	005	0	1	01	01	H4527_005_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	005	0	1	01	01	H4527_005_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	005	0	1	01	01	H4527_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	005	0	1	01	01	H4527_005_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				570.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	013	0	1	01	01	H4527_013_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	013	0	1	01	01	H4527_013_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	013	0	1	01	01	H4527_013_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	013	0	1	01	01	H4527_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	013	0	1	01	01	H4527_013_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				834.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	015	0	1	01	01	H4527_015_0	3	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	015	0	1	01	01	H4527_015_0	3	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	015	0	1	01	01	H4527_015_0	3	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	015	0	1	01	01	H4527_015_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	015	0	1	01	01	H4527_015_0	3	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	037	0	1	01	01	H4527_037_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	037	0	1	01	01	H4527_037_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	037	0	1	01	01	H4527_037_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	037	0	1	01	01	H4527_037_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4527	037	0	1	01	01	H4527_037_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				798.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	001	0	1	18	06	H4564_001_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	001	0	1	18	06	H4564_001_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	001	0	1	18	06	H4564_001_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	001	0	1	18	06	H4564_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	001	0	1	18	06	H4564_001_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	002	0	1	18	06	H4564_002_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	002	0	1	18	06	H4564_002_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	002	0	1	18	06	H4564_002_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	002	0	1	18	06	H4564_002_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	002	0	1	18	06	H4564_002_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	004	0	1	18	06	H4564_004_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	004	0	1	18	06	H4564_004_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4564	004	0	1	18	06	H4564_004_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	004	0	1	18	06	H4564_004_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	004	0	1	18	06	H4564_004_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	004	0	1	18	06	H4564_004_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					32																				32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	005	0	1	18	06	H4564_005_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	005	0	1	18	06	H4564_005_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4564	005	0	1	18	06	H4564_005_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	005	0	1	18	06	H4564_005_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	005	0	1	18	06	H4564_005_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	005	0	1	18	06	H4564_005_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					32																				32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	015	0	1	18	06	H4564_015_0	7	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	015	0	1	18	06	H4564_015_0	7	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	015	0	1	18	06	H4564_015_0	7	Preferred Brand	3	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	015	0	1	18	06	H4564_015_0	7	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	015	0	1	18	06	H4564_015_0	7	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	017	0	1	18	06	H4564_017_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	017	0	1	18	06	H4564_017_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	017	0	1	18	06	H4564_017_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	017	0	1	18	06	H4564_017_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	017	0	1	18	06	H4564_017_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	018	0	1	18	06	H4564_018_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	018	0	1	18	06	H4564_018_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4564	018	0	1	18	06	H4564_018_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	018	0	1	18	06	H4564_018_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	018	0	1	18	06	H4564_018_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4564	018	0	1	18	06	H4564_018_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					32																				32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	010	0	1	01	01	H4590_010_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	010	0	1	01	01	H4590_010_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4590	010	0	1	01	01	H4590_010_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	010	0	1	01	01	H4590_010_0	4	Generic	4	01	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4590	010	0	1	01	01	H4590_010_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	010	0	1	01	01	H4590_010_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	010	0	1	01	01	H4590_010_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				869.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	012	0	1	01	01	H4590_012_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	012	0	1	01	01	H4590_012_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						14.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	012	0	1	01	01	H4590_012_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	012	0	1	01	01	H4590_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	012	0	1	01	01	H4590_012_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				853.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	025	0	1	01	01	H4590_025_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	025	0	1	01	01	H4590_025_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	025	0	1	01	01	H4590_025_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	025	0	1	01	01	H4590_025_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	025	0	1	01	01	H4590_025_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				794.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	037	0	1	01	01	H4590_037_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	037	0	1	01	01	H4590_037_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4590	037	0	1	01	01	H4590_037_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	037	0	1	01	01	H4590_037_0	4	Generic	4	01	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H4590	037	0	1	01	01	H4590_037_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	037	0	1	01	01	H4590_037_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	037	0	1	01	01	H4590_037_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1124.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	041	0	1	01	01	H4590_041_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	041	0	1	01	01	H4590_041_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	041	0	1	01	01	H4590_041_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	041	0	1	01	01	H4590_041_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	041	0	1	01	01	H4590_041_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				867.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	042	0	1	01	01	H4590_042_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	042	0	1	01	01	H4590_042_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	042	0	1	01	01	H4590_042_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	042	0	1	01	01	H4590_042_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4590	042	0	1	01	01	H4590_042_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	003	0	1	01	01	H4604_003_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	003	0	1	01	01	H4604_003_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	003	0	1	01	01	H4604_003_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	003	0	1	01	01	H4604_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	003	0	1	01	01	H4604_003_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				694.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	011	0	1	01	01	H4604_011_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	011	0	1	01	01	H4604_011_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	011	0	1	01	01	H4604_011_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	011	0	1	01	01	H4604_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	011	0	1	01	01	H4604_011_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				713.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	012	0	1	01	01	H4604_012_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	012	0	1	01	01	H4604_012_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	012	0	1	01	01	H4604_012_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	012	0	1	01	01	H4604_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	012	0	1	01	01	H4604_012_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				515.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	013	0	1	01	01	H4604_013_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	013	0	1	01	01	H4604_013_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	013	0	1	01	01	H4604_013_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	013	0	1	01	01	H4604_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	013	0	1	01	01	H4604_013_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				515.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	014	0	1	01	01	H4604_014_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	014	0	1	01	01	H4604_014_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	014	0	1	01	01	H4604_014_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	014	0	1	01	01	H4604_014_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4604	014	0	1	01	01	H4604_014_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				515.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4605	002	0	1	04	01	H4605_002_0	9	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4605	002	0	1	04	01	H4605_002_0	9	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4605	002	0	1	04	01	H4605_002_0	9	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4605	002	0	1	04	01	H4605_002_0	9	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4605	002	0	1	04	01	H4605_002_0	9	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1192.36	26						1192.36	26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4605	002	0	1	04	01	H4605_002_0	9	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4605	004	0	1	04	01	H4605_004_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					3.00	6.00	6.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4605	004	0	1	04	01	H4605_004_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4605	004	0	1	04	01	H4605_004_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4605	004	0	1	04	01	H4605_004_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4605	004	0	1	04	01	H4605_004_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1513.38	33						1513.38	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4605	004	0	1	04	01	H4605_004_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	004	0	1	04	01	H4754_004_0	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	004	0	1	04	01	H4754_004_0	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	004	0	1	04	01	H4754_004_0	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	004	0	1	04	01	H4754_004_0	8	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H4754	004	0	1	04	01	H4754_004_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.22	33	33	33				81.46	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	004	0	1	04	01	H4754_004_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	004	0	1	04	01	H4754_004_0	8	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	004	0	1	04	01	H4754_004_0	8	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4754	007	0	1	04	01	H4754_007_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	007	0	1	04	01	H4754_007_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	007	0	1	04	01	H4754_007_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	007	0	1	04	01	H4754_007_0	7	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H4754	007	0	1	04	01	H4754_007_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											80.96	33	33	33				73.75	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	007	0	1	04	01	H4754_007_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	007	0	1	04	01	H4754_007_0	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	007	0	1	04	01	H4754_007_0	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4754	009	0	1	04	01	H4754_009_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	009	0	1	04	01	H4754_009_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	009	0	1	04	01	H4754_009_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	009	0	1	04	01	H4754_009_0	7	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H4754	009	0	1	04	01	H4754_009_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.78	33	33	33				88.10	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	009	0	1	04	01	H4754_009_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	009	0	1	04	01	H4754_009_0	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	009	0	1	04	01	H4754_009_0	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4754	011	0	1	04	01	H4754_011_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	011	0	1	04	01	H4754_011_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	011	0	1	04	01	H4754_011_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	011	0	1	04	01	H4754_011_0	7	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2		
H4754	011	0	1	04	01	H4754_011_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.31	33	33	33				90.50	31	31	31										33	33	33				31	31	31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	011	0	1	04	01	H4754_011_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	011	0	1	04	01	H4754_011_0	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4754	011	0	1	04	01	H4754_011_0	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4778	001	0	1	01	01	H4778_001_0	3	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4778	001	0	1	01	01	H4778_001_0	3	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4778	002	0	1	01	01	H4778_002_0	3	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4778	002	0	1	01	01	H4778_002_0	3	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4778	003	0	1	01	01	H4778_003_0	4	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4778	003	0	1	01	01	H4778_003_0	4	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H4853	001	0	1	01	01	H4853_001_0	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		6.00																			2.00		0.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4853	001	0	1	01	01	H4853_001_0	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		24.00																			8.00		0.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4853	001	0	1	01	01	H4853_001_0	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4853	001	0	1	01	01	H4853_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4853	001	0	1	01	01	H4853_001_0	7	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				733.18	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4853	002	0	1	01	01	H4853_002_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4853	002	0	1	01	01	H4853_002_0	6	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		24.00																			8.00		0.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4853	002	0	1	01	01	H4853_002_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4853	002	0	1	01	01	H4853_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4853	002	0	1	01	01	H4853_002_0	6	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				805.12	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4868	001	0	1	01	01	H4868_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		34	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4868	001	0	1	01	01	H4868_001_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		34	15.00		37.50																									15.00		37.50				15.00		15.00				15.00				15.00		0.50				0.50	0.50	0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4868	001	0	1	01	01	H4868_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		34	47.00		117.50																									47.00		117.50				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4868	001	0	1	01	01	H4868_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		34				1.00	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4868	001	0	1	01	01	H4868_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		34				1.00	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	1	1	04	01	H4875_016_1	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	1	1	04	01	H4875_016_1	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	1	1	04	01	H4875_016_1	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	1	1	04	01	H4875_016_1	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											89.76	50	50	50				80.78	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	1	1	04	01	H4875_016_1	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	2	1	04	01	H4875_016_2	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	2	1	04	01	H4875_016_2	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	2	1	04	01	H4875_016_2	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	2	1	04	01	H4875_016_2	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											89.76	50	50	50				80.78	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	2	1	04	01	H4875_016_2	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	3	1	04	01	H4875_016_3	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	3	1	04	01	H4875_016_3	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	3	1	04	01	H4875_016_3	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	3	1	04	01	H4875_016_3	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											89.76	50	50	50				80.78	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	3	1	04	01	H4875_016_3	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	4	1	04	01	H4875_016_4	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	4	1	04	01	H4875_016_4	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	4	1	04	01	H4875_016_4	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	4	1	04	01	H4875_016_4	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											89.76	50	50	50				80.78	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	4	1	04	01	H4875_016_4	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	5	1	04	01	H4875_016_5	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	5	1	04	01	H4875_016_5	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	5	1	04	01	H4875_016_5	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	5	1	04	01	H4875_016_5	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											89.76	50	50	50				80.78	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	016	5	1	04	01	H4875_016_5	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	1	1	04	01	H4875_017_1	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	1	1	04	01	H4875_017_1	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	1	1	04	01	H4875_017_1	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	1	1	04	01	H4875_017_1	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											81.74	45	45	45				72.66	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	1	1	04	01	H4875_017_1	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	2	1	04	01	H4875_017_2	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	2	1	04	01	H4875_017_2	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	2	1	04	01	H4875_017_2	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	2	1	04	01	H4875_017_2	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											81.74	45	45	45				72.66	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	2	1	04	01	H4875_017_2	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	3	1	04	01	H4875_017_3	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	3	1	04	01	H4875_017_3	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	3	1	04	01	H4875_017_3	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	3	1	04	01	H4875_017_3	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											81.74	45	45	45				72.66	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	3	1	04	01	H4875_017_3	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	4	1	04	01	H4875_017_4	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	4	1	04	01	H4875_017_4	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	4	1	04	01	H4875_017_4	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	4	1	04	01	H4875_017_4	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											81.74	45	45	45				72.66	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	4	1	04	01	H4875_017_4	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	5	1	04	01	H4875_017_5	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	5	1	04	01	H4875_017_5	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	5	1	04	01	H4875_017_5	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	5	1	04	01	H4875_017_5	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											81.74	45	45	45				72.66	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	017	5	1	04	01	H4875_017_5	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	1	1	04	01	H4875_018_1	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	10.00																9.00				9.00			0.30	0.13	0.13			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	1	1	04	01	H4875_018_1	6	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	32.50																18.00				18.00			0.60	0.43	0.43			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	1	1	04	01	H4875_018_1	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	1	1	04	01	H4875_018_1	6	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											99.16	50	50	50				89.24	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	1	1	04	01	H4875_018_1	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	2	1	04	01	H4875_018_2	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	10.00																9.00				9.00			0.30	0.13	0.13			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	2	1	04	01	H4875_018_2	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	32.50																18.00				18.00			0.60	0.43	0.43			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	2	1	04	01	H4875_018_2	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	2	1	04	01	H4875_018_2	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											99.16	50	50	50				89.24	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	2	1	04	01	H4875_018_2	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	3	1	04	01	H4875_018_3	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	10.00																9.00				9.00			0.30	0.13	0.13			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	3	1	04	01	H4875_018_3	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	32.50																18.00				18.00			0.60	0.43	0.43			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	3	1	04	01	H4875_018_3	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	3	1	04	01	H4875_018_3	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											99.16	50	50	50				89.24	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	3	1	04	01	H4875_018_3	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	4	1	04	01	H4875_018_4	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	10.00																9.00				9.00			0.30	0.13	0.13			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	4	1	04	01	H4875_018_4	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	32.50																18.00				18.00			0.60	0.43	0.43			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	4	1	04	01	H4875_018_4	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	4	1	04	01	H4875_018_4	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											99.16	50	50	50				89.24	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	4	1	04	01	H4875_018_4	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	5	1	04	01	H4875_018_5	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	10.00																9.00				9.00			0.30	0.13	0.13			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	5	1	04	01	H4875_018_5	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	32.50																18.00				18.00			0.60	0.43	0.43			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	5	1	04	01	H4875_018_5	4	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	5	1	04	01	H4875_018_5	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											99.16	50	50	50				89.24	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4875	018	5	1	04	01	H4875_018_5	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4876	001	0	1	04	01	H4876_001_0	8	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4876	001	0	1	04	01	H4876_001_0	8	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H4876	001	0	1	04	01	H4876_001_0	8	Preferred Brand	4	10	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	15.00	30.00	45.00																					45.00																15.00				15.00		0.50						0.48	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4876	001	0	1	04	01	H4876_001_0	8	Non-Preferred Brand	4	10	3	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	3	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4876	001	0	1	04	01	H4876_001_0	8	Specialty Tier	4	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				1540.11	33	33	33																				33															33			33								1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4876	003	0	1	04	01	H4876_003_0	9	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4876	003	0	1	04	01	H4876_003_0	9	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H4876	003	0	1	04	01	H4876_003_0	9	Preferred Brand	4	10	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4876	003	0	1	04	01	H4876_003_0	9	Non-Preferred Brand	4	10	3	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	75.00	150.00	225.00																					225.00																75.00				75.00		2.50						2.42	3	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4876	003	0	1	04	01	H4876_003_0	9	Specialty Tier	4	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				1540.11	33	33	33																				33															33			33								1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4882	001	0	1	04	01	H4882_001_0	10	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		12.00				6.00				6.00		0.20				0.20	0.20	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4882	001	0	1	04	01	H4882_001_0	10	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4882	001	0	1	04	01	H4882_001_0	10	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4882	001	0	1	04	01	H4882_001_0	10	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				40.33	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4882	001	0	1	04	01	H4882_001_0	10	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H4909	014	0	1	04	01	H4909_014_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	014	0	1	04	01	H4909_014_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	014	0	1	04	01	H4909_014_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	014	0	1	04	01	H4909_014_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	014	0	1	04	01	H4909_014_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	014	0	1	04	01	H4909_014_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	014	0	1	04	01	H4909_014_0	4	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4909	015	0	1	04	01	H4909_015_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	015	0	1	04	01	H4909_015_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	39.00	39.00																18.00				18.00			0.60	0.43	0.43			0.53		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	015	0	1	04	01	H4909_015_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	015	0	1	04	01	H4909_015_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	015	0	1	04	01	H4909_015_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	015	0	1	04	01	H4909_015_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H4909	015	0	1	04	01	H4909_015_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H4922	005	1	1	01	01	H4922_005_1	10	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	12.50																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4922	005	1	1	01	01	H4922_005_1	10	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H4922	005	1	1	01	01	H4922_005_1	10	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	37.50																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4922	005	1	1	01	01	H4922_005_1	10	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	129.25																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4922	005	1	1	01	01	H4922_005_1	10	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	261.25																					237.50																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4922	005	1	1	01	01	H4922_005_1	10	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				100.00	25	25	25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4922	005	2	1	01	01	H4922_005_2	12	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	12.50																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4922	005	2	1	01	01	H4922_005_2	12	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H4922	005	2	1	01	01	H4922_005_2	12	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	37.50																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4922	005	2	1	01	01	H4922_005_2	12	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	129.25																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4922	005	2	1	01	01	H4922_005_2	12	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	261.25																					237.50																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H4922	005	2	1	01	01	H4922_005_2	12	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				100.00	25	25	25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5009	002	0	1	04	01	H5009_002_0	9	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5009	002	0	1	04	01	H5009_002_0	9	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5009	002	0	1	04	01	H5009_002_0	9	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5009	002	0	1	04	01	H5009_002_0	9	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5009	002	0	1	04	01	H5009_002_0	9	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1238.22	27						1238.22	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5009	002	0	1	04	01	H5009_002_0	9	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5009	008	0	1	04	01	H5009_008_0	8	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	18.00					2.00	4.00	4.00					2.00	4.00	4.00																9.00				9.00			0.30	0.07	0.07			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5009	008	0	1	04	01	H5009_008_0	8	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	22.00					4.00	8.00	8.00					4.00	8.00	8.00																11.00				11.00			0.37	0.13	0.13			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5009	008	0	1	04	01	H5009_008_0	8	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5009	008	0	1	04	01	H5009_008_0	8	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5009	008	0	1	04	01	H5009_008_0	8	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1146.50	25						1146.50	25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5009	008	0	1	04	01	H5009_008_0	8	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	002	0	1	04	01	H5010_002_0	10	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	002	0	1	04	01	H5010_002_0	10	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	002	0	1	04	01	H5010_002_0	10	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	002	0	1	04	01	H5010_002_0	10	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	002	0	1	04	01	H5010_002_0	10	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1238.22	27						1238.22	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	002	0	1	04	01	H5010_002_0	10	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	004	0	1	04	01	H5010_004_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					3.00	6.00	6.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	004	0	1	04	01	H5010_004_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	004	0	1	04	01	H5010_004_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	004	0	1	04	01	H5010_004_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	004	0	1	04	01	H5010_004_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1513.38	33						1513.38	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5010	004	0	1	04	01	H5010_004_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5050	004	0	1	01	01	H5050_004_0	8	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	004	0	1	01	01	H5050_004_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.66			0.66			0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	004	0	1	01	01	H5050_004_0	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	004	0	1	01	01	H5050_004_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.16			3.16			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	004	0	1	01	01	H5050_004_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1446.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	004	0	1	01	01	H5050_004_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	009	0	1	01	01	H5050_009_0	8	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	009	0	1	01	01	H5050_009_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.66			0.66			0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	009	0	1	01	01	H5050_009_0	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	009	0	1	01	01	H5050_009_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.16			3.16			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	009	0	1	01	01	H5050_009_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1897.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	009	0	1	01	01	H5050_009_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	013	0	1	01	01	H5050_013_0	8	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	013	0	1	01	01	H5050_013_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.66			0.66			0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	013	0	1	01	01	H5050_013_0	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	013	0	1	01	01	H5050_013_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.16			3.16			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	013	0	1	01	01	H5050_013_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				2011.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	013	0	1	01	01	H5050_013_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	017	0	1	01	01	H5050_017_0	7	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.16			0.16			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	017	0	1	01	01	H5050_017_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.66			0.66			0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	017	0	1	01	01	H5050_017_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.56			1.56			1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	017	0	1	01	01	H5050_017_0	7	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	97.00	194.00	291.00																			97.00	194.00	291.00																97.00				97.00		3.23			3.23			3.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	017	0	1	01	01	H5050_017_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1165.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	017	0	1	01	01	H5050_017_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	019	0	1	01	01	H5050_019_0	8	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	019	0	1	01	01	H5050_019_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	019	0	1	01	01	H5050_019_0	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	019	0	1	01	01	H5050_019_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	270.00																90.00				90.00		3.00			3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	019	0	1	01	01	H5050_019_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				2137.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	019	0	1	01	01	H5050_019_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	021	0	1	01	01	H5050_021_0	8	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	021	0	1	01	01	H5050_021_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.66			0.66			0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	021	0	1	01	01	H5050_021_0	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	021	0	1	01	01	H5050_021_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.16			3.16			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	021	0	1	01	01	H5050_021_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1565.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5050	021	0	1	01	01	H5050_021_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H5087	001	0	1	01	01	H5087_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	001	0	1	01	01	H5087_001_0	3	Generic	4	01	3	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		40.00				16.00				16.00		0.53				0.53	0.53	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	001	0	1	01	01	H5087_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	001	0	1	01	01	H5087_001_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.71	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	001	0	1	01	01	H5087_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				389.84	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	002	0	1	01	01	H5087_002_0	2	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	002	0	1	01	01	H5087_002_0	2	Generic	4	01	3	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	002	0	1	01	01	H5087_002_0	2	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	002	0	1	01	01	H5087_002_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	002	0	1	01	01	H5087_002_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				351.94	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	005	0	1	01	01	H5087_005_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	005	0	1	01	01	H5087_005_0	4	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5087	005	0	1	01	01	H5087_005_0	4	Generic	4	01	3	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	005	0	1	01	01	H5087_005_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	005	0	1	01	01	H5087_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	005	0	1	01	01	H5087_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				633.78	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	016	0	1	01	01	H5087_016_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	016	0	1	01	01	H5087_016_0	4	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5087	016	0	1	01	01	H5087_016_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	016	0	1	01	01	H5087_016_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	016	0	1	01	01	H5087_016_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	016	0	1	01	01	H5087_016_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				574.88	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	017	0	1	01	01	H5087_017_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	017	0	1	01	01	H5087_017_0	3	Generic	4	01	3	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	017	0	1	01	01	H5087_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	017	0	1	01	01	H5087_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5087	017	0	1	01	01	H5087_017_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				422.96	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5106	013	0	1	04	01	H5106_013_0	10	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5106	013	0	1	04	01	H5106_013_0	10	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					15.00		45.00													60.00						40.00				20.00				20.00			0.65	0.48				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5106	013	0	1	04	01	H5106_013_0	10	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						115.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5106	013	0	1	04	01	H5106_013_0	10	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.23	2.90				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5106	013	0	1	04	01	H5106_013_0	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1263.54	33						1263.54	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5117	001	0	1	01	01	H5117_001_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5117	001	0	1	01	01	H5117_001_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	30.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5117	001	0	1	01	01	H5117_001_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5117	001	0	1	01	01	H5117_001_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5117	001	0	1	01	01	H5117_001_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5117	001	0	1	01	01	H5117_001_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5117	002	0	1	01	01	H5117_002_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5117	002	0	1	01	01	H5117_002_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	30.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5117	002	0	1	01	01	H5117_002_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5117	002	0	1	01	01	H5117_002_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5117	002	0	1	01	01	H5117_002_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5117	002	0	1	01	01	H5117_002_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5141	001	0	1	04	01	H5141_001_0	8	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	001	0	1	04	01	H5141_001_0	8	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							20.00																15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	001	0	1	04	01	H5141_001_0	8	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								45.00	90.00	135.00					35.00	70.00	105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	001	0	1	04	01	H5141_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								95.00	190.00	285.00					85.00	170.00	255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	001	0	1	04	01	H5141_001_0	8	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											950.84	25	25	25				950.84	25	25	25						25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	004	0	1	04	01	H5141_004_0	8	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	004	0	1	04	01	H5141_004_0	8	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							20.00																15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	004	0	1	04	01	H5141_004_0	8	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								45.00	90.00	135.00					35.00	70.00	105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	004	0	1	04	01	H5141_004_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								95.00	190.00	285.00					85.00	170.00	255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	004	0	1	04	01	H5141_004_0	8	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											950.84	25	25	25				950.84	25	25	25						25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	007	0	1	04	01	H5141_007_0	10	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	30.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	007	0	1	04	01	H5141_007_0	10	Generic	4	01	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											7.40	25	25	25				6.51	22	22	22						25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	007	0	1	04	01	H5141_007_0	10	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											55.20	25	25	25				48.57	22	22	22						25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	007	0	1	04	01	H5141_007_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											65.19	25	25	25				65.19	25	25	25						25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	007	0	1	04	01	H5141_007_0	10	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											950.84	25	25	25				950.84	25	25	25						25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	025	0	1	04	01	H5141_025_0	8	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	025	0	1	04	01	H5141_025_0	8	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							20.00																15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	025	0	1	04	01	H5141_025_0	8	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								45.00	90.00	135.00					35.00	70.00	105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	025	0	1	04	01	H5141_025_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								95.00	190.00	285.00					85.00	170.00	255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	025	0	1	04	01	H5141_025_0	8	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1141.00	30	30	30				1141.00	30	30	30						30															30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	026	0	1	04	01	H5141_026_0	8	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	026	0	1	04	01	H5141_026_0	8	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							20.00																15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	026	0	1	04	01	H5141_026_0	8	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								45.00	90.00	135.00					35.00	70.00	105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	026	0	1	04	01	H5141_026_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								95.00	190.00	285.00					85.00	170.00	255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	026	0	1	04	01	H5141_026_0	8	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1141.00	30	30	30				1141.00	30	30	30						30															30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	028	0	1	04	01	H5141_028_0	9	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	028	0	1	04	01	H5141_028_0	9	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							20.00																15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	028	0	1	04	01	H5141_028_0	9	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								45.00	90.00	135.00					35.00	70.00	105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	028	0	1	04	01	H5141_028_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								95.00	190.00	285.00					85.00	170.00	255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	028	0	1	04	01	H5141_028_0	9	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1141.00	30	30	30				1141.00	30	30	30						30															30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	032	0	1	04	01	H5141_032_0	9	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	032	0	1	04	01	H5141_032_0	9	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							20.00																15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	032	0	1	04	01	H5141_032_0	9	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								45.00	90.00	135.00					35.00	70.00	105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	032	0	1	04	01	H5141_032_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								95.00	190.00	285.00					85.00	170.00	255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5141	032	0	1	04	01	H5141_032_0	9	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1141.00	30	30	30				1141.00	30	30	30						30															30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5172	002	0	1	48	05	H5172_002_0	7	Generic Drugs	4	01			1	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	7	Brand Drugs	4	10			2	1	110		01	110		1	31		93				1	2	31		93				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1		0.00	8.35	0.00	8.35	0.00	8.35	0.00	8.35			
H5172	002	0	1	48	05	H5172_002_0	7	Non-Medicare Rx Drugs	4	11			3	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	7	Non-Medicare OTC Drugs	4	11			4	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5190	001	0	1	01	01	H5190_001_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	001	0	1	01	01	H5190_001_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5190	001	0	1	01	01	H5190_001_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	001	0	1	01	01	H5190_001_0	4	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5190	001	0	1	01	01	H5190_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	001	0	1	01	01	H5190_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	001	0	1	01	01	H5190_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	001	0	1	01	01	H5190_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	001	0	1	01	01	H5190_001_0	4	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5190	002	0	1	01	01	H5190_002_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	002	0	1	01	01	H5190_002_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5190	002	0	1	01	01	H5190_002_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	002	0	1	01	01	H5190_002_0	4	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5190	002	0	1	01	01	H5190_002_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	002	0	1	01	01	H5190_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	002	0	1	01	01	H5190_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	002	0	1	01	01	H5190_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	002	0	1	01	01	H5190_002_0	4	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5190	003	0	1	01	01	H5190_003_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	003	0	1	01	01	H5190_003_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5190	003	0	1	01	01	H5190_003_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	003	0	1	01	01	H5190_003_0	4	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5190	003	0	1	01	01	H5190_003_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	003	0	1	01	01	H5190_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	003	0	1	01	01	H5190_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	003	0	1	01	01	H5190_003_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	003	0	1	01	01	H5190_003_0	4	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5190	004	0	1	01	01	H5190_004_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	004	0	1	01	01	H5190_004_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5190	004	0	1	01	01	H5190_004_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	004	0	1	01	01	H5190_004_0	4	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5190	004	0	1	01	01	H5190_004_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	004	0	1	01	01	H5190_004_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	004	0	1	01	01	H5190_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	004	0	1	01	01	H5190_004_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5190	004	0	1	01	01	H5190_004_0	4	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5199	001	0	1	04	01	H5199_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	001	0	1	04	01	H5199_001_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	001	0	1	04	01	H5199_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	001	0	1	04	01	H5199_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	001	0	1	04	01	H5199_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				587.33	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	002	0	1	04	01	H5199_002_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	002	0	1	04	01	H5199_002_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	002	0	1	04	01	H5199_002_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	002	0	1	04	01	H5199_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	002	0	1	04	01	H5199_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				587.21	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	003	0	1	04	01	H5199_003_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	003	0	1	04	01	H5199_003_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	003	0	1	04	01	H5199_003_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	003	0	1	04	01	H5199_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	003	0	1	04	01	H5199_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				587.33	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	004	0	1	04	01	H5199_004_0	4	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	004	0	1	04	01	H5199_004_0	4	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	004	0	1	04	01	H5199_004_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	004	0	1	04	01	H5199_004_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5199	004	0	1	04	01	H5199_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				587.33	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5211	002	0	1	02	01	H5211_002_0	6	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.16			0.16			0.14		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	002	0	1	02	01	H5211_002_0	6	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.46			0.46			0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	002	0	1	02	01	H5211_002_0	6	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	002	0	1	02	01	H5211_002_0	6	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	002	0	1	02	01	H5211_002_0	6	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				1671.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	002	0	1	02	01	H5211_002_0	6	Vaccines	3	11	1	2	6	1	010		01			1	30														30		34	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	004	0	1	02	01	H5211_004_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.30			0.30			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	004	0	1	02	01	H5211_004_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.66			0.66			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	004	0	1	02	01	H5211_004_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.56			1.56			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	004	0	1	02	01	H5211_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	004	0	1	02	01	H5211_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34				2388.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	004	0	1	02	01	H5211_004_0	6	Vaccines	4	11	1	2	6	1	010		01			1	30														30		34	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	007	0	1	02	01	H5211_007_0	7	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.16			0.16			0.14		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	007	0	1	02	01	H5211_007_0	7	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	13.00	26.00	39.00																			13.00	26.00	39.00																13.00				13.00		0.43			0.43			0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	007	0	1	02	01	H5211_007_0	7	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	007	0	1	02	01	H5211_007_0	7	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	98.00	196.00	294.00																			98.00	196.00	294.00																98.00				98.00		3.27			3.27			2.88		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	007	0	1	02	01	H5211_007_0	7	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				1829.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	007	0	1	02	01	H5211_007_0	7	Vaccines	3	11	1	2	6	1	010		01			1	30														30		34	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	008	0	1	02	01	H5211_008_0	5	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.16			0.16			0.14		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	008	0	1	02	01	H5211_008_0	5	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.66			0.66			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	008	0	1	02	01	H5211_008_0	5	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	008	0	1	02	01	H5211_008_0	5	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	008	0	1	02	01	H5211_008_0	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				1671.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	008	0	1	02	01	H5211_008_0	5	Vaccines	3	11	1	2	6	1	010		01			1	30														30		34	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	009	0	1	02	01	H5211_009_0	5	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.20			0.20			0.17		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	009	0	1	02	01	H5211_009_0	5	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.66			0.66			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	009	0	1	02	01	H5211_009_0	5	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	009	0	1	02	01	H5211_009_0	5	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	009	0	1	02	01	H5211_009_0	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				1671.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	009	0	1	02	01	H5211_009_0	5	Vaccines	3	11	1	2	6	1	010		01			1	30														30		34	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	012	0	1	02	01	H5211_012_0	5	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.16			0.16			0.14		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	012	0	1	02	01	H5211_012_0	5	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.66			0.66			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	012	0	1	02	01	H5211_012_0	5	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	012	0	1	02	01	H5211_012_0	5	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	012	0	1	02	01	H5211_012_0	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				1671.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5211	012	0	1	02	01	H5211_012_0	5	Vaccines	3	11	1	2	6	1	010		01			1	30														30		34	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines													
H5215	002	0	1	04	01	H5215_002_0	8	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		5.00																2.00				2.00			0.13	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	002	0	1	04	01	H5215_002_0	8	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	002	0	1	04	01	H5215_002_0	8	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	002	0	1	04	01	H5215_002_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								91.00		228.00					84.00		210.00					84.00		210.00																84.00				84.00			3.03	2.80	2.80			2.71		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	002	0	1	04	01	H5215_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	005	0	1	04	01	H5215_005_0	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		5.00																2.00				2.00			0.13	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	005	0	1	04	01	H5215_005_0	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	005	0	1	04	01	H5215_005_0	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	005	0	1	04	01	H5215_005_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								91.00		228.00					84.00		210.00					84.00		210.00																84.00				84.00			3.03	2.80	2.80			2.71		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	005	0	1	04	01	H5215_005_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	007	0	1	04	01	H5215_007_0	7	Preferred Generic	3	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								3.00		8.00					1.00		3.00					1.00		3.00																1.00				1.00			0.10	0.03	0.03			0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	007	0	1	04	01	H5215_007_0	7	Generic	3	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	007	0	1	04	01	H5215_007_0	7	Preferred Brand	3	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	007	0	1	04	01	H5215_007_0	7	Non-Preferred Brand	3	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								91.00		228.00					84.00		210.00					84.00		210.00																84.00				84.00			3.03	2.80	2.80			2.71		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	007	0	1	04	01	H5215_007_0	7	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	008	0	1	04	01	H5215_008_0	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		5.00																2.00				2.00			0.13	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	008	0	1	04	01	H5215_008_0	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	008	0	1	04	01	H5215_008_0	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	008	0	1	04	01	H5215_008_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								91.00		228.00					84.00		210.00					84.00		210.00																84.00				84.00			3.03	2.80	2.80			2.71		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	008	0	1	04	01	H5215_008_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	009	0	1	04	01	H5215_009_0	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		5.00																2.00				2.00			0.13	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	009	0	1	04	01	H5215_009_0	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	009	0	1	04	01	H5215_009_0	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	009	0	1	04	01	H5215_009_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								91.00		228.00					84.00		210.00					84.00		210.00																84.00				84.00			3.03	2.80	2.80			2.71		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	009	0	1	04	01	H5215_009_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	010	0	1	04	01	H5215_010_0	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		5.00																2.00				2.00			0.13	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	010	0	1	04	01	H5215_010_0	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	010	0	1	04	01	H5215_010_0	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	010	0	1	04	01	H5215_010_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								91.00		228.00					84.00		210.00					84.00		210.00																84.00				84.00			3.03	2.80	2.80			2.71		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	010	0	1	04	01	H5215_010_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	011	0	1	04	01	H5215_011_0	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		5.00																2.00				2.00			0.13	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	011	0	1	04	01	H5215_011_0	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	011	0	1	04	01	H5215_011_0	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	011	0	1	04	01	H5215_011_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								91.00		228.00					84.00		210.00					84.00		210.00																84.00				84.00			3.03	2.80	2.80			2.71		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5215	011	0	1	04	01	H5215_011_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5216	001	0	1	04	01	H5216_001_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	001	0	1	04	01	H5216_001_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	001	0	1	04	01	H5216_001_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	001	0	1	04	01	H5216_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	001	0	1	04	01	H5216_001_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	006	0	1	04	01	H5216_006_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	006	0	1	04	01	H5216_006_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	006	0	1	04	01	H5216_006_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	006	0	1	04	01	H5216_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	006	0	1	04	01	H5216_006_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	009	0	1	04	01	H5216_009_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	009	0	1	04	01	H5216_009_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	009	0	1	04	01	H5216_009_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	009	0	1	04	01	H5216_009_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	009	0	1	04	01	H5216_009_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	011	0	1	04	01	H5216_011_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	011	0	1	04	01	H5216_011_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	011	0	1	04	01	H5216_011_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	011	0	1	04	01	H5216_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	011	0	1	04	01	H5216_011_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	013	0	1	04	01	H5216_013_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	013	0	1	04	01	H5216_013_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	013	0	1	04	01	H5216_013_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	013	0	1	04	01	H5216_013_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	013	0	1	04	01	H5216_013_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	014	0	1	04	01	H5216_014_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	014	0	1	04	01	H5216_014_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	014	0	1	04	01	H5216_014_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	014	0	1	04	01	H5216_014_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	50		50				80.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	014	0	1	04	01	H5216_014_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	015	1	1	04	01	H5216_015_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	015	1	1	04	01	H5216_015_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	015	1	1	04	01	H5216_015_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	015	1	1	04	01	H5216_015_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	015	1	1	04	01	H5216_015_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	015	2	1	04	01	H5216_015_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	015	2	1	04	01	H5216_015_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	015	2	1	04	01	H5216_015_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	015	2	1	04	01	H5216_015_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	015	2	1	04	01	H5216_015_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	017	0	1	04	01	H5216_017_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	017	0	1	04	01	H5216_017_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	017	0	1	04	01	H5216_017_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	017	0	1	04	01	H5216_017_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	017	0	1	04	01	H5216_017_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	018	0	1	04	01	H5216_018_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	018	0	1	04	01	H5216_018_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	018	0	1	04	01	H5216_018_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	018	0	1	04	01	H5216_018_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	018	0	1	04	01	H5216_018_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	019	0	1	04	01	H5216_019_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	019	0	1	04	01	H5216_019_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	019	0	1	04	01	H5216_019_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	019	0	1	04	01	H5216_019_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	019	0	1	04	01	H5216_019_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	020	0	1	04	01	H5216_020_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	020	0	1	04	01	H5216_020_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	020	0	1	04	01	H5216_020_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	020	0	1	04	01	H5216_020_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	020	0	1	04	01	H5216_020_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	021	0	1	04	01	H5216_021_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	021	0	1	04	01	H5216_021_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	021	0	1	04	01	H5216_021_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	021	0	1	04	01	H5216_021_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	021	0	1	04	01	H5216_021_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	022	0	1	04	01	H5216_022_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	022	0	1	04	01	H5216_022_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	022	0	1	04	01	H5216_022_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	022	0	1	04	01	H5216_022_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	022	0	1	04	01	H5216_022_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	023	0	1	04	01	H5216_023_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	023	0	1	04	01	H5216_023_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	023	0	1	04	01	H5216_023_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	023	0	1	04	01	H5216_023_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	023	0	1	04	01	H5216_023_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	024	0	1	04	01	H5216_024_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	024	0	1	04	01	H5216_024_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	024	0	1	04	01	H5216_024_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	024	0	1	04	01	H5216_024_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	024	0	1	04	01	H5216_024_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	025	0	1	04	01	H5216_025_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	025	0	1	04	01	H5216_025_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	025	0	1	04	01	H5216_025_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	025	0	1	04	01	H5216_025_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	025	0	1	04	01	H5216_025_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	026	0	1	04	01	H5216_026_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	026	0	1	04	01	H5216_026_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	026	0	1	04	01	H5216_026_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	026	0	1	04	01	H5216_026_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	026	0	1	04	01	H5216_026_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	027	0	1	04	01	H5216_027_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	027	0	1	04	01	H5216_027_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	027	0	1	04	01	H5216_027_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	027	0	1	04	01	H5216_027_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	027	0	1	04	01	H5216_027_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	028	0	1	04	01	H5216_028_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	028	0	1	04	01	H5216_028_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	028	0	1	04	01	H5216_028_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	028	0	1	04	01	H5216_028_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	028	0	1	04	01	H5216_028_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	029	0	1	04	01	H5216_029_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	029	0	1	04	01	H5216_029_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	029	0	1	04	01	H5216_029_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	029	0	1	04	01	H5216_029_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	029	0	1	04	01	H5216_029_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	030	1	1	04	01	H5216_030_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	030	1	1	04	01	H5216_030_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	030	1	1	04	01	H5216_030_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	030	1	1	04	01	H5216_030_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	030	1	1	04	01	H5216_030_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	030	2	1	04	01	H5216_030_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	030	2	1	04	01	H5216_030_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	030	2	1	04	01	H5216_030_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	030	2	1	04	01	H5216_030_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	030	2	1	04	01	H5216_030_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	031	1	1	04	01	H5216_031_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	031	1	1	04	01	H5216_031_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	031	1	1	04	01	H5216_031_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	031	1	1	04	01	H5216_031_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	031	1	1	04	01	H5216_031_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	031	2	1	04	01	H5216_031_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	031	2	1	04	01	H5216_031_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	031	2	1	04	01	H5216_031_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	031	2	1	04	01	H5216_031_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	031	2	1	04	01	H5216_031_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	032	0	1	04	01	H5216_032_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	032	0	1	04	01	H5216_032_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	032	0	1	04	01	H5216_032_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	032	0	1	04	01	H5216_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	032	0	1	04	01	H5216_032_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	033	1	1	04	01	H5216_033_1	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	033	1	1	04	01	H5216_033_1	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	033	1	1	04	01	H5216_033_1	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	033	1	1	04	01	H5216_033_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	033	1	1	04	01	H5216_033_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	033	2	1	04	01	H5216_033_2	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	033	2	1	04	01	H5216_033_2	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	033	2	1	04	01	H5216_033_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	033	2	1	04	01	H5216_033_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	033	2	1	04	01	H5216_033_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	034	0	1	04	01	H5216_034_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	034	0	1	04	01	H5216_034_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	034	0	1	04	01	H5216_034_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	034	0	1	04	01	H5216_034_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	034	0	1	04	01	H5216_034_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	035	0	1	04	01	H5216_035_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	035	0	1	04	01	H5216_035_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	035	0	1	04	01	H5216_035_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	035	0	1	04	01	H5216_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	035	0	1	04	01	H5216_035_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	036	0	1	04	01	H5216_036_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	036	0	1	04	01	H5216_036_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	036	0	1	04	01	H5216_036_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	036	0	1	04	01	H5216_036_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	036	0	1	04	01	H5216_036_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	037	0	1	04	01	H5216_037_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	037	0	1	04	01	H5216_037_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	037	0	1	04	01	H5216_037_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	037	0	1	04	01	H5216_037_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	037	0	1	04	01	H5216_037_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	038	0	1	04	01	H5216_038_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	038	0	1	04	01	H5216_038_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	038	0	1	04	01	H5216_038_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	038	0	1	04	01	H5216_038_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	038	0	1	04	01	H5216_038_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	039	0	1	04	01	H5216_039_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	039	0	1	04	01	H5216_039_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	039	0	1	04	01	H5216_039_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	039	0	1	04	01	H5216_039_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	039	0	1	04	01	H5216_039_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	040	0	1	04	01	H5216_040_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	040	0	1	04	01	H5216_040_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	040	0	1	04	01	H5216_040_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	040	0	1	04	01	H5216_040_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	040	0	1	04	01	H5216_040_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	041	0	1	04	01	H5216_041_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	041	0	1	04	01	H5216_041_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	041	0	1	04	01	H5216_041_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	041	0	1	04	01	H5216_041_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	041	0	1	04	01	H5216_041_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	042	0	1	04	01	H5216_042_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	042	0	1	04	01	H5216_042_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	042	0	1	04	01	H5216_042_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	042	0	1	04	01	H5216_042_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	042	0	1	04	01	H5216_042_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	043	1	1	04	01	H5216_043_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	043	1	1	04	01	H5216_043_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	043	1	1	04	01	H5216_043_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	043	1	1	04	01	H5216_043_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	043	1	1	04	01	H5216_043_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	043	2	1	04	01	H5216_043_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	043	2	1	04	01	H5216_043_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	043	2	1	04	01	H5216_043_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	043	2	1	04	01	H5216_043_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	043	2	1	04	01	H5216_043_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	044	0	1	04	01	H5216_044_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	044	0	1	04	01	H5216_044_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	044	0	1	04	01	H5216_044_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	044	0	1	04	01	H5216_044_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	044	0	1	04	01	H5216_044_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	045	0	1	04	01	H5216_045_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	045	0	1	04	01	H5216_045_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	045	0	1	04	01	H5216_045_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	045	0	1	04	01	H5216_045_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	045	0	1	04	01	H5216_045_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	047	0	1	04	01	H5216_047_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	047	0	1	04	01	H5216_047_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	047	0	1	04	01	H5216_047_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	047	0	1	04	01	H5216_047_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	047	0	1	04	01	H5216_047_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	048	0	1	04	01	H5216_048_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	048	0	1	04	01	H5216_048_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	048	0	1	04	01	H5216_048_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	048	0	1	04	01	H5216_048_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	048	0	1	04	01	H5216_048_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	050	0	1	04	01	H5216_050_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	050	0	1	04	01	H5216_050_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	050	0	1	04	01	H5216_050_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	050	0	1	04	01	H5216_050_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	050	0	1	04	01	H5216_050_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	051	0	1	04	01	H5216_051_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	051	0	1	04	01	H5216_051_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	051	0	1	04	01	H5216_051_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	051	0	1	04	01	H5216_051_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	051	0	1	04	01	H5216_051_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	052	1	1	04	01	H5216_052_1	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	052	1	1	04	01	H5216_052_1	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	052	1	1	04	01	H5216_052_1	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	052	1	1	04	01	H5216_052_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	052	1	1	04	01	H5216_052_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	052	2	1	04	01	H5216_052_2	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	052	2	1	04	01	H5216_052_2	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	052	2	1	04	01	H5216_052_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	052	2	1	04	01	H5216_052_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	052	2	1	04	01	H5216_052_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	053	0	1	04	01	H5216_053_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	053	0	1	04	01	H5216_053_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	053	0	1	04	01	H5216_053_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	053	0	1	04	01	H5216_053_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	053	0	1	04	01	H5216_053_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	054	0	1	04	01	H5216_054_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	054	0	1	04	01	H5216_054_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	054	0	1	04	01	H5216_054_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	054	0	1	04	01	H5216_054_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	054	0	1	04	01	H5216_054_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	055	0	1	04	01	H5216_055_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	055	0	1	04	01	H5216_055_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	055	0	1	04	01	H5216_055_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	055	0	1	04	01	H5216_055_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	055	0	1	04	01	H5216_055_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	056	0	1	04	01	H5216_056_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	056	0	1	04	01	H5216_056_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	056	0	1	04	01	H5216_056_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	056	0	1	04	01	H5216_056_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	056	0	1	04	01	H5216_056_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	057	0	1	04	01	H5216_057_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	057	0	1	04	01	H5216_057_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	057	0	1	04	01	H5216_057_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	057	0	1	04	01	H5216_057_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	057	0	1	04	01	H5216_057_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	058	0	1	04	01	H5216_058_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	058	0	1	04	01	H5216_058_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	058	0	1	04	01	H5216_058_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	058	0	1	04	01	H5216_058_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	058	0	1	04	01	H5216_058_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	060	0	1	04	01	H5216_060_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	060	0	1	04	01	H5216_060_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	060	0	1	04	01	H5216_060_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	060	0	1	04	01	H5216_060_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	060	0	1	04	01	H5216_060_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	061	0	1	04	01	H5216_061_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	061	0	1	04	01	H5216_061_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	061	0	1	04	01	H5216_061_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	061	0	1	04	01	H5216_061_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	061	0	1	04	01	H5216_061_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	062	0	1	04	01	H5216_062_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	062	0	1	04	01	H5216_062_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	062	0	1	04	01	H5216_062_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	062	0	1	04	01	H5216_062_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	062	0	1	04	01	H5216_062_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	063	0	1	04	01	H5216_063_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	063	0	1	04	01	H5216_063_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	063	0	1	04	01	H5216_063_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	063	0	1	04	01	H5216_063_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				68.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	063	0	1	04	01	H5216_063_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	064	0	1	04	01	H5216_064_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	064	0	1	04	01	H5216_064_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	064	0	1	04	01	H5216_064_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	064	0	1	04	01	H5216_064_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	064	0	1	04	01	H5216_064_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	065	0	1	04	01	H5216_065_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	065	0	1	04	01	H5216_065_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	065	0	1	04	01	H5216_065_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	065	0	1	04	01	H5216_065_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	065	0	1	04	01	H5216_065_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	066	0	1	04	01	H5216_066_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	066	0	1	04	01	H5216_066_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	066	0	1	04	01	H5216_066_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	066	0	1	04	01	H5216_066_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	066	0	1	04	01	H5216_066_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	067	0	1	04	01	H5216_067_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	067	0	1	04	01	H5216_067_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	067	0	1	04	01	H5216_067_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	067	0	1	04	01	H5216_067_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	067	0	1	04	01	H5216_067_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	068	0	1	04	01	H5216_068_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	068	0	1	04	01	H5216_068_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	068	0	1	04	01	H5216_068_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	068	0	1	04	01	H5216_068_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	068	0	1	04	01	H5216_068_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	070	0	1	04	01	H5216_070_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	070	0	1	04	01	H5216_070_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	070	0	1	04	01	H5216_070_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	070	0	1	04	01	H5216_070_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	070	0	1	04	01	H5216_070_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	071	0	1	04	01	H5216_071_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	071	0	1	04	01	H5216_071_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	071	0	1	04	01	H5216_071_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	071	0	1	04	01	H5216_071_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	071	0	1	04	01	H5216_071_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	072	0	1	04	01	H5216_072_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	072	0	1	04	01	H5216_072_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	072	0	1	04	01	H5216_072_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	072	0	1	04	01	H5216_072_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	072	0	1	04	01	H5216_072_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	073	0	1	04	01	H5216_073_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	073	0	1	04	01	H5216_073_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	073	0	1	04	01	H5216_073_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	073	0	1	04	01	H5216_073_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	073	0	1	04	01	H5216_073_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	074	0	1	04	01	H5216_074_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	074	0	1	04	01	H5216_074_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	074	0	1	04	01	H5216_074_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	074	0	1	04	01	H5216_074_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	074	0	1	04	01	H5216_074_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	075	0	1	04	01	H5216_075_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	075	0	1	04	01	H5216_075_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	075	0	1	04	01	H5216_075_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	075	0	1	04	01	H5216_075_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	075	0	1	04	01	H5216_075_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	076	0	1	04	01	H5216_076_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	076	0	1	04	01	H5216_076_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	076	0	1	04	01	H5216_076_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	076	0	1	04	01	H5216_076_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	076	0	1	04	01	H5216_076_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	078	1	1	04	01	H5216_078_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	078	1	1	04	01	H5216_078_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	078	1	1	04	01	H5216_078_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	078	1	1	04	01	H5216_078_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	078	1	1	04	01	H5216_078_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	078	2	1	04	01	H5216_078_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	078	2	1	04	01	H5216_078_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	078	2	1	04	01	H5216_078_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	078	2	1	04	01	H5216_078_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	078	2	1	04	01	H5216_078_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	079	0	1	04	01	H5216_079_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	079	0	1	04	01	H5216_079_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	079	0	1	04	01	H5216_079_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	079	0	1	04	01	H5216_079_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	079	0	1	04	01	H5216_079_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	1	1	04	01	H5216_080_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	1	1	04	01	H5216_080_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	1	1	04	01	H5216_080_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	1	1	04	01	H5216_080_1	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				66.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	1	1	04	01	H5216_080_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	2	1	04	01	H5216_080_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	2	1	04	01	H5216_080_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	2	1	04	01	H5216_080_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	2	1	04	01	H5216_080_2	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				66.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	2	1	04	01	H5216_080_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	3	1	04	01	H5216_080_3	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	3	1	04	01	H5216_080_3	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	3	1	04	01	H5216_080_3	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	3	1	04	01	H5216_080_3	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				66.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	080	3	1	04	01	H5216_080_3	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	081	0	1	04	01	H5216_081_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	081	0	1	04	01	H5216_081_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	081	0	1	04	01	H5216_081_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	081	0	1	04	01	H5216_081_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	081	0	1	04	01	H5216_081_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	082	0	1	04	01	H5216_082_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	082	0	1	04	01	H5216_082_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	082	0	1	04	01	H5216_082_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	082	0	1	04	01	H5216_082_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	082	0	1	04	01	H5216_082_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	083	0	1	04	01	H5216_083_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	083	0	1	04	01	H5216_083_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	083	0	1	04	01	H5216_083_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	083	0	1	04	01	H5216_083_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	083	0	1	04	01	H5216_083_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	084	0	1	04	01	H5216_084_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	084	0	1	04	01	H5216_084_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	084	0	1	04	01	H5216_084_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	084	0	1	04	01	H5216_084_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											58.00	50		50				58.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	084	0	1	04	01	H5216_084_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	085	0	1	04	01	H5216_085_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	085	0	1	04	01	H5216_085_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	085	0	1	04	01	H5216_085_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	085	0	1	04	01	H5216_085_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	45		45				100.00	45		45										45		45				45		45			45			45								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	085	0	1	04	01	H5216_085_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	087	0	1	04	01	H5216_087_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	087	0	1	04	01	H5216_087_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	087	0	1	04	01	H5216_087_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	087	0	1	04	01	H5216_087_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				70.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	087	0	1	04	01	H5216_087_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	088	0	1	04	01	H5216_088_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	088	0	1	04	01	H5216_088_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	088	0	1	04	01	H5216_088_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	088	0	1	04	01	H5216_088_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	50		50				72.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	088	0	1	04	01	H5216_088_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	089	0	1	04	01	H5216_089_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	089	0	1	04	01	H5216_089_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	089	0	1	04	01	H5216_089_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	089	0	1	04	01	H5216_089_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	50		50				73.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	089	0	1	04	01	H5216_089_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	091	0	1	04	01	H5216_091_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	091	0	1	04	01	H5216_091_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	091	0	1	04	01	H5216_091_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	091	0	1	04	01	H5216_091_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	50		50				81.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	091	0	1	04	01	H5216_091_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	092	0	1	04	01	H5216_092_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	092	0	1	04	01	H5216_092_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	092	0	1	04	01	H5216_092_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	092	0	1	04	01	H5216_092_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	50		50				79.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	092	0	1	04	01	H5216_092_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	093	0	1	04	01	H5216_093_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	093	0	1	04	01	H5216_093_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	093	0	1	04	01	H5216_093_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	093	0	1	04	01	H5216_093_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	093	0	1	04	01	H5216_093_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	094	0	1	04	01	H5216_094_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	094	0	1	04	01	H5216_094_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	094	0	1	04	01	H5216_094_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	094	0	1	04	01	H5216_094_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	094	0	1	04	01	H5216_094_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	095	0	1	04	01	H5216_095_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	095	0	1	04	01	H5216_095_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	095	0	1	04	01	H5216_095_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	095	0	1	04	01	H5216_095_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	095	0	1	04	01	H5216_095_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	096	0	1	04	01	H5216_096_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	096	0	1	04	01	H5216_096_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	096	0	1	04	01	H5216_096_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	096	0	1	04	01	H5216_096_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	096	0	1	04	01	H5216_096_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	097	0	1	04	01	H5216_097_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	097	0	1	04	01	H5216_097_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	097	0	1	04	01	H5216_097_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	097	0	1	04	01	H5216_097_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	097	0	1	04	01	H5216_097_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	098	0	1	04	01	H5216_098_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	098	0	1	04	01	H5216_098_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	098	0	1	04	01	H5216_098_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	098	0	1	04	01	H5216_098_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	098	0	1	04	01	H5216_098_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	099	0	1	04	01	H5216_099_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	099	0	1	04	01	H5216_099_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	099	0	1	04	01	H5216_099_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	099	0	1	04	01	H5216_099_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	099	0	1	04	01	H5216_099_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	100	0	1	04	01	H5216_100_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	100	0	1	04	01	H5216_100_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	100	0	1	04	01	H5216_100_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	100	0	1	04	01	H5216_100_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	100	0	1	04	01	H5216_100_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	103	0	1	04	01	H5216_103_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	103	0	1	04	01	H5216_103_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	103	0	1	04	01	H5216_103_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	103	0	1	04	01	H5216_103_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				67.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	103	0	1	04	01	H5216_103_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	104	0	1	04	01	H5216_104_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	104	0	1	04	01	H5216_104_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	104	0	1	04	01	H5216_104_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	104	0	1	04	01	H5216_104_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	50		50				71.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	104	0	1	04	01	H5216_104_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	106	0	1	04	01	H5216_106_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	106	0	1	04	01	H5216_106_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	106	0	1	04	01	H5216_106_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	106	0	1	04	01	H5216_106_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	106	0	1	04	01	H5216_106_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	107	0	1	04	01	H5216_107_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	107	0	1	04	01	H5216_107_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	107	0	1	04	01	H5216_107_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	107	0	1	04	01	H5216_107_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	107	0	1	04	01	H5216_107_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	108	0	1	04	01	H5216_108_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	108	0	1	04	01	H5216_108_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	108	0	1	04	01	H5216_108_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	108	0	1	04	01	H5216_108_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	108	0	1	04	01	H5216_108_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	109	0	1	04	01	H5216_109_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	109	0	1	04	01	H5216_109_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	109	0	1	04	01	H5216_109_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	109	0	1	04	01	H5216_109_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	109	0	1	04	01	H5216_109_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	110	0	1	04	01	H5216_110_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	110	0	1	04	01	H5216_110_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	110	0	1	04	01	H5216_110_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	110	0	1	04	01	H5216_110_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	110	0	1	04	01	H5216_110_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	111	0	1	04	01	H5216_111_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	111	0	1	04	01	H5216_111_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	111	0	1	04	01	H5216_111_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	111	0	1	04	01	H5216_111_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	111	0	1	04	01	H5216_111_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	112	0	1	04	01	H5216_112_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	112	0	1	04	01	H5216_112_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	112	0	1	04	01	H5216_112_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	112	0	1	04	01	H5216_112_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	112	0	1	04	01	H5216_112_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	113	0	1	04	01	H5216_113_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	113	0	1	04	01	H5216_113_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	113	0	1	04	01	H5216_113_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	113	0	1	04	01	H5216_113_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	113	0	1	04	01	H5216_113_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	114	0	1	04	01	H5216_114_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	114	0	1	04	01	H5216_114_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	114	0	1	04	01	H5216_114_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	114	0	1	04	01	H5216_114_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	114	0	1	04	01	H5216_114_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	115	0	1	04	01	H5216_115_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	115	0	1	04	01	H5216_115_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	115	0	1	04	01	H5216_115_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	115	0	1	04	01	H5216_115_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	115	0	1	04	01	H5216_115_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	117	0	1	04	01	H5216_117_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	117	0	1	04	01	H5216_117_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	117	0	1	04	01	H5216_117_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	117	0	1	04	01	H5216_117_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	117	0	1	04	01	H5216_117_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	119	0	1	04	01	H5216_119_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	119	0	1	04	01	H5216_119_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	119	0	1	04	01	H5216_119_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	119	0	1	04	01	H5216_119_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	119	0	1	04	01	H5216_119_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	120	0	1	04	01	H5216_120_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	120	0	1	04	01	H5216_120_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	120	0	1	04	01	H5216_120_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	120	0	1	04	01	H5216_120_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	120	0	1	04	01	H5216_120_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	121	0	1	04	01	H5216_121_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	121	0	1	04	01	H5216_121_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	121	0	1	04	01	H5216_121_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	121	0	1	04	01	H5216_121_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	121	0	1	04	01	H5216_121_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	122	0	1	04	01	H5216_122_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	122	0	1	04	01	H5216_122_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	122	0	1	04	01	H5216_122_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	122	0	1	04	01	H5216_122_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	122	0	1	04	01	H5216_122_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	124	0	1	04	01	H5216_124_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	124	0	1	04	01	H5216_124_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	124	0	1	04	01	H5216_124_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	124	0	1	04	01	H5216_124_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	124	0	1	04	01	H5216_124_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	125	0	1	04	01	H5216_125_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	125	0	1	04	01	H5216_125_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	125	0	1	04	01	H5216_125_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	125	0	1	04	01	H5216_125_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	125	0	1	04	01	H5216_125_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	126	0	1	04	01	H5216_126_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	126	0	1	04	01	H5216_126_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	126	0	1	04	01	H5216_126_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	126	0	1	04	01	H5216_126_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	126	0	1	04	01	H5216_126_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	131	0	1	04	01	H5216_131_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	131	0	1	04	01	H5216_131_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	131	0	1	04	01	H5216_131_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	131	0	1	04	01	H5216_131_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	131	0	1	04	01	H5216_131_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	132	0	1	04	01	H5216_132_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	132	0	1	04	01	H5216_132_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	132	0	1	04	01	H5216_132_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	132	0	1	04	01	H5216_132_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	132	0	1	04	01	H5216_132_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	133	0	1	04	01	H5216_133_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	133	0	1	04	01	H5216_133_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	133	0	1	04	01	H5216_133_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	133	0	1	04	01	H5216_133_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	133	0	1	04	01	H5216_133_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	135	0	1	04	01	H5216_135_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	135	0	1	04	01	H5216_135_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	135	0	1	04	01	H5216_135_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	135	0	1	04	01	H5216_135_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	135	0	1	04	01	H5216_135_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	136	0	1	04	01	H5216_136_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	136	0	1	04	01	H5216_136_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	136	0	1	04	01	H5216_136_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	136	0	1	04	01	H5216_136_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	136	0	1	04	01	H5216_136_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	137	0	1	04	01	H5216_137_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	137	0	1	04	01	H5216_137_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	137	0	1	04	01	H5216_137_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	137	0	1	04	01	H5216_137_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	137	0	1	04	01	H5216_137_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	138	0	1	04	01	H5216_138_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	138	0	1	04	01	H5216_138_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	138	0	1	04	01	H5216_138_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	138	0	1	04	01	H5216_138_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	138	0	1	04	01	H5216_138_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	139	0	1	04	01	H5216_139_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	139	0	1	04	01	H5216_139_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	139	0	1	04	01	H5216_139_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	139	0	1	04	01	H5216_139_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	139	0	1	04	01	H5216_139_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	141	0	1	04	01	H5216_141_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	141	0	1	04	01	H5216_141_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	141	0	1	04	01	H5216_141_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	141	0	1	04	01	H5216_141_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5216	141	0	1	04	01	H5216_141_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	004	0	1	01	01	H5253_004_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	004	0	1	01	01	H5253_004_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	004	0	1	01	01	H5253_004_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	004	0	1	01	01	H5253_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	004	0	1	01	01	H5253_004_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				667.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	011	0	1	01	01	H5253_011_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	011	0	1	01	01	H5253_011_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	011	0	1	01	01	H5253_011_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	011	0	1	01	01	H5253_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	011	0	1	01	01	H5253_011_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				598.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	030	0	1	01	01	H5253_030_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	030	0	1	01	01	H5253_030_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	030	0	1	01	01	H5253_030_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	030	0	1	01	01	H5253_030_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	030	0	1	01	01	H5253_030_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				560.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	033	0	1	01	01	H5253_033_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	033	0	1	01	01	H5253_033_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	033	0	1	01	01	H5253_033_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	033	0	1	01	01	H5253_033_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	033	0	1	01	01	H5253_033_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				667.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	034	0	1	01	01	H5253_034_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	034	0	1	01	01	H5253_034_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	034	0	1	01	01	H5253_034_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	034	0	1	01	01	H5253_034_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	034	0	1	01	01	H5253_034_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				366.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	035	0	1	02	01	H5253_035_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	035	0	1	02	01	H5253_035_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	035	0	1	02	01	H5253_035_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	035	0	1	02	01	H5253_035_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	035	0	1	02	01	H5253_035_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				723.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	036	0	1	01	01	H5253_036_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	036	0	1	01	01	H5253_036_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	036	0	1	01	01	H5253_036_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	036	0	1	01	01	H5253_036_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	036	0	1	01	01	H5253_036_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				724.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	037	0	1	01	01	H5253_037_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	037	0	1	01	01	H5253_037_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5253	037	0	1	01	01	H5253_037_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	037	0	1	01	01	H5253_037_0	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5253	037	0	1	01	01	H5253_037_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	037	0	1	01	01	H5253_037_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	037	0	1	01	01	H5253_037_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				903.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	038	0	1	01	01	H5253_038_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	038	0	1	01	01	H5253_038_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	038	0	1	01	01	H5253_038_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	038	0	1	01	01	H5253_038_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	038	0	1	01	01	H5253_038_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				868.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	039	0	1	01	01	H5253_039_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	039	0	1	01	01	H5253_039_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	039	0	1	01	01	H5253_039_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	039	0	1	01	01	H5253_039_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	039	0	1	01	01	H5253_039_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				728.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	043	0	1	02	01	H5253_043_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	043	0	1	02	01	H5253_043_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	043	0	1	02	01	H5253_043_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	043	0	1	02	01	H5253_043_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	043	0	1	02	01	H5253_043_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1032.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	044	0	1	01	01	H5253_044_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	044	0	1	01	01	H5253_044_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	044	0	1	01	01	H5253_044_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	044	0	1	01	01	H5253_044_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	044	0	1	01	01	H5253_044_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				581.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	045	0	1	01	01	H5253_045_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	045	0	1	01	01	H5253_045_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	045	0	1	01	01	H5253_045_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	045	0	1	01	01	H5253_045_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	045	0	1	01	01	H5253_045_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				450.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	046	0	1	01	01	H5253_046_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	046	0	1	01	01	H5253_046_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	046	0	1	01	01	H5253_046_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	046	0	1	01	01	H5253_046_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	046	0	1	01	01	H5253_046_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				697.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	047	0	1	02	01	H5253_047_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	047	0	1	02	01	H5253_047_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	047	0	1	02	01	H5253_047_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	047	0	1	02	01	H5253_047_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	047	0	1	02	01	H5253_047_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				741.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	048	0	1	02	01	H5253_048_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	048	0	1	02	01	H5253_048_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	048	0	1	02	01	H5253_048_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	048	0	1	02	01	H5253_048_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	048	0	1	02	01	H5253_048_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				729.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	049	0	1	01	01	H5253_049_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	049	0	1	01	01	H5253_049_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	049	0	1	01	01	H5253_049_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	049	0	1	01	01	H5253_049_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	049	0	1	01	01	H5253_049_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				673.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	050	0	1	01	01	H5253_050_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	050	0	1	01	01	H5253_050_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	050	0	1	01	01	H5253_050_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	050	0	1	01	01	H5253_050_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	050	0	1	01	01	H5253_050_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				777.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	051	0	1	01	01	H5253_051_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	051	0	1	01	01	H5253_051_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	051	0	1	01	01	H5253_051_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	051	0	1	01	01	H5253_051_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	051	0	1	01	01	H5253_051_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				565.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	052	0	1	01	01	H5253_052_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	052	0	1	01	01	H5253_052_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	052	0	1	01	01	H5253_052_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	052	0	1	01	01	H5253_052_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	052	0	1	01	01	H5253_052_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				695.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	053	0	1	01	01	H5253_053_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	053	0	1	01	01	H5253_053_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	053	0	1	01	01	H5253_053_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	053	0	1	01	01	H5253_053_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	053	0	1	01	01	H5253_053_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				711.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	054	0	1	01	01	H5253_054_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	054	0	1	01	01	H5253_054_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	054	0	1	01	01	H5253_054_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	054	0	1	01	01	H5253_054_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	054	0	1	01	01	H5253_054_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				704.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	055	0	1	01	01	H5253_055_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	055	0	1	01	01	H5253_055_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	055	0	1	01	01	H5253_055_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	055	0	1	01	01	H5253_055_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	055	0	1	01	01	H5253_055_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				798.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	056	0	1	01	01	H5253_056_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	056	0	1	01	01	H5253_056_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	056	0	1	01	01	H5253_056_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	056	0	1	01	01	H5253_056_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	056	0	1	01	01	H5253_056_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				797.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	057	0	1	01	01	H5253_057_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	057	0	1	01	01	H5253_057_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	057	0	1	01	01	H5253_057_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	057	0	1	01	01	H5253_057_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	057	0	1	01	01	H5253_057_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				680.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	061	0	1	02	01	H5253_061_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	061	0	1	02	01	H5253_061_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	061	0	1	02	01	H5253_061_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	061	0	1	02	01	H5253_061_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	061	0	1	02	01	H5253_061_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				941.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	062	0	1	01	01	H5253_062_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	062	0	1	01	01	H5253_062_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	062	0	1	01	01	H5253_062_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	062	0	1	01	01	H5253_062_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	062	0	1	01	01	H5253_062_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				835.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	063	0	1	01	01	H5253_063_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	063	0	1	01	01	H5253_063_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	063	0	1	01	01	H5253_063_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	063	0	1	01	01	H5253_063_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	063	0	1	01	01	H5253_063_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				828.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	064	0	1	02	01	H5253_064_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	064	0	1	02	01	H5253_064_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	064	0	1	02	01	H5253_064_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	064	0	1	02	01	H5253_064_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	064	0	1	02	01	H5253_064_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1157.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	067	0	1	01	01	H5253_067_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	067	0	1	01	01	H5253_067_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	067	0	1	01	01	H5253_067_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	067	0	1	01	01	H5253_067_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	067	0	1	01	01	H5253_067_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				664.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	068	0	1	01	01	H5253_068_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	068	0	1	01	01	H5253_068_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	068	0	1	01	01	H5253_068_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	068	0	1	01	01	H5253_068_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	068	0	1	01	01	H5253_068_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				693.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	072	0	1	01	01	H5253_072_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	072	0	1	01	01	H5253_072_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	072	0	1	01	01	H5253_072_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	072	0	1	01	01	H5253_072_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	072	0	1	01	01	H5253_072_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				357.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	073	0	1	01	01	H5253_073_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	073	0	1	01	01	H5253_073_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	073	0	1	01	01	H5253_073_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	073	0	1	01	01	H5253_073_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	073	0	1	01	01	H5253_073_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				567.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	074	0	1	01	01	H5253_074_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	074	0	1	01	01	H5253_074_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	074	0	1	01	01	H5253_074_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	074	0	1	01	01	H5253_074_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	074	0	1	01	01	H5253_074_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				515.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	075	0	1	01	01	H5253_075_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	075	0	1	01	01	H5253_075_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	075	0	1	01	01	H5253_075_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	075	0	1	01	01	H5253_075_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	075	0	1	01	01	H5253_075_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				654.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	076	0	1	01	01	H5253_076_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	076	0	1	01	01	H5253_076_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	076	0	1	01	01	H5253_076_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	076	0	1	01	01	H5253_076_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	076	0	1	01	01	H5253_076_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				514.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	077	0	1	01	01	H5253_077_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	077	0	1	01	01	H5253_077_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	077	0	1	01	01	H5253_077_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	077	0	1	01	01	H5253_077_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	077	0	1	01	01	H5253_077_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				534.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	079	0	1	01	01	H5253_079_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	079	0	1	01	01	H5253_079_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	079	0	1	01	01	H5253_079_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	079	0	1	01	01	H5253_079_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	079	0	1	01	01	H5253_079_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				809.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	080	0	1	01	01	H5253_080_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	080	0	1	01	01	H5253_080_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	080	0	1	01	01	H5253_080_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	080	0	1	01	01	H5253_080_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	080	0	1	01	01	H5253_080_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				877.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	081	0	1	01	01	H5253_081_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	081	0	1	01	01	H5253_081_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	081	0	1	01	01	H5253_081_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	081	0	1	01	01	H5253_081_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	081	0	1	01	01	H5253_081_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				670.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	082	0	1	01	01	H5253_082_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	082	0	1	01	01	H5253_082_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	082	0	1	01	01	H5253_082_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	082	0	1	01	01	H5253_082_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	082	0	1	01	01	H5253_082_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				700.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	083	0	1	01	01	H5253_083_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	083	0	1	01	01	H5253_083_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	083	0	1	01	01	H5253_083_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	083	0	1	01	01	H5253_083_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	083	0	1	01	01	H5253_083_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				676.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	084	0	1	01	01	H5253_084_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	084	0	1	01	01	H5253_084_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	084	0	1	01	01	H5253_084_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	084	0	1	01	01	H5253_084_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	084	0	1	01	01	H5253_084_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				700.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	085	0	1	01	01	H5253_085_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	085	0	1	01	01	H5253_085_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	13.00		39.00																											39.00						0.00				13.00				13.00		0.43						0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	085	0	1	01	01	H5253_085_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	085	0	1	01	01	H5253_085_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	085	0	1	01	01	H5253_085_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				998.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	086	0	1	01	01	H5253_086_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	086	0	1	01	01	H5253_086_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	086	0	1	01	01	H5253_086_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	086	0	1	01	01	H5253_086_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	086	0	1	01	01	H5253_086_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				974.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	087	0	1	01	01	H5253_087_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	087	0	1	01	01	H5253_087_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	087	0	1	01	01	H5253_087_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	087	0	1	01	01	H5253_087_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	087	0	1	01	01	H5253_087_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				818.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	088	0	1	01	01	H5253_088_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	088	0	1	01	01	H5253_088_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	088	0	1	01	01	H5253_088_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	088	0	1	01	01	H5253_088_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	088	0	1	01	01	H5253_088_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1117.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	089	0	1	01	01	H5253_089_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	089	0	1	01	01	H5253_089_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	089	0	1	01	01	H5253_089_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	089	0	1	01	01	H5253_089_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	089	0	1	01	01	H5253_089_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				903.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	090	0	1	01	01	H5253_090_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	090	0	1	01	01	H5253_090_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	090	0	1	01	01	H5253_090_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	090	0	1	01	01	H5253_090_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	090	0	1	01	01	H5253_090_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1021.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	091	0	1	01	01	H5253_091_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	091	0	1	01	01	H5253_091_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	091	0	1	01	01	H5253_091_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	091	0	1	01	01	H5253_091_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	091	0	1	01	01	H5253_091_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				701.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	097	0	1	01	01	H5253_097_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	097	0	1	01	01	H5253_097_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	097	0	1	01	01	H5253_097_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	097	0	1	01	01	H5253_097_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5253	097	0	1	01	01	H5253_097_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				459.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	001	0	1	01	01	H5262_001_0	2	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	001	0	1	01	01	H5262_001_0	2	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	001	0	1	01	01	H5262_001_0	2	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	001	0	1	01	01	H5262_001_0	2	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				37.30	40	40	40																				40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	001	0	1	01	01	H5262_001_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	003	0	1	01	01	H5262_003_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	003	0	1	01	01	H5262_003_0	4	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	003	0	1	01	01	H5262_003_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	003	0	1	01	01	H5262_003_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				32.75	40	40	40																				40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	003	0	1	01	01	H5262_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	007	0	1	01	01	H5262_007_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	6.00	12.00	18.00																					15.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	007	0	1	01	01	H5262_007_0	4	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	007	0	1	01	01	H5262_007_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	007	0	1	01	01	H5262_007_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				37.20	40	40	40																				40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	007	0	1	01	01	H5262_007_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	008	0	1	01	01	H5262_008_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	6.00	12.00	18.00																					15.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	008	0	1	01	01	H5262_008_0	4	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	008	0	1	01	01	H5262_008_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	008	0	1	01	01	H5262_008_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				32.97	40	40	40																				40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	008	0	1	01	01	H5262_008_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	011	0	1	01	01	H5262_011_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	011	0	1	01	01	H5262_011_0	4	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					30.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	011	0	1	01	01	H5262_011_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	011	0	1	01	01	H5262_011_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				41.36	40	40	40																				40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	011	0	1	01	01	H5262_011_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	012	0	1	01	01	H5262_012_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	012	0	1	01	01	H5262_012_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					30.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	012	0	1	01	01	H5262_012_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	012	0	1	01	01	H5262_012_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				36.89	40	40	40																				40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5262	012	0	1	01	01	H5262_012_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5280	001	0	1	48	05	H5280_001_0	4	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5280	001	0	1	48	05	H5280_001_0	4	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5280	001	0	1	48	05	H5280_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5294	002	1	1	01	01	H5294_002_1	3	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	1	1	01	01	H5294_002_1	3	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	38.00	57.00																			19.00	38.00	57.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	1	1	01	01	H5294_002_1	3	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	1	1	01	01	H5294_002_1	3	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	1	1	01	01	H5294_002_1	3	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					32																				32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	1	1	01	01	H5294_002_1	3	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	2	1	01	01	H5294_002_2	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	2	1	01	01	H5294_002_2	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	38.00	57.00																			19.00	38.00	57.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	2	1	01	01	H5294_002_2	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	2	1	01	01	H5294_002_2	4	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	2	1	01	01	H5294_002_2	4	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					32																				32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	2	1	01	01	H5294_002_2	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	3	1	01	01	H5294_002_3	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	3	1	01	01	H5294_002_3	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	38.00	57.00																			19.00	38.00	57.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	3	1	01	01	H5294_002_3	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	3	1	01	01	H5294_002_3	4	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	3	1	01	01	H5294_002_3	4	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					32																				32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	3	1	01	01	H5294_002_3	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	4	1	01	01	H5294_002_4	5	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	4	1	01	01	H5294_002_4	5	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	38.00	57.00																			19.00	38.00	57.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	4	1	01	01	H5294_002_4	5	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	4	1	01	01	H5294_002_4	5	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	4	1	01	01	H5294_002_4	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					32																				32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5294	002	4	1	01	01	H5294_002_4	5	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5302	011	0	1	01	01	H5302_011_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5302	011	0	1	01	01	H5302_011_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5302	011	0	1	01	01	H5302_011_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5302	011	0	1	01	01	H5302_011_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5302	011	0	1	01	01	H5302_011_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5302	011	0	1	01	01	H5302_011_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5302	011	0	1	01	01	H5302_011_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5322	024	0	1	01	01	H5322_024_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5322	024	0	1	01	01	H5322_024_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5322	024	0	1	01	01	H5322_024_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5322	024	0	1	01	01	H5322_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5322	024	0	1	01	01	H5322_024_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				801.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5355	001	0	1	48	05	H5355_001_0	5	Generic Drugs	4	01			1	1	110		01	110		1	31		90				2	2	31		90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	3.35	0.00	3.35	0.00	3.35	0.00	3.35			
H5355	001	0	1	48	05	H5355_001_0	5	Brand Drugs	4	10			2	1	110		01	110		1	31		90				2	2	31		90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	8.35	0.00	8.35	0.00	8.35	0.00	8.35			
H5355	001	0	1	48	05	H5355_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01	110		1	31		90				1	2	31		90				31		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5386	003	0	1	01	01	H5386_003_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		34	4.00	8.00	12.00																					0.00																4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5386	003	0	1	01	01	H5386_003_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		34	8.00	16.00	24.00																					0.00																8.00				8.00		0.27						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5386	003	0	1	01	01	H5386_003_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		34	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5386	003	0	1	01	01	H5386_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		34	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5386	003	0	1	01	01	H5386_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5386	004	0	1	01	01	H5386_004_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		34	4.00	8.00	12.00																					0.00																4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5386	004	0	1	01	01	H5386_004_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		34	8.00	16.00	24.00																					0.00																8.00				8.00		0.27						0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5386	004	0	1	01	01	H5386_004_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		34	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5386	004	0	1	01	01	H5386_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		34	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5386	004	0	1	01	01	H5386_004_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5410	001	0	1	01	01	H5410_001_0	6	Generic	4	11	3	2	1	1		110	01			1				30		90	1	2							30		31								5.00		15.00					0.00		0.00																							5.00				5.00			0.17	0.00				0.16		Generic, Brand, Specialty Tier													
H5410	001	0	1	01	01	H5410_001_0	6	Generic	4	11	3	2	1	3		110	01			1				30		90	1	2							30		31								5.00		15.00					0.00		0.00																							5.00				5.00			0.17	0.00				0.16		Generic, Brand, Specialty Tier											1		3
H5410	001	0	1	01	01	H5410_001_0	6	Brand	4	10	1	2	2	1		110	01			1				30		90	1	2							30		31								10.00		30.00					0.00		0.00																							10.00				10.00			0.33	0.00				0.32		Generic, Brand, Specialty Tier													
H5410	001	0	1	01	01	H5410_001_0	6	Specialty Tier	4	11	1	1	3	1		010	01			1				30											30		31											795.07	33						666.23	33																							33			33									Generic, Brand, Specialty Tier													
H5410	018	0	1	02	01	H5410_018_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00	12.00	6.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5410	018	0	1	02	01	H5410_018_0	4	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00	12.00	6.00																6.00				6.00			0.20	0.03	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5410	018	0	1	02	01	H5410_018_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	15.00					9.00	18.00	9.00					15.00	30.00	15.00																15.00				15.00			0.50	0.30	0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5410	018	0	1	02	01	H5410_018_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5410	018	0	1	02	01	H5410_018_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											59.80	50	50	50				62.48	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5410	018	0	1	02	01	H5410_018_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											417.78	31						453.96	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	001	0	1	01	01	H5420_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	001	0	1	01	01	H5420_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5420	001	0	1	01	01	H5420_001_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	001	0	1	01	01	H5420_001_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5420	001	0	1	01	01	H5420_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	30.00		90.00																											90.00						80.00				30.00				30.00		1.00						0.96		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	001	0	1	01	01	H5420_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	65.00		195.00																											195.00						185.00				65.00				65.00		2.16						2.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	001	0	1	01	01	H5420_001_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				825.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	003	0	1	01	01	H5420_003_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	003	0	1	01	01	H5420_003_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5420	003	0	1	01	01	H5420_003_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	003	0	1	01	01	H5420_003_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5420	003	0	1	01	01	H5420_003_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	003	0	1	01	01	H5420_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	003	0	1	01	01	H5420_003_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				646.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	006	0	1	01	01	H5420_006_0	3	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	006	0	1	01	01	H5420_006_0	3	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5420	006	0	1	01	01	H5420_006_0	3	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	006	0	1	01	01	H5420_006_0	3	Generic	4	01	3	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5420	006	0	1	01	01	H5420_006_0	3	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				48.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	006	0	1	01	01	H5420_006_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				47.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5420	006	0	1	01	01	H5420_006_0	3	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				746.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5422	007	0	1	01	01	H5422_007_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	007	0	1	01	01	H5422_007_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	30.00	30.00																10.00				10.00			0.33	0.33	0.33			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	007	0	1	01	01	H5422_007_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								46.00	92.00	138.00					46.00	92.00	138.00					46.00	138.00	138.00																46.00				46.00			1.53	1.53	1.53			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	007	0	1	01	01	H5422_007_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	007	0	1	01	01	H5422_007_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	007	0	1	01	01	H5422_007_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	007	0	1	01	01	H5422_007_0	8	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5422	008	0	1	01	01	H5422_008_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	008	0	1	01	01	H5422_008_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	008	0	1	01	01	H5422_008_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	008	0	1	01	01	H5422_008_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	008	0	1	01	01	H5422_008_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	008	0	1	01	01	H5422_008_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	008	0	1	01	01	H5422_008_0	4	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5422	009	0	1	01	01	H5422_009_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	009	0	1	01	01	H5422_009_0	5	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5422	009	0	1	01	01	H5422_009_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	009	0	1	01	01	H5422_009_0	5	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5422	009	0	1	01	01	H5422_009_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	009	0	1	01	01	H5422_009_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	009	0	1	01	01	H5422_009_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	009	0	1	01	01	H5422_009_0	5	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5422	009	0	1	01	01	H5422_009_0	5	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5425	001	0	1	01	01	H5425_001_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	001	0	1	01	01	H5425_001_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	001	0	1	01	01	H5425_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	001	0	1	01	01	H5425_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	001	0	1	01	01	H5425_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	004	0	1	01	01	H5425_004_0	3	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	004	0	1	01	01	H5425_004_0	3	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	004	0	1	01	01	H5425_004_0	3	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	004	0	1	01	01	H5425_004_0	3	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	004	0	1	01	01	H5425_004_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	004	0	1	01	01	H5425_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	004	0	1	01	01	H5425_004_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	005	0	1	01	01	H5425_005_0	3	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	005	0	1	01	01	H5425_005_0	3	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	005	0	1	01	01	H5425_005_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	005	0	1	01	01	H5425_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	005	0	1	01	01	H5425_005_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	006	0	1	01	01	H5425_006_0	3	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	006	0	1	01	01	H5425_006_0	3	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	006	0	1	01	01	H5425_006_0	3	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	006	0	1	01	01	H5425_006_0	3	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	006	0	1	01	01	H5425_006_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	006	0	1	01	01	H5425_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	006	0	1	01	01	H5425_006_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	007	0	1	01	01	H5425_007_0	3	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	007	0	1	01	01	H5425_007_0	3	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	007	0	1	01	01	H5425_007_0	3	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	007	0	1	01	01	H5425_007_0	3	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	007	0	1	01	01	H5425_007_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	007	0	1	01	01	H5425_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	007	0	1	01	01	H5425_007_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	008	0	1	01	01	H5425_008_0	3	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	008	0	1	01	01	H5425_008_0	3	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	008	0	1	01	01	H5425_008_0	3	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	008	0	1	01	01	H5425_008_0	3	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	008	0	1	01	01	H5425_008_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	008	0	1	01	01	H5425_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	008	0	1	01	01	H5425_008_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	009	0	1	01	01	H5425_009_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	009	0	1	01	01	H5425_009_0	4	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	009	0	1	01	01	H5425_009_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	009	0	1	01	01	H5425_009_0	4	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	009	0	1	01	01	H5425_009_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	009	0	1	01	01	H5425_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	009	0	1	01	01	H5425_009_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	010	0	1	01	01	H5425_010_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					0.00	0.00	0.00					0.00	0.00	0.00																13.00				13.00			0.43	0.00	0.00			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	010	0	1	01	01	H5425_010_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					0.00	0.00	0.00					0.00	0.00	0.00																13.00				13.00			0.43	0.00	0.00			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	010	0	1	01	01	H5425_010_0	5	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											5.81	25	25	25				5.81	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	010	0	1	01	01	H5425_010_0	5	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											60.27	25	25	25				60.27	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	010	0	1	01	01	H5425_010_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											69.34	25	25	25				69.34	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	010	0	1	01	01	H5425_010_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	019	0	1	01	01	H5425_019_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	019	0	1	01	01	H5425_019_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	019	0	1	01	01	H5425_019_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	019	0	1	01	01	H5425_019_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	019	0	1	01	01	H5425_019_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	020	0	1	01	01	H5425_020_0	6	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	020	0	1	01	01	H5425_020_0	6	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	020	0	1	01	01	H5425_020_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	020	0	1	01	01	H5425_020_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	020	0	1	01	01	H5425_020_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	028	0	1	01	01	H5425_028_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	028	0	1	01	01	H5425_028_0	4	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	028	0	1	01	01	H5425_028_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	028	0	1	01	01	H5425_028_0	4	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	028	0	1	01	01	H5425_028_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	028	0	1	01	01	H5425_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	028	0	1	01	01	H5425_028_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	029	0	1	01	01	H5425_029_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.50	15.00	22.50					0.00	0.00	0.00					0.00	0.00	0.00																7.50				7.50			0.25	0.00	0.00			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	029	0	1	01	01	H5425_029_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.50	15.00	22.50					0.00	0.00	0.00					0.00	0.00	0.00																7.50				7.50			0.25	0.00	0.00			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	029	0	1	01	01	H5425_029_0	5	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											5.58	25	25	25				5.58	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	029	0	1	01	01	H5425_029_0	5	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											57.46	25	25	25				57.46	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	029	0	1	01	01	H5425_029_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											71.53	25	25	25				71.53	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	029	0	1	01	01	H5425_029_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	030	0	1	01	01	H5425_030_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					0.00	0.00	0.00					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	030	0	1	01	01	H5425_030_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					0.00	0.00	0.00					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	030	0	1	01	01	H5425_030_0	5	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											5.95	25	25	25				5.95	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	030	0	1	01	01	H5425_030_0	5	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											56.21	25	25	25				56.21	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	030	0	1	01	01	H5425_030_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											67.53	25	25	25				67.53	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	030	0	1	01	01	H5425_030_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	031	0	1	01	01	H5425_031_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.50	19.00	28.50					0.00	0.00	0.00					0.00	0.00	0.00																9.50				9.50			0.32	0.00	0.00			0.31		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	031	0	1	01	01	H5425_031_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.50	19.00	28.50					0.00	0.00	0.00					0.00	0.00	0.00																9.50				9.50			0.32	0.00	0.00			0.31		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	031	0	1	01	01	H5425_031_0	5	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											5.45	25	25	25				5.45	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	031	0	1	01	01	H5425_031_0	5	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											57.35	25	25	25				57.35	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	031	0	1	01	01	H5425_031_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											68.57	25	25	25				68.57	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	031	0	1	01	01	H5425_031_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	033	0	1	01	01	H5425_033_0	3	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	033	0	1	01	01	H5425_033_0	3	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	033	0	1	01	01	H5425_033_0	3	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	033	0	1	01	01	H5425_033_0	3	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	033	0	1	01	01	H5425_033_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	033	0	1	01	01	H5425_033_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	033	0	1	01	01	H5425_033_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	034	0	1	01	01	H5425_034_0	3	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	034	0	1	01	01	H5425_034_0	3	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	034	0	1	01	01	H5425_034_0	3	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	034	0	1	01	01	H5425_034_0	3	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	034	0	1	01	01	H5425_034_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								35.00	70.00	95.00					30.00	60.00	80.00					30.00	60.00	80.00																35.00				35.00			1.17	1.00	1.00			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	034	0	1	01	01	H5425_034_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	034	0	1	01	01	H5425_034_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	037	0	1	01	01	H5425_037_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.50	15.00	22.50					0.00	0.00	0.00					0.00	0.00	0.00																7.50				7.50			0.25	0.00	0.00			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	037	0	1	01	01	H5425_037_0	5	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											6.81	25	25	25				6.81	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	037	0	1	01	01	H5425_037_0	5	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											55.63	25	25	25				55.63	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	037	0	1	01	01	H5425_037_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											77.88	25	25	25				77.88	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	037	0	1	01	01	H5425_037_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	040	0	1	01	01	H5425_040_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					0.00	0.00	0.00					0.00	0.00	0.00																6.00				6.00			0.20	0.00	0.00			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	040	0	1	01	01	H5425_040_0	4	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											5.92	25	25	25				5.92	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	040	0	1	01	01	H5425_040_0	4	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											60.54	25	25	25				60.54	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	040	0	1	01	01	H5425_040_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											68.93	25	25	25				68.93	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	040	0	1	01	01	H5425_040_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	045	0	1	01	01	H5425_045_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.50	17.00	25.50					0.00	0.00	0.00					0.00	0.00	0.00																8.50				8.50			0.28	0.00	0.00			0.27		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	045	0	1	01	01	H5425_045_0	5	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											6.44	25	25	25				6.44	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	045	0	1	01	01	H5425_045_0	5	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											57.38	25	25	25				57.38	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	045	0	1	01	01	H5425_045_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											75.24	25	25	25				75.24	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	045	0	1	01	01	H5425_045_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	046	0	1	01	01	H5425_046_0	6	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	046	0	1	01	01	H5425_046_0	6	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	046	0	1	01	01	H5425_046_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	125.00					40.00	80.00	110.00					40.00	80.00	110.00																45.00				45.00			1.50	1.33	1.33			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	046	0	1	01	01	H5425_046_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								85.00	170.00	245.00					80.00	160.00	230.00					80.00	160.00	230.00																85.00				85.00			2.83	2.67	2.67			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	046	0	1	01	01	H5425_046_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	047	0	1	01	01	H5425_047_0	6	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	047	0	1	01	01	H5425_047_0	6	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	047	0	1	01	01	H5425_047_0	6	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	047	0	1	01	01	H5425_047_0	6	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	047	0	1	01	01	H5425_047_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	125.00					40.00	80.00	110.00					40.00	80.00	110.00																45.00				45.00			1.50	1.33	1.33			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	047	0	1	01	01	H5425_047_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	275.00					90.00	180.00	260.00					90.00	180.00	260.00																95.00				95.00			3.17	3.00	3.00			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	047	0	1	01	01	H5425_047_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	048	0	1	01	01	H5425_048_0	6	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	048	0	1	01	01	H5425_048_0	6	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	048	0	1	01	01	H5425_048_0	6	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	048	0	1	01	01	H5425_048_0	6	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	048	0	1	01	01	H5425_048_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	125.00					40.00	80.00	110.00					40.00	80.00	110.00																45.00				45.00			1.50	1.33	1.33			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	048	0	1	01	01	H5425_048_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	275.00					90.00	180.00	260.00					90.00	180.00	260.00																95.00				95.00			3.17	3.00	3.00			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	048	0	1	01	01	H5425_048_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	052	0	1	01	01	H5425_052_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	052	0	1	01	01	H5425_052_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	052	0	1	01	01	H5425_052_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	052	0	1	01	01	H5425_052_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	052	0	1	01	01	H5425_052_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	053	0	1	01	01	H5425_053_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	053	0	1	01	01	H5425_053_0	4	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	053	0	1	01	01	H5425_053_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	053	0	1	01	01	H5425_053_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	053	0	1	01	01	H5425_053_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	053	0	1	01	01	H5425_053_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	054	0	1	01	01	H5425_054_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	054	0	1	01	01	H5425_054_0	4	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	054	0	1	01	01	H5425_054_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	054	0	1	01	01	H5425_054_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	054	0	1	01	01	H5425_054_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	054	0	1	01	01	H5425_054_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	055	0	1	01	01	H5425_055_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	055	0	1	01	01	H5425_055_0	4	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	055	0	1	01	01	H5425_055_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	055	0	1	01	01	H5425_055_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	055	0	1	01	01	H5425_055_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	055	0	1	01	01	H5425_055_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	061	0	1	01	01	H5425_061_0	3	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	061	0	1	01	01	H5425_061_0	3	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	061	0	1	01	01	H5425_061_0	3	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	061	0	1	01	01	H5425_061_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	061	0	1	01	01	H5425_061_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	061	0	1	01	01	H5425_061_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	062	0	1	01	01	H5425_062_0	3	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	062	0	1	01	01	H5425_062_0	3	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	062	0	1	01	01	H5425_062_0	3	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	062	0	1	01	01	H5425_062_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	062	0	1	01	01	H5425_062_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	062	0	1	01	01	H5425_062_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	064	0	1	01	01	H5425_064_0	3	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	064	0	1	01	01	H5425_064_0	3	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	064	0	1	01	01	H5425_064_0	3	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	064	0	1	01	01	H5425_064_0	3	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5425	064	0	1	01	01	H5425_064_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	064	0	1	01	01	H5425_064_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5425	064	0	1	01	01	H5425_064_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	059	0	1	01	01	H5427_059_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	059	0	1	01	01	H5427_059_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5427	059	0	1	01	01	H5427_059_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	059	0	1	01	01	H5427_059_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	059	0	1	01	01	H5427_059_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	060	0	1	01	01	H5427_060_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	060	0	1	01	01	H5427_060_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5427	060	0	1	01	01	H5427_060_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	060	0	1	01	01	H5427_060_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	060	0	1	01	01	H5427_060_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	070	0	1	01	01	H5427_070_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	070	0	1	01	01	H5427_070_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs											1		3
H5427	070	0	1	01	01	H5427_070_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	25.00		75.00																			25.00		50.00																25.00				25.00		0.83			0.83			0.81	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	070	0	1	01	01	H5427_070_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	75.00		225.00																			75.00		150.00																75.00				75.00		2.50			2.50			2.42	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	070	0	1	01	01	H5427_070_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	070	0	1	01	01	H5427_070_0	5	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	070	0	1	01	01	H5427_070_0	5	Select Diabetic Drugs	4	10	1	2	5	3	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs											1		
H5427	072	0	1	01	01	H5427_072_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	072	0	1	01	01	H5427_072_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs											1		3
H5427	072	0	1	01	01	H5427_072_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	072	0	1	01	01	H5427_072_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	072	0	1	01	01	H5427_072_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	072	0	1	01	01	H5427_072_0	5	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	077	0	1	01	01	H5427_077_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	077	0	1	01	01	H5427_077_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5427	077	0	1	01	01	H5427_077_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	077	0	1	01	01	H5427_077_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	077	0	1	01	01	H5427_077_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	082	0	1	01	01	H5427_082_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	082	0	1	01	01	H5427_082_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs											1		3
H5427	082	0	1	01	01	H5427_082_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	082	0	1	01	01	H5427_082_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	082	0	1	01	01	H5427_082_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	082	0	1	01	01	H5427_082_0	5	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5427	083	0	1	01	01	H5427_083_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	083	0	1	01	01	H5427_083_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5427	083	0	1	01	01	H5427_083_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	083	0	1	01	01	H5427_083_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	083	0	1	01	01	H5427_083_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	087	0	1	01	01	H5427_087_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	087	0	1	01	01	H5427_087_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	087	0	1	01	01	H5427_087_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	087	0	1	01	01	H5427_087_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	088	0	1	01	01	H5427_088_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	088	0	1	01	01	H5427_088_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5427	088	0	1	01	01	H5427_088_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	088	0	1	01	01	H5427_088_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	088	0	1	01	01	H5427_088_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	089	0	1	01	01	H5427_089_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	089	0	1	01	01	H5427_089_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5427	089	0	1	01	01	H5427_089_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	089	0	1	01	01	H5427_089_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	75.00		225.00																			75.00		150.00																75.00				75.00		2.50			2.50			2.42	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	089	0	1	01	01	H5427_089_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	091	0	1	01	01	H5427_091_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	091	0	1	01	01	H5427_091_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5427	091	0	1	01	01	H5427_091_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	091	0	1	01	01	H5427_091_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	091	0	1	01	01	H5427_091_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	092	0	1	01	01	H5427_092_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	092	0	1	01	01	H5427_092_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5427	092	0	1	01	01	H5427_092_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	092	0	1	01	01	H5427_092_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.26	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	092	0	1	01	01	H5427_092_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	093	0	1	01	01	H5427_093_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	093	0	1	01	01	H5427_093_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5427	093	0	1	01	01	H5427_093_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	093	0	1	01	01	H5427_093_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.26	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	093	0	1	01	01	H5427_093_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	094	0	1	01	01	H5427_094_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	094	0	1	01	01	H5427_094_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5427	094	0	1	01	01	H5427_094_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	094	0	1	01	01	H5427_094_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5427	094	0	1	01	01	H5427_094_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5430	001	0	1	01	01	H5430_001_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5430	001	0	1	01	01	H5430_001_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5430	001	0	1	01	01	H5430_001_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5430	001	0	1	01	01	H5430_001_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				63.14	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5430	001	0	1	01	01	H5430_001_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				357.86	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5431	001	0	1	01	01	H5431_001_0	8	Preferred Generic	4	01	1	2	1	1		110	01			1				30		90	2	2							30		31								0.00		0.00					0.00		0.00																							0.00				0.00			0.00	0.00				0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	001	0	1	01	01	H5431_001_0	8	Preferred Generic	4	01	1	2	1	3		110	01			1				30		90	2	2							30		31								0.00		0.00					0.00		0.00																							0.00				0.00			0.00	0.00				0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs											1		
H5431	001	0	1	01	01	H5431_001_0	8	Generic	4	01	1	2	2	1		110	01			1				30		90	2	2							30		31								10.00		20.00					0.00		0.00																							10.00				10.00			0.33	0.00				0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	001	0	1	01	01	H5431_001_0	8	Generic	4	01	1	2	2	3		110	01			1				30		90	2	2							30		31								10.00		20.00					0.00		0.00																							10.00				10.00			0.33	0.00				0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs											1		
H5431	001	0	1	01	01	H5431_001_0	8	Preferred Brand	4	10	1	2	3	1		010	01			1				30											30		31								25.00							5.00																									25.00				25.00			0.83	0.17				0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	001	0	1	01	01	H5431_001_0	8	Non-Preferred Brand	4	10	1	2	4	1		010	01			1				30											30		31								50.00							25.00																									50.00				25.00			1.67	0.83				0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	001	0	1	01	01	H5431_001_0	8	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1350.79	33						465.78	33																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	001	0	1	01	01	H5431_001_0	8	Supplemental Brand and Generic Drugs	4	11	2	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	006	0	1	01	01	H5431_006_0	8	Preferred Generic	4	01	1	1	1	1	110		01			1	30		90				2	2							30		31				2.31	25		25																																			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	006	0	1	01	01	H5431_006_0	8	Generic	4	01	1	1	2	1	110		01			1	30		90				2	2							30		31				16.44	25		25																																			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	006	0	1	01	01	H5431_006_0	8	Preferred Brand	4	10	1	1	3	1	010		01			1	30														30		31				79.96	25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	006	0	1	01	01	H5431_006_0	8	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		31				82.60	25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	006	0	1	01	01	H5431_006_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				662.54	25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	006	0	1	01	01	H5431_006_0	8	Supplemental Brand and Generic Drugs	4	11	2	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	006	0	1	01	01	H5431_006_0	8	Supplemental Brand and Generic Drugs	4	11	2	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs											1		
H5431	012	0	1	01	01	H5431_012_0	8	Preferred Generic	4	01	1	2	1	1		110	01			1				30		90	2	2							30		31								0.00		0.00					0.00		0.00																							0.00				0.00			0.00	0.00				0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	012	0	1	01	01	H5431_012_0	8	Preferred Generic	4	01	1	2	1	3		110	01			1				30		90	2	2							30		31								0.00		0.00					0.00		0.00																							0.00				0.00			0.00	0.00				0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs											1		
H5431	012	0	1	01	01	H5431_012_0	8	Generic	4	01	1	2	2	1		110	01			1				30		90	2	2							30		31								10.00		20.00					0.00		0.00																							10.00				10.00			0.33	0.00				0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	012	0	1	01	01	H5431_012_0	8	Generic	4	01	1	2	2	3		110	01			1				30		90	2	2							30		31								10.00		20.00					0.00		0.00																							10.00				10.00			0.33	0.00				0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs											1		
H5431	012	0	1	01	01	H5431_012_0	8	Preferred Brand	4	10	1	2	3	1		010	01			1				30											30		31								25.00							15.00																									25.00				25.00			0.83	0.50				0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	012	0	1	01	01	H5431_012_0	8	Non-Preferred Brand	4	10	1	2	4	1		010	01			1				30											30		31								50.00							30.00																									50.00				50.00			1.67	1.00				1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	012	0	1	01	01	H5431_012_0	8	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											2248.11	33						324.17	33																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5431	012	0	1	01	01	H5431_012_0	8	Supplemental Brand and Generic Drugs	4	11	2	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs													
H5433	001	0	1	01	01	H5433_001_0	7	Generic	2	01	1	2	1	1	111		01			1	30	60	90				1	1							30		31	6.00	12.00	18.00																																					6.00				6.00		0.20						0.19		Generic, Brand													
H5433	001	0	1	01	01	H5433_001_0	7	Brand	2	10	1	1	2	1	111		01			1	30	60	90				1	1							30		31				74.00	25	25	25																																			25			25									Generic, Brand													
H5434	002	0	1	04	01	H5434_002_0	13	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5434	002	0	1	04	01	H5434_002_0	13	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H5434	002	0	1	04	01	H5434_002_0	13	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					10.00		30.00					10.00		30.00																20.00				10.00			0.65	0.32	0.32			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5434	002	0	1	04	01	H5434_002_0	13	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		141.00					47.00		141.00																47.00				47.00			1.52	1.52	1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5434	002	0	1	04	01	H5434_002_0	13	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					100.00		300.00					100.00		300.00																100.00				100.00			3.23	3.23	3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5434	002	0	1	04	01	H5434_002_0	13	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											513.87	27						513.87	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5434	002	0	1	04	01	H5434_002_0	13	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5434	002	0	1	04	01	H5434_002_0	13	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H5435	024	0	1	09	04	H5435_024_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5435	024	0	1	09	04	H5435_024_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5435	024	0	1	09	04	H5435_024_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5435	024	0	1	09	04	H5435_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5435	024	0	1	09	04	H5435_024_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				798.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5439	011	0	1	04	01	H5439_011_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	011	0	1	04	01	H5439_011_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	011	0	1	04	01	H5439_011_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	011	0	1	04	01	H5439_011_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	011	0	1	04	01	H5439_011_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	011	0	1	04	01	H5439_011_0	4	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	013	0	1	04	01	H5439_013_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	013	0	1	04	01	H5439_013_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	013	0	1	04	01	H5439_013_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	013	0	1	04	01	H5439_013_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	013	0	1	04	01	H5439_013_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	013	0	1	04	01	H5439_013_0	4	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	1	1	04	01	H5439_014_1	5	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	1	1	04	01	H5439_014_1	5	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	1	1	04	01	H5439_014_1	5	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	1	1	04	01	H5439_014_1	5	Non-Preferred Brand	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	1	1	04	01	H5439_014_1	5	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	1	1	04	01	H5439_014_1	5	Select Care Drugs	3	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	2	1	04	01	H5439_014_2	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	2	1	04	01	H5439_014_2	4	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	2	1	04	01	H5439_014_2	4	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	2	1	04	01	H5439_014_2	4	Non-Preferred Brand	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	2	1	04	01	H5439_014_2	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	2	1	04	01	H5439_014_2	4	Select Care Drugs	3	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	3	1	04	01	H5439_014_3	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	3	1	04	01	H5439_014_3	4	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	3	1	04	01	H5439_014_3	4	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	3	1	04	01	H5439_014_3	4	Non-Preferred Brand	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	3	1	04	01	H5439_014_3	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	3	1	04	01	H5439_014_3	4	Select Care Drugs	3	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	4	1	04	01	H5439_014_4	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	4	1	04	01	H5439_014_4	4	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	4	1	04	01	H5439_014_4	4	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	4	1	04	01	H5439_014_4	4	Non-Preferred Brand	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	4	1	04	01	H5439_014_4	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	014	4	1	04	01	H5439_014_4	4	Select Care Drugs	3	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	015	0	1	04	01	H5439_015_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	015	0	1	04	01	H5439_015_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	015	0	1	04	01	H5439_015_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	015	0	1	04	01	H5439_015_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	015	0	1	04	01	H5439_015_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	015	0	1	04	01	H5439_015_0	4	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	1	1	04	01	H5439_016_1	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	1	1	04	01	H5439_016_1	4	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	1	1	04	01	H5439_016_1	4	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	1	1	04	01	H5439_016_1	4	Non-Preferred Brand	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	1	1	04	01	H5439_016_1	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	1	1	04	01	H5439_016_1	4	Select Care Drugs	3	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	2	1	04	01	H5439_016_2	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	2	1	04	01	H5439_016_2	4	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	2	1	04	01	H5439_016_2	4	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	2	1	04	01	H5439_016_2	4	Non-Preferred Brand	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	2	1	04	01	H5439_016_2	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5439	016	2	1	04	01	H5439_016_2	4	Select Care Drugs	3	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5441	001	0	1	48	05	H5441_001_0	5	Generic Drugs	4	01			1	1	110		01	100		1	30		90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5441	001	0	1	48	05	H5441_001_0	5	Brand Drugs	4	10			2	1	110		01	100		1	30		90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5441	001	0	1	48	05	H5441_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01			1	30														30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H5471	001	0	1	01	01	H5471_001_0	6	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	001	0	1	01	01	H5471_001_0	6	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	001	0	1	01	01	H5471_001_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	001	0	1	01	01	H5471_001_0	6	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	001	0	1	01	01	H5471_001_0	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	001	0	1	01	01	H5471_001_0	6	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								80.00							75.00							75.00																		80.00				80.00			2.67	2.50	2.50			2.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	001	0	1	01	01	H5471_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	002	0	1	01	01	H5471_002_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	002	0	1	01	01	H5471_002_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	002	0	1	01	01	H5471_002_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	002	0	1	01	01	H5471_002_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	002	0	1	01	01	H5471_002_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	002	0	1	01	01	H5471_002_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	5.00																					5.00																		5.00				5.00		0.17			0.17			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	002	0	1	01	01	H5471_002_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	007	0	1	01	01	H5471_007_0	6	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	007	0	1	01	01	H5471_007_0	6	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	007	0	1	01	01	H5471_007_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	007	0	1	01	01	H5471_007_0	6	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	007	0	1	01	01	H5471_007_0	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	007	0	1	01	01	H5471_007_0	6	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								95.00							90.00							90.00																		95.00				95.00			3.17	3.00	3.00			2.79		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	007	0	1	01	01	H5471_007_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	008	0	1	01	01	H5471_008_0	7	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	008	0	1	01	01	H5471_008_0	7	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	008	0	1	01	01	H5471_008_0	7	Generic	4	01	1	2	2	1	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	008	0	1	01	01	H5471_008_0	7	Generic	4	01	1	2	2	3	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	008	0	1	01	01	H5471_008_0	7	Preferred Brand	4	10	1	2	3	1	111		01			1	30	60	90				1	2							30		34	15.00	30.00	45.00																																					15.00				15.00		0.50						0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	008	0	1	01	01	H5471_008_0	7	Non-Preferred Brand	4	10	1	2	4	1	010		01			1	30														30		34	35.00																																							35.00				35.00		1.17						1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	008	0	1	01	01	H5471_008_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	009	0	1	01	01	H5471_009_0	7	Preferred Generic	4	01	3	2	1	1	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	009	0	1	01	01	H5471_009_0	7	Preferred Generic	4	01	3	2	1	3	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	009	0	1	01	01	H5471_009_0	7	Generic	4	01	1	2	2	1	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	009	0	1	01	01	H5471_009_0	7	Generic	4	01	1	2	2	3	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	009	0	1	01	01	H5471_009_0	7	Preferred Brand	4	10	1	2	3	1	111		01			1	30	60	90				1	2							30		34	15.00	30.00	45.00																																					15.00				15.00		0.50						0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	009	0	1	01	01	H5471_009_0	7	Non-Preferred Brand	4	10	1	2	4	1	010		01			1	30														30		34	35.00																																							35.00				35.00		1.17						1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	009	0	1	01	01	H5471_009_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	012	0	1	01	01	H5471_012_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	012	0	1	01	01	H5471_012_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	012	0	1	01	01	H5471_012_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	012	0	1	01	01	H5471_012_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	012	0	1	01	01	H5471_012_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	012	0	1	01	01	H5471_012_0	6	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	012	0	1	01	01	H5471_012_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	10.00																					10.00																		10.00				10.00		0.33			0.33			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	012	0	1	01	01	H5471_012_0	6	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	10.00																					10.00																		10.00				10.00		0.33			0.33			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	012	0	1	01	01	H5471_012_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	020	0	1	01	01	H5471_020_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	020	0	1	01	01	H5471_020_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	020	0	1	01	01	H5471_020_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	020	0	1	01	01	H5471_020_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	020	0	1	01	01	H5471_020_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	020	0	1	01	01	H5471_020_0	6	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	020	0	1	01	01	H5471_020_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	55.00																					55.00																		55.00				55.00		1.83			1.83			1.62		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	020	0	1	01	01	H5471_020_0	6	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	55.00																					55.00																		55.00				55.00		1.83			1.83			1.62		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	020	0	1	01	01	H5471_020_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	021	0	1	01	01	H5471_021_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	021	0	1	01	01	H5471_021_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	021	0	1	01	01	H5471_021_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	021	0	1	01	01	H5471_021_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	021	0	1	01	01	H5471_021_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	15.00	30.00	45.00																			15.00	45.00	45.00																15.00				15.00		0.50			0.50			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	021	0	1	01	01	H5471_021_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	55.00																					55.00																		55.00				55.00		1.83			1.83			1.62		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	021	0	1	01	01	H5471_021_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	039	0	1	01	01	H5471_039_0	6	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	039	0	1	01	01	H5471_039_0	6	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	039	0	1	01	01	H5471_039_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	039	0	1	01	01	H5471_039_0	6	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	039	0	1	01	01	H5471_039_0	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	039	0	1	01	01	H5471_039_0	6	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	039	0	1	01	01	H5471_039_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	042	0	1	01	01	H5471_042_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	042	0	1	01	01	H5471_042_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	042	0	1	01	01	H5471_042_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	042	0	1	01	01	H5471_042_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	042	0	1	01	01	H5471_042_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	25.00	50.00	75.00																			25.00	75.00	75.00																25.00				25.00		0.83			0.83			0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	042	0	1	01	01	H5471_042_0	6	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	25.00	50.00	75.00																			25.00	75.00	75.00																25.00				25.00		0.83			0.83			0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	042	0	1	01	01	H5471_042_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	042	0	1	01	01	H5471_042_0	6	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	042	0	1	01	01	H5471_042_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	043	0	1	01	01	H5471_043_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	043	0	1	01	01	H5471_043_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	043	0	1	01	01	H5471_043_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	043	0	1	01	01	H5471_043_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	043	0	1	01	01	H5471_043_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	25.00	50.00	75.00																			25.00	75.00	75.00																25.00				25.00		0.83			0.83			0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	043	0	1	01	01	H5471_043_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	043	0	1	01	01	H5471_043_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	049	0	1	01	01	H5471_049_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	049	0	1	01	01	H5471_049_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	049	0	1	01	01	H5471_049_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	049	0	1	01	01	H5471_049_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	049	0	1	01	01	H5471_049_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	049	0	1	01	01	H5471_049_0	6	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	049	0	1	01	01	H5471_049_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	049	0	1	01	01	H5471_049_0	6	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	049	0	1	01	01	H5471_049_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	050	0	1	01	01	H5471_050_0	7	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	050	0	1	01	01	H5471_050_0	7	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	050	0	1	01	01	H5471_050_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	050	0	1	01	01	H5471_050_0	7	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	050	0	1	01	01	H5471_050_0	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	050	0	1	01	01	H5471_050_0	7	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								95.00							90.00							90.00																		95.00				95.00			3.17	3.00	3.00			2.79		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	050	0	1	01	01	H5471_050_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	051	0	1	01	01	H5471_051_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	051	0	1	01	01	H5471_051_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	051	0	1	01	01	H5471_051_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	051	0	1	01	01	H5471_051_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	051	0	1	01	01	H5471_051_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	25.00	50.00	75.00																			25.00	75.00	75.00																25.00				25.00		0.83			0.83			0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	051	0	1	01	01	H5471_051_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	051	0	1	01	01	H5471_051_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	052	0	1	01	01	H5471_052_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	052	0	1	01	01	H5471_052_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	052	0	1	01	01	H5471_052_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	052	0	1	01	01	H5471_052_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	052	0	1	01	01	H5471_052_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	052	0	1	01	01	H5471_052_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	052	0	1	01	01	H5471_052_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	053	0	1	01	01	H5471_053_0	6	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	053	0	1	01	01	H5471_053_0	6	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	053	0	1	01	01	H5471_053_0	6	Generic	4	01	1	2	2	1	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	053	0	1	01	01	H5471_053_0	6	Generic	4	01	1	2	2	3	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	053	0	1	01	01	H5471_053_0	6	Preferred Brand	4	10	1	2	3	1	111		01			1	30	60	90				1	2							30		34	15.00	30.00	45.00																																					15.00				15.00		0.50						0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	053	0	1	01	01	H5471_053_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01			1	30														30		34	35.00																																							35.00				35.00		1.17						1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	053	0	1	01	01	H5471_053_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	054	0	1	01	01	H5471_054_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	054	0	1	01	01	H5471_054_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	054	0	1	01	01	H5471_054_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	054	0	1	01	01	H5471_054_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	054	0	1	01	01	H5471_054_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	054	0	1	01	01	H5471_054_0	6	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	054	0	1	01	01	H5471_054_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	054	0	1	01	01	H5471_054_0	6	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	054	0	1	01	01	H5471_054_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	055	0	1	01	01	H5471_055_0	6	Preferred Generic	4	01	3	2	1	1	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	055	0	1	01	01	H5471_055_0	6	Preferred Generic	4	01	3	2	1	3	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	055	0	1	01	01	H5471_055_0	6	Generic	4	01	1	2	2	1	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	055	0	1	01	01	H5471_055_0	6	Generic	4	01	1	2	2	3	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	055	0	1	01	01	H5471_055_0	6	Preferred Brand	4	10	1	2	3	1	111		01			1	30	60	90				1	2							30		34	15.00	30.00	45.00																																					15.00				15.00		0.50						0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	055	0	1	01	01	H5471_055_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01			1	30														30		34	35.00																																							35.00				35.00		1.17						1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	055	0	1	01	01	H5471_055_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	056	0	1	01	01	H5471_056_0	6	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	056	0	1	01	01	H5471_056_0	6	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	056	0	1	01	01	H5471_056_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	056	0	1	01	01	H5471_056_0	6	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	056	0	1	01	01	H5471_056_0	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	056	0	1	01	01	H5471_056_0	6	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	056	0	1	01	01	H5471_056_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	057	0	1	01	01	H5471_057_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	057	0	1	01	01	H5471_057_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	057	0	1	01	01	H5471_057_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	057	0	1	01	01	H5471_057_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	057	0	1	01	01	H5471_057_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	20.00	40.00	60.00																			20.00	60.00	60.00																20.00				20.00		0.67			0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	057	0	1	01	01	H5471_057_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	057	0	1	01	01	H5471_057_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	058	0	1	01	01	H5471_058_0	7	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	058	0	1	01	01	H5471_058_0	7	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	058	0	1	01	01	H5471_058_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	058	0	1	01	01	H5471_058_0	7	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	058	0	1	01	01	H5471_058_0	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	058	0	1	01	01	H5471_058_0	7	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								95.00							90.00							90.00																		95.00				95.00			3.17	3.00	3.00			2.79		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	058	0	1	01	01	H5471_058_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	059	0	1	01	01	H5471_059_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	059	0	1	01	01	H5471_059_0	6	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	059	0	1	01	01	H5471_059_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	059	0	1	01	01	H5471_059_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	059	0	1	01	01	H5471_059_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	059	0	1	01	01	H5471_059_0	6	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	059	0	1	01	01	H5471_059_0	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	059	0	1	01	01	H5471_059_0	6	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H5471	059	0	1	01	01	H5471_059_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	060	0	1	01	01	H5471_060_0	5	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	060	0	1	01	01	H5471_060_0	5	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	060	0	1	01	01	H5471_060_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	060	0	1	01	01	H5471_060_0	5	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	060	0	1	01	01	H5471_060_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	060	0	1	01	01	H5471_060_0	5	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	060	0	1	01	01	H5471_060_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	061	0	1	01	01	H5471_061_0	5	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	061	0	1	01	01	H5471_061_0	5	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	061	0	1	01	01	H5471_061_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	061	0	1	01	01	H5471_061_0	5	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	061	0	1	01	01	H5471_061_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	061	0	1	01	01	H5471_061_0	5	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								95.00							90.00							90.00																		95.00				95.00			3.17	3.00	3.00			2.79		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	061	0	1	01	01	H5471_061_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	062	0	1	01	01	H5471_062_0	5	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	062	0	1	01	01	H5471_062_0	5	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	062	0	1	01	01	H5471_062_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	062	0	1	01	01	H5471_062_0	5	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	062	0	1	01	01	H5471_062_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	062	0	1	01	01	H5471_062_0	5	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	062	0	1	01	01	H5471_062_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	063	0	1	01	01	H5471_063_0	5	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	063	0	1	01	01	H5471_063_0	5	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H5471	063	0	1	01	01	H5471_063_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	063	0	1	01	01	H5471_063_0	5	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5471	063	0	1	01	01	H5471_063_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	063	0	1	01	01	H5471_063_0	5	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								95.00							90.00							90.00																		95.00				95.00			3.17	3.00	3.00			2.79		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5471	063	0	1	01	01	H5471_063_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5475	001	0	1	01	01	H5475_001_0	9	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				2.60	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	001	0	1	01	01	H5475_001_0	9	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				7.48	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	001	0	1	01	01	H5475_001_0	9	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				68.11	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	001	0	1	01	01	H5475_001_0	9	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				62.46	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	001	0	1	01	01	H5475_001_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	001	0	1	01	01	H5475_001_0	9	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	003	0	1	01	01	H5475_003_0	8	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	003	0	1	01	01	H5475_003_0	8	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	003	0	1	01	01	H5475_003_0	8	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	003	0	1	01	01	H5475_003_0	8	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	003	0	1	01	01	H5475_003_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	003	0	1	01	01	H5475_003_0	8	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	40.00																																							40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	004	0	1	01	01	H5475_004_0	9	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				2.57	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	004	0	1	01	01	H5475_004_0	9	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				7.71	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	004	0	1	01	01	H5475_004_0	9	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				61.57	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	004	0	1	01	01	H5475_004_0	9	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				59.45	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	004	0	1	01	01	H5475_004_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	004	0	1	01	01	H5475_004_0	9	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	005	0	1	01	01	H5475_005_0	8	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	2.00		4.00																					0.00																2.00				2.00		0.07						0.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	005	0	1	01	01	H5475_005_0	8	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	005	0	1	01	01	H5475_005_0	8	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	005	0	1	01	01	H5475_005_0	8	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	005	0	1	01	01	H5475_005_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	005	0	1	01	01	H5475_005_0	8	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	65.00																																							65.00				65.00		2.17						2.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	006	0	1	01	01	H5475_006_0	9	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	006	0	1	01	01	H5475_006_0	9	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	006	0	1	01	01	H5475_006_0	9	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		94.00																					94.00																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	006	0	1	01	01	H5475_006_0	9	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	006	0	1	01	01	H5475_006_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	006	0	1	01	01	H5475_006_0	9	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	50.00																																							50.00				50.00		1.67						1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	007	0	1	01	01	H5475_007_0	8	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	007	0	1	01	01	H5475_007_0	8	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	007	0	1	01	01	H5475_007_0	8	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	007	0	1	01	01	H5475_007_0	8	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	007	0	1	01	01	H5475_007_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	007	0	1	01	01	H5475_007_0	8	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	65.00																																							65.00				65.00		2.17						2.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	008	0	1	01	01	H5475_008_0	9	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				1.94	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	008	0	1	01	01	H5475_008_0	9	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				6.21	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	008	0	1	01	01	H5475_008_0	9	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				63.92	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	008	0	1	01	01	H5475_008_0	9	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				54.84	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	008	0	1	01	01	H5475_008_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	008	0	1	01	01	H5475_008_0	9	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	009	0	1	01	01	H5475_009_0	9	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	009	0	1	01	01	H5475_009_0	9	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	009	0	1	01	01	H5475_009_0	9	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		94.00																					94.00																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	009	0	1	01	01	H5475_009_0	9	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	009	0	1	01	01	H5475_009_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	009	0	1	01	01	H5475_009_0	9	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	65.00																																							65.00				65.00		2.17						2.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	010	0	1	01	01	H5475_010_0	9	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				1.96	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	010	0	1	01	01	H5475_010_0	9	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				6.21	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	010	0	1	01	01	H5475_010_0	9	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				63.71	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	010	0	1	01	01	H5475_010_0	9	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				54.22	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	010	0	1	01	01	H5475_010_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	010	0	1	01	01	H5475_010_0	9	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	011	0	1	01	01	H5475_011_0	9	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	011	0	1	01	01	H5475_011_0	9	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	011	0	1	01	01	H5475_011_0	9	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		94.00																					94.00																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	011	0	1	01	01	H5475_011_0	9	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	011	0	1	01	01	H5475_011_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	011	0	1	01	01	H5475_011_0	9	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	65.00																																							65.00				65.00		2.17						2.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	012	0	1	01	01	H5475_012_0	9	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				1.96	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	012	0	1	01	01	H5475_012_0	9	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				6.21	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	012	0	1	01	01	H5475_012_0	9	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				63.71	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	012	0	1	01	01	H5475_012_0	9	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				54.22	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	012	0	1	01	01	H5475_012_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	012	0	1	01	01	H5475_012_0	9	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	013	0	1	01	01	H5475_013_0	9	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	013	0	1	01	01	H5475_013_0	9	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	013	0	1	01	01	H5475_013_0	9	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	013	0	1	01	01	H5475_013_0	9	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	013	0	1	01	01	H5475_013_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	013	0	1	01	01	H5475_013_0	9	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	50.00																																							50.00				50.00		1.67						1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	014	0	1	01	01	H5475_014_0	8	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	014	0	1	01	01	H5475_014_0	8	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	014	0	1	01	01	H5475_014_0	8	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	014	0	1	01	01	H5475_014_0	8	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	014	0	1	01	01	H5475_014_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	014	0	1	01	01	H5475_014_0	8	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	65.00																																							65.00				65.00		2.17						2.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	015	0	1	01	01	H5475_015_0	9	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				1.96	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	015	0	1	01	01	H5475_015_0	9	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				6.21	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	015	0	1	01	01	H5475_015_0	9	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				63.71	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	015	0	1	01	01	H5475_015_0	9	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				54.22	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	015	0	1	01	01	H5475_015_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	015	0	1	01	01	H5475_015_0	9	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	016	0	1	01	01	H5475_016_0	9	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	016	0	1	01	01	H5475_016_0	9	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	016	0	1	01	01	H5475_016_0	9	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		94.00																					94.00																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	016	0	1	01	01	H5475_016_0	9	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	016	0	1	01	01	H5475_016_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	016	0	1	01	01	H5475_016_0	9	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	65.00																																							65.00				65.00		2.17						2.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	018	0	1	01	01	H5475_018_0	8	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	3.00		6.00																					6.00																3.00				3.00		0.10						0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	018	0	1	01	01	H5475_018_0	8	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	018	0	1	01	01	H5475_018_0	8	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		94.00																					94.00																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	018	0	1	01	01	H5475_018_0	8	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	018	0	1	01	01	H5475_018_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5475	018	0	1	01	01	H5475_018_0	8	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	65.00																																							65.00				65.00		2.17						2.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5496	005	0	1	01	01	H5496_005_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5496	005	0	1	01	01	H5496_005_0	5	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5496	005	0	1	01	01	H5496_005_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		12.00																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5496	005	0	1	01	01	H5496_005_0	5	Generic	4	01	1	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5496	005	0	1	01	01	H5496_005_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		110.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5496	005	0	1	01	01	H5496_005_0	5	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		225.00																					180.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5496	005	0	1	01	01	H5496_005_0	5	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5496	005	0	1	01	01	H5496_005_0	5	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	3.00		6.00																					0.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5496	006	0	1	01	01	H5496_006_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	006	0	1	01	01	H5496_006_0	6	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5496	006	0	1	01	01	H5496_006_0	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		12.00																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	006	0	1	01	01	H5496_006_0	6	Generic	4	01	1	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5496	006	0	1	01	01	H5496_006_0	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		110.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	006	0	1	01	01	H5496_006_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		225.00																					180.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	006	0	1	01	01	H5496_006_0	6	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	007	0	1	01	01	H5496_007_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	007	0	1	01	01	H5496_007_0	6	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5496	007	0	1	01	01	H5496_007_0	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		12.00																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	007	0	1	01	01	H5496_007_0	6	Generic	4	01	1	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5496	007	0	1	01	01	H5496_007_0	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		110.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	007	0	1	01	01	H5496_007_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		225.00																					180.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	007	0	1	01	01	H5496_007_0	6	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	008	0	1	01	01	H5496_008_0	6	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	008	0	1	01	01	H5496_008_0	6	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5496	008	0	1	01	01	H5496_008_0	6	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				3.29	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	008	0	1	01	01	H5496_008_0	6	Generic	4	01	1	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5496	008	0	1	01	01	H5496_008_0	6	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				101.03	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	008	0	1	01	01	H5496_008_0	6	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				52.93	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	008	0	1	01	01	H5496_008_0	6	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31					25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	009	0	1	01	01	H5496_009_0	6	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	009	0	1	01	01	H5496_009_0	6	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5496	009	0	1	01	01	H5496_009_0	6	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				3.29	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	009	0	1	01	01	H5496_009_0	6	Generic	4	01	1	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5496	009	0	1	01	01	H5496_009_0	6	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				101.03	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	009	0	1	01	01	H5496_009_0	6	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				52.93	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	009	0	1	01	01	H5496_009_0	6	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31					25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5496	010	0	1	01	01	H5496_010_0	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5496	010	0	1	01	01	H5496_010_0	6	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5496	010	0	1	01	01	H5496_010_0	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		12.00																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5496	010	0	1	01	01	H5496_010_0	6	Generic	4	01	1	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5496	010	0	1	01	01	H5496_010_0	6	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		110.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5496	010	0	1	01	01	H5496_010_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		225.00																					180.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5496	010	0	1	01	01	H5496_010_0	6	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5496	010	0	1	01	01	H5496_010_0	6	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	3.00		6.00																					0.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5521	012	0	1	04	01	H5521_012_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	012	0	1	04	01	H5521_012_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	012	0	1	04	01	H5521_012_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	012	0	1	04	01	H5521_012_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	012	0	1	04	01	H5521_012_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	012	0	1	04	01	H5521_012_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	012	0	1	04	01	H5521_012_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	013	0	1	04	01	H5521_013_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	013	0	1	04	01	H5521_013_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	013	0	1	04	01	H5521_013_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	013	0	1	04	01	H5521_013_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	013	0	1	04	01	H5521_013_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	013	0	1	04	01	H5521_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	013	0	1	04	01	H5521_013_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	015	0	1	04	01	H5521_015_0	3	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	015	0	1	04	01	H5521_015_0	3	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	015	0	1	04	01	H5521_015_0	3	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	015	0	1	04	01	H5521_015_0	3	Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	015	0	1	04	01	H5521_015_0	3	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	016	0	1	04	01	H5521_016_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	016	0	1	04	01	H5521_016_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	016	0	1	04	01	H5521_016_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	016	0	1	04	01	H5521_016_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	016	0	1	04	01	H5521_016_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	016	0	1	04	01	H5521_016_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	016	0	1	04	01	H5521_016_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	020	0	1	04	01	H5521_020_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	020	0	1	04	01	H5521_020_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	020	0	1	04	01	H5521_020_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	020	0	1	04	01	H5521_020_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	020	0	1	04	01	H5521_020_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	020	0	1	04	01	H5521_020_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	020	0	1	04	01	H5521_020_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	022	0	1	04	01	H5521_022_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	022	0	1	04	01	H5521_022_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	022	0	1	04	01	H5521_022_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	022	0	1	04	01	H5521_022_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	022	0	1	04	01	H5521_022_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	022	0	1	04	01	H5521_022_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	022	0	1	04	01	H5521_022_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	027	0	1	04	01	H5521_027_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	027	0	1	04	01	H5521_027_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	027	0	1	04	01	H5521_027_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	027	0	1	04	01	H5521_027_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	027	0	1	04	01	H5521_027_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	027	0	1	04	01	H5521_027_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	027	0	1	04	01	H5521_027_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	033	0	1	04	01	H5521_033_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	033	0	1	04	01	H5521_033_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	033	0	1	04	01	H5521_033_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	033	0	1	04	01	H5521_033_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	033	0	1	04	01	H5521_033_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	033	0	1	04	01	H5521_033_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	033	0	1	04	01	H5521_033_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	037	0	1	04	01	H5521_037_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	037	0	1	04	01	H5521_037_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	037	0	1	04	01	H5521_037_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	037	0	1	04	01	H5521_037_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	037	0	1	04	01	H5521_037_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	037	0	1	04	01	H5521_037_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	037	0	1	04	01	H5521_037_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	040	0	1	04	01	H5521_040_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	040	0	1	04	01	H5521_040_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	040	0	1	04	01	H5521_040_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	040	0	1	04	01	H5521_040_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	040	0	1	04	01	H5521_040_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	040	0	1	04	01	H5521_040_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	040	0	1	04	01	H5521_040_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	053	0	1	04	01	H5521_053_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	053	0	1	04	01	H5521_053_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	053	0	1	04	01	H5521_053_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	053	0	1	04	01	H5521_053_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	053	0	1	04	01	H5521_053_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	053	0	1	04	01	H5521_053_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	053	0	1	04	01	H5521_053_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	055	0	1	04	01	H5521_055_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	055	0	1	04	01	H5521_055_0	4	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	055	0	1	04	01	H5521_055_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	055	0	1	04	01	H5521_055_0	4	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	055	0	1	04	01	H5521_055_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	055	0	1	04	01	H5521_055_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	055	0	1	04	01	H5521_055_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	31																				31																		31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	056	0	1	04	01	H5521_056_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	056	0	1	04	01	H5521_056_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	056	0	1	04	01	H5521_056_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	056	0	1	04	01	H5521_056_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	056	0	1	04	01	H5521_056_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	056	0	1	04	01	H5521_056_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	056	0	1	04	01	H5521_056_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	057	0	1	04	01	H5521_057_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	057	0	1	04	01	H5521_057_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	057	0	1	04	01	H5521_057_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	057	0	1	04	01	H5521_057_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	057	0	1	04	01	H5521_057_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	057	0	1	04	01	H5521_057_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	057	0	1	04	01	H5521_057_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	31																				31																		31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	058	0	1	04	01	H5521_058_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	058	0	1	04	01	H5521_058_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	058	0	1	04	01	H5521_058_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	058	0	1	04	01	H5521_058_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	058	0	1	04	01	H5521_058_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	058	0	1	04	01	H5521_058_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	058	0	1	04	01	H5521_058_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	059	0	1	04	01	H5521_059_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	059	0	1	04	01	H5521_059_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	059	0	1	04	01	H5521_059_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	059	0	1	04	01	H5521_059_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	059	0	1	04	01	H5521_059_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	059	0	1	04	01	H5521_059_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	059	0	1	04	01	H5521_059_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	060	0	1	04	01	H5521_060_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	060	0	1	04	01	H5521_060_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	060	0	1	04	01	H5521_060_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	060	0	1	04	01	H5521_060_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	060	0	1	04	01	H5521_060_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	060	0	1	04	01	H5521_060_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	060	0	1	04	01	H5521_060_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	076	0	1	04	01	H5521_076_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	076	0	1	04	01	H5521_076_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	076	0	1	04	01	H5521_076_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	076	0	1	04	01	H5521_076_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	076	0	1	04	01	H5521_076_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	076	0	1	04	01	H5521_076_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	076	0	1	04	01	H5521_076_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	077	0	1	04	01	H5521_077_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	077	0	1	04	01	H5521_077_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	077	0	1	04	01	H5521_077_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	077	0	1	04	01	H5521_077_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	077	0	1	04	01	H5521_077_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	077	0	1	04	01	H5521_077_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	077	0	1	04	01	H5521_077_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	081	0	1	04	01	H5521_081_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	081	0	1	04	01	H5521_081_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	081	0	1	04	01	H5521_081_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	081	0	1	04	01	H5521_081_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	081	0	1	04	01	H5521_081_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	081	0	1	04	01	H5521_081_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	081	0	1	04	01	H5521_081_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	082	0	1	04	01	H5521_082_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	082	0	1	04	01	H5521_082_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	082	0	1	04	01	H5521_082_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	082	0	1	04	01	H5521_082_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	082	0	1	04	01	H5521_082_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	082	0	1	04	01	H5521_082_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	082	0	1	04	01	H5521_082_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	083	0	1	04	01	H5521_083_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	083	0	1	04	01	H5521_083_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	083	0	1	04	01	H5521_083_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	083	0	1	04	01	H5521_083_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	083	0	1	04	01	H5521_083_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	083	0	1	04	01	H5521_083_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	083	0	1	04	01	H5521_083_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	084	0	1	04	01	H5521_084_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	084	0	1	04	01	H5521_084_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	084	0	1	04	01	H5521_084_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	084	0	1	04	01	H5521_084_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	084	0	1	04	01	H5521_084_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	084	0	1	04	01	H5521_084_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	084	0	1	04	01	H5521_084_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	085	0	1	04	01	H5521_085_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	085	0	1	04	01	H5521_085_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	085	0	1	04	01	H5521_085_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	085	0	1	04	01	H5521_085_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	085	0	1	04	01	H5521_085_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	085	0	1	04	01	H5521_085_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	085	0	1	04	01	H5521_085_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	086	0	1	04	01	H5521_086_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	086	0	1	04	01	H5521_086_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	086	0	1	04	01	H5521_086_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	086	0	1	04	01	H5521_086_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	086	0	1	04	01	H5521_086_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	086	0	1	04	01	H5521_086_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	086	0	1	04	01	H5521_086_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	087	0	1	04	01	H5521_087_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	087	0	1	04	01	H5521_087_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	087	0	1	04	01	H5521_087_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	087	0	1	04	01	H5521_087_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	087	0	1	04	01	H5521_087_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	087	0	1	04	01	H5521_087_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	087	0	1	04	01	H5521_087_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	088	0	1	04	01	H5521_088_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	088	0	1	04	01	H5521_088_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	088	0	1	04	01	H5521_088_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	088	0	1	04	01	H5521_088_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	088	0	1	04	01	H5521_088_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	088	0	1	04	01	H5521_088_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	088	0	1	04	01	H5521_088_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	089	0	1	04	01	H5521_089_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	089	0	1	04	01	H5521_089_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	089	0	1	04	01	H5521_089_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	089	0	1	04	01	H5521_089_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	089	0	1	04	01	H5521_089_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	089	0	1	04	01	H5521_089_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	089	0	1	04	01	H5521_089_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	090	0	1	04	01	H5521_090_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	090	0	1	04	01	H5521_090_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	090	0	1	04	01	H5521_090_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	090	0	1	04	01	H5521_090_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	090	0	1	04	01	H5521_090_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	090	0	1	04	01	H5521_090_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	090	0	1	04	01	H5521_090_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	091	0	1	04	01	H5521_091_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	091	0	1	04	01	H5521_091_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	091	0	1	04	01	H5521_091_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	091	0	1	04	01	H5521_091_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	091	0	1	04	01	H5521_091_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	091	0	1	04	01	H5521_091_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	091	0	1	04	01	H5521_091_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	092	0	1	04	01	H5521_092_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	092	0	1	04	01	H5521_092_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	092	0	1	04	01	H5521_092_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	092	0	1	04	01	H5521_092_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	092	0	1	04	01	H5521_092_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	092	0	1	04	01	H5521_092_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	092	0	1	04	01	H5521_092_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	094	0	1	04	01	H5521_094_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	094	0	1	04	01	H5521_094_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	094	0	1	04	01	H5521_094_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	094	0	1	04	01	H5521_094_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	094	0	1	04	01	H5521_094_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	094	0	1	04	01	H5521_094_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	094	0	1	04	01	H5521_094_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	095	0	1	04	01	H5521_095_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	095	0	1	04	01	H5521_095_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	095	0	1	04	01	H5521_095_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	095	0	1	04	01	H5521_095_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	095	0	1	04	01	H5521_095_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								42.00	84.00	126.00					42.00	84.00	126.00											42.00	84.00	121.00				42.00	84.00	121.00					42.00			42.00			1.40	1.40		1.40	1.40	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	095	0	1	04	01	H5521_095_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	095	0	1	04	01	H5521_095_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	099	0	1	04	01	H5521_099_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	099	0	1	04	01	H5521_099_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	099	0	1	04	01	H5521_099_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	099	0	1	04	01	H5521_099_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	099	0	1	04	01	H5521_099_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	099	0	1	04	01	H5521_099_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	099	0	1	04	01	H5521_099_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	100	0	1	04	01	H5521_100_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	100	0	1	04	01	H5521_100_0	4	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	100	0	1	04	01	H5521_100_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	100	0	1	04	01	H5521_100_0	4	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	100	0	1	04	01	H5521_100_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	100	0	1	04	01	H5521_100_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	100	0	1	04	01	H5521_100_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	30																				30																		30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	101	0	1	04	01	H5521_101_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	101	0	1	04	01	H5521_101_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	101	0	1	04	01	H5521_101_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	101	0	1	04	01	H5521_101_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	101	0	1	04	01	H5521_101_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	101	0	1	04	01	H5521_101_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	101	0	1	04	01	H5521_101_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	31																				31																		31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	102	0	1	04	01	H5521_102_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	102	0	1	04	01	H5521_102_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	102	0	1	04	01	H5521_102_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	102	0	1	04	01	H5521_102_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	102	0	1	04	01	H5521_102_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	102	0	1	04	01	H5521_102_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	102	0	1	04	01	H5521_102_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	103	0	1	04	01	H5521_103_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	103	0	1	04	01	H5521_103_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	103	0	1	04	01	H5521_103_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	103	0	1	04	01	H5521_103_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	103	0	1	04	01	H5521_103_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	103	0	1	04	01	H5521_103_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	103	0	1	04	01	H5521_103_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	104	0	1	04	01	H5521_104_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	104	0	1	04	01	H5521_104_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	104	0	1	04	01	H5521_104_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	104	0	1	04	01	H5521_104_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	104	0	1	04	01	H5521_104_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	104	0	1	04	01	H5521_104_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	104	0	1	04	01	H5521_104_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	105	0	1	04	01	H5521_105_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	105	0	1	04	01	H5521_105_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	105	0	1	04	01	H5521_105_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	105	0	1	04	01	H5521_105_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	105	0	1	04	01	H5521_105_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	105	0	1	04	01	H5521_105_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	105	0	1	04	01	H5521_105_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	107	0	1	04	01	H5521_107_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	107	0	1	04	01	H5521_107_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	107	0	1	04	01	H5521_107_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	107	0	1	04	01	H5521_107_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	107	0	1	04	01	H5521_107_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	107	0	1	04	01	H5521_107_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	107	0	1	04	01	H5521_107_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	108	0	1	04	01	H5521_108_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	108	0	1	04	01	H5521_108_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	108	0	1	04	01	H5521_108_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	108	0	1	04	01	H5521_108_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	108	0	1	04	01	H5521_108_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	108	0	1	04	01	H5521_108_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	108	0	1	04	01	H5521_108_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	109	0	1	04	01	H5521_109_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	109	0	1	04	01	H5521_109_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	109	0	1	04	01	H5521_109_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	109	0	1	04	01	H5521_109_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	109	0	1	04	01	H5521_109_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	109	0	1	04	01	H5521_109_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	109	0	1	04	01	H5521_109_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	110	0	1	04	01	H5521_110_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	110	0	1	04	01	H5521_110_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	110	0	1	04	01	H5521_110_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	110	0	1	04	01	H5521_110_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	110	0	1	04	01	H5521_110_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	110	0	1	04	01	H5521_110_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	110	0	1	04	01	H5521_110_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	111	0	1	04	01	H5521_111_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	111	0	1	04	01	H5521_111_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	111	0	1	04	01	H5521_111_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	111	0	1	04	01	H5521_111_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	111	0	1	04	01	H5521_111_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	111	0	1	04	01	H5521_111_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	111	0	1	04	01	H5521_111_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	112	0	1	04	01	H5521_112_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	112	0	1	04	01	H5521_112_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	112	0	1	04	01	H5521_112_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	112	0	1	04	01	H5521_112_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	112	0	1	04	01	H5521_112_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	112	0	1	04	01	H5521_112_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	112	0	1	04	01	H5521_112_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	113	0	1	04	01	H5521_113_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	113	0	1	04	01	H5521_113_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	113	0	1	04	01	H5521_113_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	113	0	1	04	01	H5521_113_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	113	0	1	04	01	H5521_113_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	113	0	1	04	01	H5521_113_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	113	0	1	04	01	H5521_113_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	114	0	1	04	01	H5521_114_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	114	0	1	04	01	H5521_114_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	114	0	1	04	01	H5521_114_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	114	0	1	04	01	H5521_114_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	114	0	1	04	01	H5521_114_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	114	0	1	04	01	H5521_114_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	114	0	1	04	01	H5521_114_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	115	0	1	04	01	H5521_115_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	115	0	1	04	01	H5521_115_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	115	0	1	04	01	H5521_115_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	115	0	1	04	01	H5521_115_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	115	0	1	04	01	H5521_115_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	115	0	1	04	01	H5521_115_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	115	0	1	04	01	H5521_115_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	116	0	1	04	01	H5521_116_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	116	0	1	04	01	H5521_116_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	116	0	1	04	01	H5521_116_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	116	0	1	04	01	H5521_116_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	116	0	1	04	01	H5521_116_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	116	0	1	04	01	H5521_116_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	116	0	1	04	01	H5521_116_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	117	0	1	04	01	H5521_117_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	117	0	1	04	01	H5521_117_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	117	0	1	04	01	H5521_117_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	117	0	1	04	01	H5521_117_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	117	0	1	04	01	H5521_117_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	117	0	1	04	01	H5521_117_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	117	0	1	04	01	H5521_117_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	118	0	1	04	01	H5521_118_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	118	0	1	04	01	H5521_118_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	118	0	1	04	01	H5521_118_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	118	0	1	04	01	H5521_118_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	118	0	1	04	01	H5521_118_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	118	0	1	04	01	H5521_118_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	118	0	1	04	01	H5521_118_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	119	0	1	04	01	H5521_119_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	119	0	1	04	01	H5521_119_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	119	0	1	04	01	H5521_119_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	119	0	1	04	01	H5521_119_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	119	0	1	04	01	H5521_119_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	119	0	1	04	01	H5521_119_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	119	0	1	04	01	H5521_119_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	120	0	1	04	01	H5521_120_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	120	0	1	04	01	H5521_120_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	120	0	1	04	01	H5521_120_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	120	0	1	04	01	H5521_120_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	120	0	1	04	01	H5521_120_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	120	0	1	04	01	H5521_120_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	120	0	1	04	01	H5521_120_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	121	0	1	04	01	H5521_121_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	121	0	1	04	01	H5521_121_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	121	0	1	04	01	H5521_121_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	121	0	1	04	01	H5521_121_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	121	0	1	04	01	H5521_121_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	121	0	1	04	01	H5521_121_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	121	0	1	04	01	H5521_121_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	122	0	1	04	01	H5521_122_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	122	0	1	04	01	H5521_122_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	122	0	1	04	01	H5521_122_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	122	0	1	04	01	H5521_122_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	122	0	1	04	01	H5521_122_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	122	0	1	04	01	H5521_122_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	122	0	1	04	01	H5521_122_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	123	0	1	04	01	H5521_123_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	123	0	1	04	01	H5521_123_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	123	0	1	04	01	H5521_123_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	123	0	1	04	01	H5521_123_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	123	0	1	04	01	H5521_123_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	123	0	1	04	01	H5521_123_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	123	0	1	04	01	H5521_123_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	124	0	1	04	01	H5521_124_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	124	0	1	04	01	H5521_124_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	124	0	1	04	01	H5521_124_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	124	0	1	04	01	H5521_124_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	124	0	1	04	01	H5521_124_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	124	0	1	04	01	H5521_124_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	124	0	1	04	01	H5521_124_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	125	0	1	04	01	H5521_125_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	125	0	1	04	01	H5521_125_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	125	0	1	04	01	H5521_125_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	125	0	1	04	01	H5521_125_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	125	0	1	04	01	H5521_125_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	125	0	1	04	01	H5521_125_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	125	0	1	04	01	H5521_125_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	126	0	1	04	01	H5521_126_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	126	0	1	04	01	H5521_126_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	126	0	1	04	01	H5521_126_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	126	0	1	04	01	H5521_126_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	126	0	1	04	01	H5521_126_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	126	0	1	04	01	H5521_126_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	126	0	1	04	01	H5521_126_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	127	0	1	04	01	H5521_127_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	127	0	1	04	01	H5521_127_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	127	0	1	04	01	H5521_127_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	127	0	1	04	01	H5521_127_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	127	0	1	04	01	H5521_127_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	127	0	1	04	01	H5521_127_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	127	0	1	04	01	H5521_127_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	128	0	1	04	01	H5521_128_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	128	0	1	04	01	H5521_128_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	128	0	1	04	01	H5521_128_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	128	0	1	04	01	H5521_128_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	128	0	1	04	01	H5521_128_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	128	0	1	04	01	H5521_128_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	128	0	1	04	01	H5521_128_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	130	0	1	04	01	H5521_130_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	130	0	1	04	01	H5521_130_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	130	0	1	04	01	H5521_130_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	130	0	1	04	01	H5521_130_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	130	0	1	04	01	H5521_130_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	130	0	1	04	01	H5521_130_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	130	0	1	04	01	H5521_130_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	31																				31																		31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	131	0	1	04	01	H5521_131_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	131	0	1	04	01	H5521_131_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	131	0	1	04	01	H5521_131_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	131	0	1	04	01	H5521_131_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	131	0	1	04	01	H5521_131_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	131	0	1	04	01	H5521_131_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	131	0	1	04	01	H5521_131_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	30																				30																		30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	134	0	1	04	01	H5521_134_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	134	0	1	04	01	H5521_134_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	134	0	1	04	01	H5521_134_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	134	0	1	04	01	H5521_134_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	134	0	1	04	01	H5521_134_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	134	0	1	04	01	H5521_134_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	134	0	1	04	01	H5521_134_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	139	0	1	04	01	H5521_139_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	139	0	1	04	01	H5521_139_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	139	0	1	04	01	H5521_139_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	139	0	1	04	01	H5521_139_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	139	0	1	04	01	H5521_139_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	139	0	1	04	01	H5521_139_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	139	0	1	04	01	H5521_139_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	140	0	1	04	01	H5521_140_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	140	0	1	04	01	H5521_140_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	140	0	1	04	01	H5521_140_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	140	0	1	04	01	H5521_140_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	140	0	1	04	01	H5521_140_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	140	0	1	04	01	H5521_140_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	140	0	1	04	01	H5521_140_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	141	0	1	04	01	H5521_141_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	141	0	1	04	01	H5521_141_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	141	0	1	04	01	H5521_141_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	141	0	1	04	01	H5521_141_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	141	0	1	04	01	H5521_141_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	141	0	1	04	01	H5521_141_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	141	0	1	04	01	H5521_141_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	142	0	1	04	01	H5521_142_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	142	0	1	04	01	H5521_142_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	142	0	1	04	01	H5521_142_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	142	0	1	04	01	H5521_142_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	142	0	1	04	01	H5521_142_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	142	0	1	04	01	H5521_142_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	142	0	1	04	01	H5521_142_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	143	0	1	04	01	H5521_143_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	143	0	1	04	01	H5521_143_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	143	0	1	04	01	H5521_143_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	143	0	1	04	01	H5521_143_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	143	0	1	04	01	H5521_143_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	143	0	1	04	01	H5521_143_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	143	0	1	04	01	H5521_143_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	144	0	1	04	01	H5521_144_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	144	0	1	04	01	H5521_144_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	144	0	1	04	01	H5521_144_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	144	0	1	04	01	H5521_144_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	144	0	1	04	01	H5521_144_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	144	0	1	04	01	H5521_144_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	144	0	1	04	01	H5521_144_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	145	0	1	04	01	H5521_145_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	145	0	1	04	01	H5521_145_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	145	0	1	04	01	H5521_145_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	145	0	1	04	01	H5521_145_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	145	0	1	04	01	H5521_145_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	145	0	1	04	01	H5521_145_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	145	0	1	04	01	H5521_145_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	146	0	1	04	01	H5521_146_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	146	0	1	04	01	H5521_146_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	146	0	1	04	01	H5521_146_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	146	0	1	04	01	H5521_146_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	146	0	1	04	01	H5521_146_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	146	0	1	04	01	H5521_146_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	146	0	1	04	01	H5521_146_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	147	0	1	04	01	H5521_147_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	147	0	1	04	01	H5521_147_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	147	0	1	04	01	H5521_147_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	147	0	1	04	01	H5521_147_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	147	0	1	04	01	H5521_147_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	147	0	1	04	01	H5521_147_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	147	0	1	04	01	H5521_147_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	148	0	1	04	01	H5521_148_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	148	0	1	04	01	H5521_148_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	148	0	1	04	01	H5521_148_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	148	0	1	04	01	H5521_148_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	148	0	1	04	01	H5521_148_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	148	0	1	04	01	H5521_148_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	148	0	1	04	01	H5521_148_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	149	0	1	04	01	H5521_149_0	3	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	149	0	1	04	01	H5521_149_0	3	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	149	0	1	04	01	H5521_149_0	3	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	149	0	1	04	01	H5521_149_0	3	Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	149	0	1	04	01	H5521_149_0	3	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	150	0	1	04	01	H5521_150_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	150	0	1	04	01	H5521_150_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	150	0	1	04	01	H5521_150_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	150	0	1	04	01	H5521_150_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	150	0	1	04	01	H5521_150_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	150	0	1	04	01	H5521_150_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	150	0	1	04	01	H5521_150_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	151	0	1	04	01	H5521_151_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	151	0	1	04	01	H5521_151_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	151	0	1	04	01	H5521_151_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	151	0	1	04	01	H5521_151_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	151	0	1	04	01	H5521_151_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	151	0	1	04	01	H5521_151_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	151	0	1	04	01	H5521_151_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	152	0	1	04	01	H5521_152_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	152	0	1	04	01	H5521_152_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	152	0	1	04	01	H5521_152_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	152	0	1	04	01	H5521_152_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	152	0	1	04	01	H5521_152_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	152	0	1	04	01	H5521_152_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	152	0	1	04	01	H5521_152_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	153	0	1	04	01	H5521_153_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	153	0	1	04	01	H5521_153_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	153	0	1	04	01	H5521_153_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	153	0	1	04	01	H5521_153_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	153	0	1	04	01	H5521_153_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	153	0	1	04	01	H5521_153_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	153	0	1	04	01	H5521_153_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	154	0	1	04	01	H5521_154_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	154	0	1	04	01	H5521_154_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	154	0	1	04	01	H5521_154_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	154	0	1	04	01	H5521_154_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	154	0	1	04	01	H5521_154_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	154	0	1	04	01	H5521_154_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	154	0	1	04	01	H5521_154_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	156	0	1	04	01	H5521_156_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	156	0	1	04	01	H5521_156_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	156	0	1	04	01	H5521_156_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	156	0	1	04	01	H5521_156_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	156	0	1	04	01	H5521_156_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	156	0	1	04	01	H5521_156_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	156	0	1	04	01	H5521_156_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	157	0	1	04	01	H5521_157_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	157	0	1	04	01	H5521_157_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	157	0	1	04	01	H5521_157_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	157	0	1	04	01	H5521_157_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	157	0	1	04	01	H5521_157_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	157	0	1	04	01	H5521_157_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	157	0	1	04	01	H5521_157_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	158	0	1	04	01	H5521_158_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	158	0	1	04	01	H5521_158_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	158	0	1	04	01	H5521_158_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	158	0	1	04	01	H5521_158_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	158	0	1	04	01	H5521_158_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	158	0	1	04	01	H5521_158_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	158	0	1	04	01	H5521_158_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	159	0	1	04	01	H5521_159_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	159	0	1	04	01	H5521_159_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	159	0	1	04	01	H5521_159_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	159	0	1	04	01	H5521_159_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	159	0	1	04	01	H5521_159_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	159	0	1	04	01	H5521_159_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	159	0	1	04	01	H5521_159_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	160	0	1	04	01	H5521_160_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	160	0	1	04	01	H5521_160_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	160	0	1	04	01	H5521_160_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	160	0	1	04	01	H5521_160_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	160	0	1	04	01	H5521_160_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	160	0	1	04	01	H5521_160_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	160	0	1	04	01	H5521_160_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	167	0	1	04	01	H5521_167_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	167	0	1	04	01	H5521_167_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	167	0	1	04	01	H5521_167_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	167	0	1	04	01	H5521_167_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	167	0	1	04	01	H5521_167_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	167	0	1	04	01	H5521_167_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	167	0	1	04	01	H5521_167_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	168	0	1	04	01	H5521_168_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	168	0	1	04	01	H5521_168_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	168	0	1	04	01	H5521_168_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	168	0	1	04	01	H5521_168_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	168	0	1	04	01	H5521_168_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	168	0	1	04	01	H5521_168_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	168	0	1	04	01	H5521_168_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	169	0	1	04	01	H5521_169_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	169	0	1	04	01	H5521_169_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	169	0	1	04	01	H5521_169_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	169	0	1	04	01	H5521_169_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	169	0	1	04	01	H5521_169_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	169	0	1	04	01	H5521_169_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	169	0	1	04	01	H5521_169_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	170	0	1	04	01	H5521_170_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	170	0	1	04	01	H5521_170_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	170	0	1	04	01	H5521_170_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	170	0	1	04	01	H5521_170_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	170	0	1	04	01	H5521_170_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	170	0	1	04	01	H5521_170_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	170	0	1	04	01	H5521_170_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	171	0	1	04	01	H5521_171_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	171	0	1	04	01	H5521_171_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	171	0	1	04	01	H5521_171_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	171	0	1	04	01	H5521_171_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	171	0	1	04	01	H5521_171_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	171	0	1	04	01	H5521_171_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	171	0	1	04	01	H5521_171_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	177	0	1	04	01	H5521_177_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	177	0	1	04	01	H5521_177_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	177	0	1	04	01	H5521_177_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	177	0	1	04	01	H5521_177_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	177	0	1	04	01	H5521_177_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	177	0	1	04	01	H5521_177_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	177	0	1	04	01	H5521_177_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	178	0	1	04	01	H5521_178_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	178	0	1	04	01	H5521_178_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	178	0	1	04	01	H5521_178_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	178	0	1	04	01	H5521_178_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	178	0	1	04	01	H5521_178_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	178	0	1	04	01	H5521_178_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	178	0	1	04	01	H5521_178_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	183	0	1	04	01	H5521_183_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	183	0	1	04	01	H5521_183_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	183	0	1	04	01	H5521_183_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	183	0	1	04	01	H5521_183_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	183	0	1	04	01	H5521_183_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	183	0	1	04	01	H5521_183_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	183	0	1	04	01	H5521_183_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	184	0	1	04	01	H5521_184_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	184	0	1	04	01	H5521_184_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	184	0	1	04	01	H5521_184_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	184	0	1	04	01	H5521_184_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	184	0	1	04	01	H5521_184_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	184	0	1	04	01	H5521_184_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	184	0	1	04	01	H5521_184_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	28																				28																		28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	185	0	1	04	01	H5521_185_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	185	0	1	04	01	H5521_185_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	185	0	1	04	01	H5521_185_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	185	0	1	04	01	H5521_185_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	185	0	1	04	01	H5521_185_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	185	0	1	04	01	H5521_185_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	185	0	1	04	01	H5521_185_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	28																				28																		28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	186	0	1	04	01	H5521_186_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	186	0	1	04	01	H5521_186_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	186	0	1	04	01	H5521_186_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	186	0	1	04	01	H5521_186_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	186	0	1	04	01	H5521_186_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	186	0	1	04	01	H5521_186_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	186	0	1	04	01	H5521_186_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	28																				28																		28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	187	0	1	04	01	H5521_187_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	187	0	1	04	01	H5521_187_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	187	0	1	04	01	H5521_187_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	187	0	1	04	01	H5521_187_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	187	0	1	04	01	H5521_187_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	187	0	1	04	01	H5521_187_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	187	0	1	04	01	H5521_187_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	31																				31																		31		31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	190	0	1	04	01	H5521_190_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	190	0	1	04	01	H5521_190_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	190	0	1	04	01	H5521_190_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	190	0	1	04	01	H5521_190_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	190	0	1	04	01	H5521_190_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	190	0	1	04	01	H5521_190_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	190	0	1	04	01	H5521_190_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	194	0	1	04	01	H5521_194_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	194	0	1	04	01	H5521_194_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	194	0	1	04	01	H5521_194_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	194	0	1	04	01	H5521_194_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	194	0	1	04	01	H5521_194_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	194	0	1	04	01	H5521_194_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	194	0	1	04	01	H5521_194_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	195	0	1	04	01	H5521_195_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	195	0	1	04	01	H5521_195_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	195	0	1	04	01	H5521_195_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	195	0	1	04	01	H5521_195_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	195	0	1	04	01	H5521_195_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	195	0	1	04	01	H5521_195_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	195	0	1	04	01	H5521_195_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	196	0	1	04	01	H5521_196_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	196	0	1	04	01	H5521_196_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	196	0	1	04	01	H5521_196_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	196	0	1	04	01	H5521_196_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	196	0	1	04	01	H5521_196_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	196	0	1	04	01	H5521_196_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	196	0	1	04	01	H5521_196_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	28																				28																		28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	197	0	1	04	01	H5521_197_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	197	0	1	04	01	H5521_197_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	197	0	1	04	01	H5521_197_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	197	0	1	04	01	H5521_197_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	197	0	1	04	01	H5521_197_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	197	0	1	04	01	H5521_197_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	197	0	1	04	01	H5521_197_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	29																				29																		29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	199	0	1	04	01	H5521_199_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	199	0	1	04	01	H5521_199_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	199	0	1	04	01	H5521_199_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	199	0	1	04	01	H5521_199_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5521	199	0	1	04	01	H5521_199_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	199	0	1	04	01	H5521_199_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5521	199	0	1	04	01	H5521_199_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	001	0	1	04	01	H5522_001_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	001	0	1	04	01	H5522_001_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	001	0	1	04	01	H5522_001_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	001	0	1	04	01	H5522_001_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	001	0	1	04	01	H5522_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	001	0	1	04	01	H5522_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	001	0	1	04	01	H5522_001_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	002	0	1	04	01	H5522_002_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	002	0	1	04	01	H5522_002_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	002	0	1	04	01	H5522_002_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	002	0	1	04	01	H5522_002_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	002	0	1	04	01	H5522_002_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	002	0	1	04	01	H5522_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	002	0	1	04	01	H5522_002_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	004	0	1	04	01	H5522_004_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	004	0	1	04	01	H5522_004_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	004	0	1	04	01	H5522_004_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	004	0	1	04	01	H5522_004_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	004	0	1	04	01	H5522_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	004	0	1	04	01	H5522_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	004	0	1	04	01	H5522_004_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	005	0	1	04	01	H5522_005_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	005	0	1	04	01	H5522_005_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	005	0	1	04	01	H5522_005_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	005	0	1	04	01	H5522_005_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	005	0	1	04	01	H5522_005_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	005	0	1	04	01	H5522_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	005	0	1	04	01	H5522_005_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	013	0	1	04	01	H5522_013_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	013	0	1	04	01	H5522_013_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	013	0	1	04	01	H5522_013_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	013	0	1	04	01	H5522_013_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	013	0	1	04	01	H5522_013_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	013	0	1	04	01	H5522_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	013	0	1	04	01	H5522_013_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	014	0	1	04	01	H5522_014_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	014	0	1	04	01	H5522_014_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	014	0	1	04	01	H5522_014_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	014	0	1	04	01	H5522_014_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	014	0	1	04	01	H5522_014_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	014	0	1	04	01	H5522_014_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	014	0	1	04	01	H5522_014_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	017	0	1	04	01	H5522_017_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	017	0	1	04	01	H5522_017_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	017	0	1	04	01	H5522_017_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	017	0	1	04	01	H5522_017_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	017	0	1	04	01	H5522_017_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	017	0	1	04	01	H5522_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	017	0	1	04	01	H5522_017_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	018	0	1	04	01	H5522_018_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	018	0	1	04	01	H5522_018_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	018	0	1	04	01	H5522_018_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	018	0	1	04	01	H5522_018_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5522	018	0	1	04	01	H5522_018_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	018	0	1	04	01	H5522_018_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5522	018	0	1	04	01	H5522_018_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	004	0	1	04	01	H5525_004_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	004	0	1	04	01	H5525_004_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	004	0	1	04	01	H5525_004_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	004	0	1	04	01	H5525_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	004	0	1	04	01	H5525_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	005	0	1	04	01	H5525_005_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	005	0	1	04	01	H5525_005_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	005	0	1	04	01	H5525_005_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	005	0	1	04	01	H5525_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	005	0	1	04	01	H5525_005_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	006	0	1	04	01	H5525_006_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	006	0	1	04	01	H5525_006_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	006	0	1	04	01	H5525_006_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	006	0	1	04	01	H5525_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	006	0	1	04	01	H5525_006_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	007	0	1	04	01	H5525_007_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	007	0	1	04	01	H5525_007_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	007	0	1	04	01	H5525_007_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	007	0	1	04	01	H5525_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	007	0	1	04	01	H5525_007_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	008	0	1	04	01	H5525_008_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	008	0	1	04	01	H5525_008_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	008	0	1	04	01	H5525_008_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	008	0	1	04	01	H5525_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	008	0	1	04	01	H5525_008_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	015	0	1	04	01	H5525_015_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	015	0	1	04	01	H5525_015_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	015	0	1	04	01	H5525_015_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	015	0	1	04	01	H5525_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	015	0	1	04	01	H5525_015_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	017	0	1	04	01	H5525_017_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	017	0	1	04	01	H5525_017_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	017	0	1	04	01	H5525_017_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	017	0	1	04	01	H5525_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	017	0	1	04	01	H5525_017_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	020	0	1	04	01	H5525_020_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	020	0	1	04	01	H5525_020_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	020	0	1	04	01	H5525_020_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	020	0	1	04	01	H5525_020_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	020	0	1	04	01	H5525_020_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	022	0	1	04	01	H5525_022_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	022	0	1	04	01	H5525_022_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	022	0	1	04	01	H5525_022_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	022	0	1	04	01	H5525_022_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	022	0	1	04	01	H5525_022_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	023	0	1	04	01	H5525_023_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	023	0	1	04	01	H5525_023_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	023	0	1	04	01	H5525_023_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	023	0	1	04	01	H5525_023_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	023	0	1	04	01	H5525_023_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	024	0	1	04	01	H5525_024_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	024	0	1	04	01	H5525_024_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	024	0	1	04	01	H5525_024_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	024	0	1	04	01	H5525_024_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	024	0	1	04	01	H5525_024_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	025	0	1	04	01	H5525_025_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	025	0	1	04	01	H5525_025_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	025	0	1	04	01	H5525_025_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	025	0	1	04	01	H5525_025_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	025	0	1	04	01	H5525_025_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	026	0	1	04	01	H5525_026_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	026	0	1	04	01	H5525_026_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	026	0	1	04	01	H5525_026_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	026	0	1	04	01	H5525_026_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	026	0	1	04	01	H5525_026_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	027	0	1	04	01	H5525_027_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	027	0	1	04	01	H5525_027_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	027	0	1	04	01	H5525_027_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	027	0	1	04	01	H5525_027_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											54.00	50		50				57.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	027	0	1	04	01	H5525_027_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	030	0	1	04	01	H5525_030_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	030	0	1	04	01	H5525_030_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	030	0	1	04	01	H5525_030_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	030	0	1	04	01	H5525_030_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5525	030	0	1	04	01	H5525_030_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	004	0	1	04	01	H5526_004_0	3	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		5.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	004	0	1	04	01	H5526_004_0	3	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		5.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5526	004	0	1	04	01	H5526_004_0	3	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								13.00		39.00					8.00		24.00					8.00		20.00																13.00				13.00			0.43	0.27	0.27			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	004	0	1	04	01	H5526_004_0	3	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	004	0	1	04	01	H5526_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								99.00		297.00					94.00		282.00					94.00		235.00																99.00				99.00			3.30	3.13	3.13			3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	004	0	1	04	01	H5526_004_0	3	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	016	0	1	04	01	H5526_016_0	4	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					4.00		12.00					4.00		10.00																9.00				9.00			0.30	0.13	0.13			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	016	0	1	04	01	H5526_016_0	4	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	016	0	1	04	01	H5526_016_0	4	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	016	0	1	04	01	H5526_016_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											51.63	50		50				51.63	50		50				50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	016	0	1	04	01	H5526_016_0	4	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	017	0	1	04	01	H5526_017_0	3	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								12.00		36.00					7.00		21.00					7.00		17.50																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	017	0	1	04	01	H5526_017_0	3	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								12.00		36.00					7.00		21.00					7.00		17.50																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5526	017	0	1	04	01	H5526_017_0	3	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					15.00		45.00					15.00		37.50																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	017	0	1	04	01	H5526_017_0	3	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	017	0	1	04	01	H5526_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	017	0	1	04	01	H5526_017_0	3	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	018	0	1	04	01	H5526_018_0	3	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		5.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	018	0	1	04	01	H5526_018_0	3	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		5.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5526	018	0	1	04	01	H5526_018_0	3	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		51.00					12.00		36.00					12.00		30.00																17.00				17.00			0.57	0.40	0.40			0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	018	0	1	04	01	H5526_018_0	3	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	018	0	1	04	01	H5526_018_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	018	0	1	04	01	H5526_018_0	3	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	019	0	1	04	01	H5526_019_0	3	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	019	0	1	04	01	H5526_019_0	3	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					15.00		45.00					15.00		37.50																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	019	0	1	04	01	H5526_019_0	3	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	019	0	1	04	01	H5526_019_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5526	019	0	1	04	01	H5526_019_0	3	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												27		27					27		27				27		27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	003	0	1	04	01	H5533_003_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	003	0	1	04	01	H5533_003_0	5	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	003	0	1	04	01	H5533_003_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	003	0	1	04	01	H5533_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	003	0	1	04	01	H5533_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											907.39	33						421.26	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	005	0	1	04	01	H5533_005_0	5	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	005	0	1	04	01	H5533_005_0	5	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	005	0	1	04	01	H5533_005_0	5	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	005	0	1	04	01	H5533_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	005	0	1	04	01	H5533_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											704.92	33						562.77	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	007	0	1	04	01	H5533_007_0	8	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	007	0	1	04	01	H5533_007_0	8	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	007	0	1	04	01	H5533_007_0	8	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	007	0	1	04	01	H5533_007_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	007	0	1	04	01	H5533_007_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											704.91	33						562.47	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	008	0	1	04	01	H5533_008_0	7	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							18.00																9.00				9.00			0.30	0.00				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	008	0	1	04	01	H5533_008_0	7	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		48.00					10.00		30.00							32.00																16.00				16.00			0.53	0.33				0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	008	0	1	04	01	H5533_008_0	7	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							117.50																47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	008	0	1	04	01	H5533_008_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5533	008	0	1	04	01	H5533_008_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											704.91	33						562.47	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5549	002	0	1	01	01	H5549_002_0	4	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5549	002	0	1	01	01	H5549_002_0	4	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5549	002	0	1	01	01	H5549_002_0	4	Preferred Brand	2	10	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.43	25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5549	002	0	1	01	01	H5549_002_0	4	Non-Preferred Brand	2	10	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				79.11	50	50	50																		50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5549	002	0	1	01	01	H5549_002_0	4	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5549	006	0	1	01	01	H5549_006_0	3	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5549	006	0	1	01	01	H5549_006_0	3	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5549	006	0	1	01	01	H5549_006_0	3	Preferred Brand	2	10	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				77.01	25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5549	006	0	1	01	01	H5549_006_0	3	Non-Preferred Brand	2	10	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				72.82	50	50	50																		50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5549	006	0	1	01	01	H5549_006_0	3	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	017	1	1	02	01	H5576_017_1	12	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	017	1	1	02	01	H5576_017_1	12	Generic	4	01	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	12.00		36.00																											36.00						36.00				12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	017	1	1	02	01	H5576_017_1	12	Preferred Brand	4	10	1	2	3	1	110		01		100	1	31		90				1	2						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	017	1	1	02	01	H5576_017_1	12	Non-Preferred Brand	4	10	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				122.02	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	017	1	1	02	01	H5576_017_1	12	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				1764.34	28																																					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	017	2	1	02	01	H5576_017_2	12	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	017	2	1	02	01	H5576_017_2	12	Generic	4	01	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	12.00		36.00																											36.00						36.00				12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	017	2	1	02	01	H5576_017_2	12	Preferred Brand	4	10	1	2	3	1	110		01		100	1	31		90				1	2						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	017	2	1	02	01	H5576_017_2	12	Non-Preferred Brand	4	10	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				122.02	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	017	2	1	02	01	H5576_017_2	12	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				1764.34	28																																					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	018	1	1	02	01	H5576_018_1	12	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	018	1	1	02	01	H5576_018_1	12	Preferred Generic	4	01	1	2	1	3	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5576	018	1	1	02	01	H5576_018_1	12	Generic	4	01	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	12.00		36.00																											36.00						36.00				12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	018	1	1	02	01	H5576_018_1	12	Preferred Brand	4	10	1	2	3	1	110		01		100	1	31		90				1	2						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	018	1	1	02	01	H5576_018_1	12	Non-Preferred Brand	4	10	1	2	4	1	110		01		100	1	31		90				1	2						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	018	1	1	02	01	H5576_018_1	12	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				1365.54	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	018	2	1	02	01	H5576_018_2	12	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	018	2	1	02	01	H5576_018_2	12	Preferred Generic	4	01	1	2	1	3	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5576	018	2	1	02	01	H5576_018_2	12	Generic	4	01	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	12.00		36.00																											36.00						36.00				12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	018	2	1	02	01	H5576_018_2	12	Preferred Brand	4	10	1	2	3	1	110		01		100	1	31		90				1	2						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	018	2	1	02	01	H5576_018_2	12	Non-Preferred Brand	4	10	1	2	4	1	110		01		100	1	31		90				1	2						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	018	2	1	02	01	H5576_018_2	12	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				1365.54	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	020	1	1	02	01	H5576_020_1	11	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	020	1	1	02	01	H5576_020_1	11	Generic	4	01	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	12.00		36.00																											36.00						36.00				12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	020	1	1	02	01	H5576_020_1	11	Preferred Brand	4	10	1	1	3	1	110		01		100	1	31		90				1	2						90	31		31				100.94	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	020	1	1	02	01	H5576_020_1	11	Non-Preferred Brand	4	10	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				91.81	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	020	1	1	02	01	H5576_020_1	11	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				1323.60	25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	020	2	1	02	01	H5576_020_2	11	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	020	2	1	02	01	H5576_020_2	11	Generic	4	01	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	12.00		36.00																											36.00						36.00				12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	020	2	1	02	01	H5576_020_2	11	Preferred Brand	4	10	1	1	3	1	110		01		100	1	31		90				1	2						90	31		31				100.94	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	020	2	1	02	01	H5576_020_2	11	Non-Preferred Brand	4	10	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				91.81	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	020	2	1	02	01	H5576_020_2	11	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				1323.60	25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	022	0	1	02	01	H5576_022_0	7	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	022	0	1	02	01	H5576_022_0	7	Preferred Generic	4	01	1	2	1	3	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5576	022	0	1	02	01	H5576_022_0	7	Generic	4	01	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	12.00		36.00																											36.00						36.00				12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	022	0	1	02	01	H5576_022_0	7	Preferred Brand	4	10	1	2	3	1	110		01		100	1	31		90				1	2						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	022	0	1	02	01	H5576_022_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01		100	1	31		90				1	2						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5576	022	0	1	02	01	H5576_022_0	7	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				1342.80	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5577	005	0	1	01	01	H5577_005_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	005	0	1	01	01	H5577_005_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H5577	005	0	1	01	01	H5577_005_0	4	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	005	0	1	01	01	H5577_005_0	4	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H5577	005	0	1	01	01	H5577_005_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	25.00	50.00	75.00																					50.00																25.00				25.00		0.83						0.81	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	005	0	1	01	01	H5577_005_0	4	Non-Preferred Brand	4	10	3	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	005	0	1	01	01	H5577_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	005	0	1	01	01	H5577_005_0	4	Select Care Drugs	4	01	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	1.00	2.00	3.00																					2.00																1.00				1.00		0.03						0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	005	0	1	01	01	H5577_005_0	4	Select Care Drugs	4	01	1	2	6	3	111		01	100		1	30	60	90				1	2			90				30		31	1.00	2.00	3.00																					2.00																1.00				1.00		0.03						0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H5577	008	0	1	02	01	H5577_008_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	3.00	6.00	9.00																					6.00																3.00				3.00		0.10						0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	008	0	1	02	01	H5577_008_0	5	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	3.00	6.00	9.00																					6.00																3.00				3.00		0.10						0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H5577	008	0	1	02	01	H5577_008_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	6.00	12.00	18.00																					12.00																6.00				6.00		0.20						0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	008	0	1	02	01	H5577_008_0	5	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	6.00	12.00	18.00																					12.00																6.00				6.00		0.20						0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H5577	008	0	1	02	01	H5577_008_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	28.00	56.00	84.00																					56.00																28.00				28.00		0.93						0.90	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	008	0	1	02	01	H5577_008_0	5	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	58.00	116.00	174.00																					116.00																58.00				58.00		1.93						1.87	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	008	0	1	02	01	H5577_008_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	008	0	1	02	01	H5577_008_0	5	Select Care Drugs	4	01	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	1.00	2.00	3.00																					2.00																1.00				1.00		0.03						0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5577	008	0	1	02	01	H5577_008_0	5	Select Care Drugs	4	01	1	2	6	3	111		01	100		1	30	60	90				1	2			90				30		31	1.00	2.00	3.00																					2.00																1.00				1.00		0.03						0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H5591	001	0	1	02	01	H5591_001_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	001	0	1	02	01	H5591_001_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	001	0	1	02	01	H5591_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	001	0	1	02	01	H5591_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	001	0	1	02	01	H5591_001_0	4	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	005	0	1	02	01	H5591_005_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	005	0	1	02	01	H5591_005_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	005	0	1	02	01	H5591_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	005	0	1	02	01	H5591_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	005	0	1	02	01	H5591_005_0	4	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	1	1	02	01	H5591_006_1	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	1	1	02	01	H5591_006_1	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	1	1	02	01	H5591_006_1	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	1	1	02	01	H5591_006_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	1	1	02	01	H5591_006_1	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	2	1	02	01	H5591_006_2	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	2	1	02	01	H5591_006_2	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	2	1	02	01	H5591_006_2	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	2	1	02	01	H5591_006_2	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	2	1	02	01	H5591_006_2	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	3	1	02	01	H5591_006_3	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	3	1	02	01	H5591_006_3	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	3	1	02	01	H5591_006_3	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	3	1	02	01	H5591_006_3	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	006	3	1	02	01	H5591_006_3	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	007	0	1	01	01	H5591_007_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	007	0	1	01	01	H5591_007_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5591	007	0	1	01	01	H5591_007_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	007	0	1	01	01	H5591_007_0	5	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5591	007	0	1	01	01	H5591_007_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	007	0	1	01	01	H5591_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	007	0	1	01	01	H5591_007_0	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	008	0	1	01	01	H5591_008_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	008	0	1	01	01	H5591_008_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	008	0	1	01	01	H5591_008_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	008	0	1	01	01	H5591_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	008	0	1	01	01	H5591_008_0	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	009	0	1	01	01	H5591_009_0	6	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	009	0	1	01	01	H5591_009_0	6	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	009	0	1	01	01	H5591_009_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	009	0	1	01	01	H5591_009_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	009	0	1	01	01	H5591_009_0	6	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	011	0	1	01	01	H5591_011_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	011	0	1	01	01	H5591_011_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	011	0	1	01	01	H5591_011_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	011	0	1	01	01	H5591_011_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	011	0	1	01	01	H5591_011_0	4	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	013	0	1	01	01	H5591_013_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	013	0	1	01	01	H5591_013_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	013	0	1	01	01	H5591_013_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	013	0	1	01	01	H5591_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5591	013	0	1	01	01	H5591_013_0	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	001	0	1	01	01	H5594_001_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	001	0	1	01	01	H5594_001_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5594	001	0	1	01	01	H5594_001_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	001	0	1	01	01	H5594_001_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	001	0	1	01	01	H5594_001_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	002	0	1	01	01	H5594_002_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	002	0	1	01	01	H5594_002_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5594	002	0	1	01	01	H5594_002_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	002	0	1	01	01	H5594_002_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	69.00		207.00																			69.00		138.00																69.00				69.00		2.30			2.30			2.23	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	002	0	1	01	01	H5594_002_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	016	0	1	01	01	H5594_016_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	016	0	1	01	01	H5594_016_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	016	0	1	01	01	H5594_016_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	016	0	1	01	01	H5594_016_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	017	0	1	01	01	H5594_017_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	017	0	1	01	01	H5594_017_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	017	0	1	01	01	H5594_017_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	017	0	1	01	01	H5594_017_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	019	0	1	01	01	H5594_019_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	019	0	1	01	01	H5594_019_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5594	019	0	1	01	01	H5594_019_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	019	0	1	01	01	H5594_019_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	019	0	1	01	01	H5594_019_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	022	0	1	01	01	H5594_022_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	022	0	1	01	01	H5594_022_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5594	022	0	1	01	01	H5594_022_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	022	0	1	01	01	H5594_022_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	022	0	1	01	01	H5594_022_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	026	0	1	01	01	H5594_026_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	026	0	1	01	01	H5594_026_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5594	026	0	1	01	01	H5594_026_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	026	0	1	01	01	H5594_026_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	026	0	1	01	01	H5594_026_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	028	0	1	01	01	H5594_028_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5594	028	0	1	01	01	H5594_028_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs											1		3
H5594	028	0	1	01	01	H5594_028_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5594	028	0	1	01	01	H5594_028_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.94	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5594	028	0	1	01	01	H5594_028_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5594	028	0	1	01	01	H5594_028_0	5	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5594	029	0	1	01	01	H5594_029_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	029	0	1	01	01	H5594_029_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5594	029	0	1	01	01	H5594_029_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	25.00		75.00																			25.00		50.00																25.00				25.00		0.83			0.83			0.81	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	029	0	1	01	01	H5594_029_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	69.00		207.00																			69.00		138.00																69.00				69.00		2.30			2.30			2.23	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	029	0	1	01	01	H5594_029_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	030	0	1	01	01	H5594_030_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5594	030	0	1	01	01	H5594_030_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs											1		3
H5594	030	0	1	01	01	H5594_030_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5594	030	0	1	01	01	H5594_030_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5594	030	0	1	01	01	H5594_030_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5594	030	0	1	01	01	H5594_030_0	5	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs													
H5594	031	0	1	01	01	H5594_031_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	031	0	1	01	01	H5594_031_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5594	031	0	1	01	01	H5594_031_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	031	0	1	01	01	H5594_031_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	031	0	1	01	01	H5594_031_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	032	0	1	01	01	H5594_032_0	5	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	032	0	1	01	01	H5594_032_0	5	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5594	032	0	1	01	01	H5594_032_0	5	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	032	0	1	01	01	H5594_032_0	5	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.94	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	032	0	1	01	01	H5594_032_0	5	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	034	0	1	01	01	H5594_034_0	4	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	034	0	1	01	01	H5594_034_0	4	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5594	034	0	1	01	01	H5594_034_0	4	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	034	0	1	01	01	H5594_034_0	4	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	034	0	1	01	01	H5594_034_0	4	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	035	0	1	01	01	H5594_035_0	4	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	035	0	1	01	01	H5594_035_0	4	Preferred Generic	4	01	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		3
H5594	035	0	1	01	01	H5594_035_0	4	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	035	0	1	01	01	H5594_035_0	4	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5594	035	0	1	01	01	H5594_035_0	4	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5608	002	0	1	01	01	H5608_002_0	6	Preferred Generic	3	01	1	2	1	1	110		10	100		1	30		90				1	2			90					10	31	3.50		7.00																					7.00																	3.50			3.50		0.12						0.11		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5608	002	0	1	01	01	H5608_002_0	6	Generic	3	01	1	2	2	1	110		10	100		1	30		90				1	2			90					10	31	10.50		21.00																					21.00																	10.50			10.50		0.35						0.34		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5608	002	0	1	01	01	H5608_002_0	6	Preferred Brand	3	10	1	1	3	1	110		10	100		1	30		90				1	2			90					10	31				27.90	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5608	002	0	1	01	01	H5608_002_0	6	Non-Preferred Brand	3	10	1	1	4	1	110		10	100		1	30		90				1	2			90					10	31				58.35	50		50																				50																50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5608	002	0	1	01	01	H5608_002_0	6	Specialty Tier	3	11	1	1	5	1	010		10	010		1	30								30							10	31				239.96	25																				25																		25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5608	002	0	1	01	01	H5608_002_0	6	Select Care Drugs	3	01	1	2	6	1	110		10	100		1	30		90				1	2			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5619	001	0	1	01	01	H5619_001_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	001	0	1	01	01	H5619_001_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	001	0	1	01	01	H5619_001_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	001	0	1	01	01	H5619_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	001	0	1	01	01	H5619_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	003	0	1	01	01	H5619_003_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	003	0	1	01	01	H5619_003_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	003	0	1	01	01	H5619_003_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	003	0	1	01	01	H5619_003_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	003	0	1	01	01	H5619_003_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	012	0	1	01	01	H5619_012_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	012	0	1	01	01	H5619_012_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	012	0	1	01	01	H5619_012_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	012	0	1	01	01	H5619_012_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	012	0	1	01	01	H5619_012_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	013	0	1	01	01	H5619_013_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	013	0	1	01	01	H5619_013_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	013	0	1	01	01	H5619_013_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	013	0	1	01	01	H5619_013_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	013	0	1	01	01	H5619_013_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	015	0	1	01	01	H5619_015_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	015	0	1	01	01	H5619_015_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	015	0	1	01	01	H5619_015_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	015	0	1	01	01	H5619_015_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	015	0	1	01	01	H5619_015_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	016	0	1	01	01	H5619_016_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	016	0	1	01	01	H5619_016_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	016	0	1	01	01	H5619_016_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	016	0	1	01	01	H5619_016_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	016	0	1	01	01	H5619_016_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	021	0	1	01	01	H5619_021_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	021	0	1	01	01	H5619_021_0	2	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5619	021	0	1	01	01	H5619_021_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	021	0	1	01	01	H5619_021_0	2	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5619	021	0	1	01	01	H5619_021_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	021	0	1	01	01	H5619_021_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	021	0	1	01	01	H5619_021_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	023	0	1	01	01	H5619_023_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	023	0	1	01	01	H5619_023_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	023	0	1	01	01	H5619_023_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	023	0	1	01	01	H5619_023_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	023	0	1	01	01	H5619_023_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	026	0	1	01	01	H5619_026_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	026	0	1	01	01	H5619_026_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	026	0	1	01	01	H5619_026_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	026	0	1	01	01	H5619_026_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	026	0	1	01	01	H5619_026_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	029	0	1	01	01	H5619_029_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	029	0	1	01	01	H5619_029_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	029	0	1	01	01	H5619_029_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	029	0	1	01	01	H5619_029_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	029	0	1	01	01	H5619_029_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	032	0	1	01	01	H5619_032_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	032	0	1	01	01	H5619_032_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	032	0	1	01	01	H5619_032_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	032	0	1	01	01	H5619_032_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	032	0	1	01	01	H5619_032_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	037	0	1	01	01	H5619_037_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	037	0	1	01	01	H5619_037_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	037	0	1	01	01	H5619_037_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	037	0	1	01	01	H5619_037_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	037	0	1	01	01	H5619_037_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	038	0	1	01	01	H5619_038_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	038	0	1	01	01	H5619_038_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	038	0	1	01	01	H5619_038_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	038	0	1	01	01	H5619_038_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	038	0	1	01	01	H5619_038_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	039	1	1	01	01	H5619_039_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	039	1	1	01	01	H5619_039_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	039	1	1	01	01	H5619_039_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	039	1	1	01	01	H5619_039_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	039	1	1	01	01	H5619_039_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	039	2	1	01	01	H5619_039_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	039	2	1	01	01	H5619_039_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	039	2	1	01	01	H5619_039_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	039	2	1	01	01	H5619_039_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	039	2	1	01	01	H5619_039_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	1	1	01	01	H5619_040_1	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	1	1	01	01	H5619_040_1	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	1	1	01	01	H5619_040_1	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	1	1	01	01	H5619_040_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	1	1	01	01	H5619_040_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	2	1	01	01	H5619_040_2	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	2	1	01	01	H5619_040_2	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	2	1	01	01	H5619_040_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	2	1	01	01	H5619_040_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	2	1	01	01	H5619_040_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	3	1	01	01	H5619_040_3	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	3	1	01	01	H5619_040_3	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	3	1	01	01	H5619_040_3	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	3	1	01	01	H5619_040_3	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	040	3	1	01	01	H5619_040_3	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	041	0	1	01	01	H5619_041_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	041	0	1	01	01	H5619_041_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	041	0	1	01	01	H5619_041_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	041	0	1	01	01	H5619_041_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	041	0	1	01	01	H5619_041_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	042	1	1	01	01	H5619_042_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	042	1	1	01	01	H5619_042_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	042	1	1	01	01	H5619_042_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	042	1	1	01	01	H5619_042_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	042	1	1	01	01	H5619_042_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	042	2	1	01	01	H5619_042_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	042	2	1	01	01	H5619_042_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	042	2	1	01	01	H5619_042_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	042	2	1	01	01	H5619_042_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	042	2	1	01	01	H5619_042_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	044	0	1	01	01	H5619_044_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	044	0	1	01	01	H5619_044_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	044	0	1	01	01	H5619_044_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	044	0	1	01	01	H5619_044_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	044	0	1	01	01	H5619_044_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	045	0	1	01	01	H5619_045_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	045	0	1	01	01	H5619_045_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	045	0	1	01	01	H5619_045_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	045	0	1	01	01	H5619_045_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	045	0	1	01	01	H5619_045_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	046	0	1	01	01	H5619_046_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	046	0	1	01	01	H5619_046_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	046	0	1	01	01	H5619_046_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	046	0	1	01	01	H5619_046_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	046	0	1	01	01	H5619_046_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	046	0	1	01	01	H5619_046_0	3	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	047	0	1	01	01	H5619_047_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	047	0	1	01	01	H5619_047_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	047	0	1	01	01	H5619_047_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	047	0	1	01	01	H5619_047_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	047	0	1	01	01	H5619_047_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	049	0	1	01	01	H5619_049_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	049	0	1	01	01	H5619_049_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	049	0	1	01	01	H5619_049_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	049	0	1	01	01	H5619_049_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	049	0	1	01	01	H5619_049_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	050	0	1	01	01	H5619_050_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	050	0	1	01	01	H5619_050_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	050	0	1	01	01	H5619_050_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	050	0	1	01	01	H5619_050_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	050	0	1	01	01	H5619_050_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	051	0	1	01	01	H5619_051_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	051	0	1	01	01	H5619_051_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	051	0	1	01	01	H5619_051_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	051	0	1	01	01	H5619_051_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	051	0	1	01	01	H5619_051_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	052	0	1	01	01	H5619_052_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	052	0	1	01	01	H5619_052_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	052	0	1	01	01	H5619_052_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	052	0	1	01	01	H5619_052_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	052	0	1	01	01	H5619_052_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	053	0	1	01	01	H5619_053_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	053	0	1	01	01	H5619_053_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	053	0	1	01	01	H5619_053_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	053	0	1	01	01	H5619_053_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	053	0	1	01	01	H5619_053_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	054	0	1	01	01	H5619_054_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	054	0	1	01	01	H5619_054_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	054	0	1	01	01	H5619_054_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	054	0	1	01	01	H5619_054_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	054	0	1	01	01	H5619_054_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	055	0	1	01	01	H5619_055_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	055	0	1	01	01	H5619_055_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	055	0	1	01	01	H5619_055_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	055	0	1	01	01	H5619_055_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	055	0	1	01	01	H5619_055_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	055	0	1	01	01	H5619_055_0	4	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					7.00		21.00											11.00		33.00				7.00		0.00				11.00				11.00			0.37	0.23		0.37	0.23	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	056	0	1	01	01	H5619_056_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	056	0	1	01	01	H5619_056_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	056	0	1	01	01	H5619_056_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	056	0	1	01	01	H5619_056_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	056	0	1	01	01	H5619_056_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	057	0	1	01	01	H5619_057_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	057	0	1	01	01	H5619_057_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	057	0	1	01	01	H5619_057_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	057	0	1	01	01	H5619_057_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	057	0	1	01	01	H5619_057_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	059	0	1	01	01	H5619_059_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	059	0	1	01	01	H5619_059_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	059	0	1	01	01	H5619_059_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	059	0	1	01	01	H5619_059_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	059	0	1	01	01	H5619_059_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	060	0	1	01	01	H5619_060_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	060	0	1	01	01	H5619_060_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	060	0	1	01	01	H5619_060_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	060	0	1	01	01	H5619_060_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	060	0	1	01	01	H5619_060_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	061	0	1	01	01	H5619_061_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	061	0	1	01	01	H5619_061_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	061	0	1	01	01	H5619_061_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	061	0	1	01	01	H5619_061_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	061	0	1	01	01	H5619_061_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	062	0	1	01	01	H5619_062_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	062	0	1	01	01	H5619_062_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	062	0	1	01	01	H5619_062_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	062	0	1	01	01	H5619_062_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	062	0	1	01	01	H5619_062_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	063	0	1	01	01	H5619_063_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	063	0	1	01	01	H5619_063_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	063	0	1	01	01	H5619_063_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	063	0	1	01	01	H5619_063_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	063	0	1	01	01	H5619_063_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	064	0	1	01	01	H5619_064_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	064	0	1	01	01	H5619_064_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	064	0	1	01	01	H5619_064_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	064	0	1	01	01	H5619_064_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	064	0	1	01	01	H5619_064_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	065	0	1	01	01	H5619_065_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	065	0	1	01	01	H5619_065_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	065	0	1	01	01	H5619_065_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	065	0	1	01	01	H5619_065_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	065	0	1	01	01	H5619_065_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	066	0	1	01	01	H5619_066_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	066	0	1	01	01	H5619_066_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	066	0	1	01	01	H5619_066_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	066	0	1	01	01	H5619_066_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	066	0	1	01	01	H5619_066_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	067	0	1	01	01	H5619_067_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	067	0	1	01	01	H5619_067_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	067	0	1	01	01	H5619_067_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	067	0	1	01	01	H5619_067_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	067	0	1	01	01	H5619_067_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	069	0	1	01	01	H5619_069_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	069	0	1	01	01	H5619_069_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	069	0	1	01	01	H5619_069_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	069	0	1	01	01	H5619_069_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	069	0	1	01	01	H5619_069_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	070	1	1	01	01	H5619_070_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	070	1	1	01	01	H5619_070_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	070	1	1	01	01	H5619_070_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	070	1	1	01	01	H5619_070_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	070	1	1	01	01	H5619_070_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	070	2	1	01	01	H5619_070_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	070	2	1	01	01	H5619_070_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	070	2	1	01	01	H5619_070_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	070	2	1	01	01	H5619_070_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	070	2	1	01	01	H5619_070_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	071	0	1	01	01	H5619_071_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	071	0	1	01	01	H5619_071_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	071	0	1	01	01	H5619_071_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	071	0	1	01	01	H5619_071_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	071	0	1	01	01	H5619_071_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	072	0	1	01	01	H5619_072_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	072	0	1	01	01	H5619_072_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	072	0	1	01	01	H5619_072_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	072	0	1	01	01	H5619_072_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	50		50				85.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	072	0	1	01	01	H5619_072_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	073	0	1	01	01	H5619_073_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	073	0	1	01	01	H5619_073_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	073	0	1	01	01	H5619_073_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	073	0	1	01	01	H5619_073_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	073	0	1	01	01	H5619_073_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	074	1	1	01	01	H5619_074_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	074	1	1	01	01	H5619_074_1	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	074	1	1	01	01	H5619_074_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	074	1	1	01	01	H5619_074_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	074	1	1	01	01	H5619_074_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	074	2	1	01	01	H5619_074_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	074	2	1	01	01	H5619_074_2	2	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	074	2	1	01	01	H5619_074_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	074	2	1	01	01	H5619_074_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	074	2	1	01	01	H5619_074_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	075	0	1	01	01	H5619_075_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	075	0	1	01	01	H5619_075_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	075	0	1	01	01	H5619_075_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	075	0	1	01	01	H5619_075_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	075	0	1	01	01	H5619_075_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	076	0	1	01	01	H5619_076_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	076	0	1	01	01	H5619_076_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	076	0	1	01	01	H5619_076_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	076	0	1	01	01	H5619_076_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	076	0	1	01	01	H5619_076_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	077	0	1	01	01	H5619_077_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	077	0	1	01	01	H5619_077_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	077	0	1	01	01	H5619_077_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	077	0	1	01	01	H5619_077_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	077	0	1	01	01	H5619_077_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	078	0	1	01	01	H5619_078_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	078	0	1	01	01	H5619_078_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	078	0	1	01	01	H5619_078_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	078	0	1	01	01	H5619_078_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	078	0	1	01	01	H5619_078_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	079	0	1	01	01	H5619_079_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	079	0	1	01	01	H5619_079_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	079	0	1	01	01	H5619_079_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	079	0	1	01	01	H5619_079_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	079	0	1	01	01	H5619_079_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	080	0	1	01	01	H5619_080_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	080	0	1	01	01	H5619_080_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	080	0	1	01	01	H5619_080_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	080	0	1	01	01	H5619_080_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	080	0	1	01	01	H5619_080_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	081	0	1	01	01	H5619_081_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	081	0	1	01	01	H5619_081_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	081	0	1	01	01	H5619_081_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	081	0	1	01	01	H5619_081_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	081	0	1	01	01	H5619_081_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	082	0	1	01	01	H5619_082_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	082	0	1	01	01	H5619_082_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	082	0	1	01	01	H5619_082_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	082	0	1	01	01	H5619_082_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	082	0	1	01	01	H5619_082_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	083	0	1	01	01	H5619_083_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	083	0	1	01	01	H5619_083_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	083	0	1	01	01	H5619_083_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	083	0	1	01	01	H5619_083_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	083	0	1	01	01	H5619_083_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	084	0	1	01	01	H5619_084_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	084	0	1	01	01	H5619_084_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	084	0	1	01	01	H5619_084_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	084	0	1	01	01	H5619_084_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	084	0	1	01	01	H5619_084_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	086	0	1	01	01	H5619_086_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	086	0	1	01	01	H5619_086_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	086	0	1	01	01	H5619_086_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	086	0	1	01	01	H5619_086_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	086	0	1	01	01	H5619_086_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	087	0	1	01	01	H5619_087_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	087	0	1	01	01	H5619_087_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	087	0	1	01	01	H5619_087_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	087	0	1	01	01	H5619_087_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	087	0	1	01	01	H5619_087_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	087	0	1	01	01	H5619_087_0	4	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5619	088	0	1	01	01	H5619_088_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	088	0	1	01	01	H5619_088_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	088	0	1	01	01	H5619_088_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	088	0	1	01	01	H5619_088_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	088	0	1	01	01	H5619_088_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	089	0	1	01	01	H5619_089_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	089	0	1	01	01	H5619_089_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	089	0	1	01	01	H5619_089_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	089	0	1	01	01	H5619_089_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	089	0	1	01	01	H5619_089_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	090	0	1	01	01	H5619_090_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	090	0	1	01	01	H5619_090_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	090	0	1	01	01	H5619_090_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	090	0	1	01	01	H5619_090_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	090	0	1	01	01	H5619_090_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	091	0	1	01	01	H5619_091_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	091	0	1	01	01	H5619_091_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	091	0	1	01	01	H5619_091_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	091	0	1	01	01	H5619_091_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	091	0	1	01	01	H5619_091_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	093	0	1	01	01	H5619_093_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	093	0	1	01	01	H5619_093_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	093	0	1	01	01	H5619_093_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	093	0	1	01	01	H5619_093_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	093	0	1	01	01	H5619_093_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	094	0	1	01	01	H5619_094_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	094	0	1	01	01	H5619_094_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	094	0	1	01	01	H5619_094_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	094	0	1	01	01	H5619_094_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	094	0	1	01	01	H5619_094_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	095	0	1	01	01	H5619_095_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	095	0	1	01	01	H5619_095_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	095	0	1	01	01	H5619_095_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	095	0	1	01	01	H5619_095_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	095	0	1	01	01	H5619_095_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	096	1	1	01	01	H5619_096_1	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	096	1	1	01	01	H5619_096_1	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	096	1	1	01	01	H5619_096_1	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	096	1	1	01	01	H5619_096_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	096	1	1	01	01	H5619_096_1	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	096	2	1	01	01	H5619_096_2	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	096	2	1	01	01	H5619_096_2	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	096	2	1	01	01	H5619_096_2	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	096	2	1	01	01	H5619_096_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	096	2	1	01	01	H5619_096_2	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	097	0	1	01	01	H5619_097_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	097	0	1	01	01	H5619_097_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	097	0	1	01	01	H5619_097_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	097	0	1	01	01	H5619_097_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	097	0	1	01	01	H5619_097_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	099	0	1	01	01	H5619_099_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	099	0	1	01	01	H5619_099_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	099	0	1	01	01	H5619_099_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	099	0	1	01	01	H5619_099_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	099	0	1	01	01	H5619_099_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	100	0	1	01	01	H5619_100_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	100	0	1	01	01	H5619_100_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	100	0	1	01	01	H5619_100_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	100	0	1	01	01	H5619_100_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	100	0	1	01	01	H5619_100_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	101	0	1	01	01	H5619_101_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	101	0	1	01	01	H5619_101_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	101	0	1	01	01	H5619_101_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	101	0	1	01	01	H5619_101_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	101	0	1	01	01	H5619_101_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	102	0	1	01	01	H5619_102_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	102	0	1	01	01	H5619_102_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	102	0	1	01	01	H5619_102_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	102	0	1	01	01	H5619_102_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	102	0	1	01	01	H5619_102_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	104	0	1	01	01	H5619_104_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	104	0	1	01	01	H5619_104_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	104	0	1	01	01	H5619_104_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	104	0	1	01	01	H5619_104_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	104	0	1	01	01	H5619_104_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	109	0	1	01	01	H5619_109_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	109	0	1	01	01	H5619_109_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	109	0	1	01	01	H5619_109_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	109	0	1	01	01	H5619_109_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5619	109	0	1	01	01	H5619_109_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	001	0	1	01	01	H5628_001_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	001	0	1	01	01	H5628_001_0	5	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	001	0	1	01	01	H5628_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	23.00	46.00	69.00																			23.00	46.00	69.00																23.00				23.00		0.74			0.74			0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	001	0	1	01	01	H5628_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				78.49	45	45	45																		45	45	45															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	001	0	1	01	01	H5628_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	006	0	1	01	01	H5628_006_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	006	0	1	01	01	H5628_006_0	5	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	006	0	1	01	01	H5628_006_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	21.00	42.00	63.00																			21.00	42.00	63.00																21.00				21.00		0.68			0.68			0.68		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	006	0	1	01	01	H5628_006_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				75.00	45	45	45																		45	45	45															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	006	0	1	01	01	H5628_006_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	007	0	1	01	01	H5628_007_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.06			0.06			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	007	0	1	01	01	H5628_007_0	7	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	007	0	1	01	01	H5628_007_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	007	0	1	01	01	H5628_007_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	007	0	1	01	01	H5628_007_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	009	0	1	01	01	H5628_009_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	009	0	1	01	01	H5628_009_0	5	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	9.00	18.00	27.00																			9.00	18.00	18.00																9.00				9.00		0.29			0.29			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	009	0	1	01	01	H5628_009_0	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	009	0	1	01	01	H5628_009_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	009	0	1	01	01	H5628_009_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	010	0	1	01	01	H5628_010_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.06			0.06			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	010	0	1	01	01	H5628_010_0	6	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	010	0	1	01	01	H5628_010_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	010	0	1	01	01	H5628_010_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5628	010	0	1	01	01	H5628_010_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5649	001	0	1	01	01	H5649_001_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	001	0	1	01	01	H5649_001_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	001	0	1	01	01	H5649_001_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	001	0	1	01	01	H5649_001_0	6	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	001	0	1	01	01	H5649_001_0	6	Preferred Brand	4	11	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	001	0	1	01	01	H5649_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	001	0	1	01	01	H5649_001_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				506.12	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	001	0	1	01	01	H5649_001_0	6	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	002	0	1	01	01	H5649_002_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	002	0	1	01	01	H5649_002_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	002	0	1	01	01	H5649_002_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	002	0	1	01	01	H5649_002_0	5	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	002	0	1	01	01	H5649_002_0	5	Preferred Brand	4	11	3	1	3	1	110		01	100		1	30		90				1	2			90				30		31				97.80	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	002	0	1	01	01	H5649_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				76.51	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	002	0	1	01	01	H5649_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				373.49	25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	002	0	1	01	01	H5649_002_0	5	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	004	0	1	01	01	H5649_004_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	004	0	1	01	01	H5649_004_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	004	0	1	01	01	H5649_004_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	004	0	1	01	01	H5649_004_0	6	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	004	0	1	01	01	H5649_004_0	6	Preferred Brand	4	11	3	1	3	1	110		01	100		1	30		90				1	2			90				30		31				62.27	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	004	0	1	01	01	H5649_004_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				87.94	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	004	0	1	01	01	H5649_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				358.47	25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	004	0	1	01	01	H5649_004_0	6	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	006	0	1	01	01	H5649_006_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	006	0	1	01	01	H5649_006_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	006	0	1	01	01	H5649_006_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	006	0	1	01	01	H5649_006_0	6	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	006	0	1	01	01	H5649_006_0	6	Preferred Brand	4	11	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	006	0	1	01	01	H5649_006_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	006	0	1	01	01	H5649_006_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				480.07	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	006	0	1	01	01	H5649_006_0	6	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	006	0	1	01	01	H5649_006_0	6	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	008	0	1	01	01	H5649_008_0	7	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	008	0	1	01	01	H5649_008_0	7	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	008	0	1	01	01	H5649_008_0	7	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	008	0	1	01	01	H5649_008_0	7	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	008	0	1	01	01	H5649_008_0	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	008	0	1	01	01	H5649_008_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	008	0	1	01	01	H5649_008_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				688.07	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	008	0	1	01	01	H5649_008_0	7	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		10.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	009	0	1	01	01	H5649_009_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	009	0	1	01	01	H5649_009_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	009	0	1	01	01	H5649_009_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	009	0	1	01	01	H5649_009_0	6	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5649	009	0	1	01	01	H5649_009_0	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				97.80	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	009	0	1	01	01	H5649_009_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				76.51	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	009	0	1	01	01	H5649_009_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				373.49	25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5649	009	0	1	01	01	H5649_009_0	6	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5652	001	0	1	02	01	H5652_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	001	0	1	02	01	H5652_001_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	001	0	1	02	01	H5652_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	001	0	1	02	01	H5652_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	001	0	1	02	01	H5652_001_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				456.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	003	0	1	02	01	H5652_003_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	003	0	1	02	01	H5652_003_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	003	0	1	02	01	H5652_003_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	28.00		84.00																											84.00						74.00				28.00				28.00		.93						.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	003	0	1	02	01	H5652_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	70.00		210.00																											210.00						200.00				70.00				70.00		2.33						2.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	003	0	1	02	01	H5652_003_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				398.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	004	0	1	02	01	H5652_004_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	004	0	1	02	01	H5652_004_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	004	0	1	02	01	H5652_004_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	004	0	1	02	01	H5652_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	004	0	1	02	01	H5652_004_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				593.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	006	0	1	02	01	H5652_006_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	006	0	1	02	01	H5652_006_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	006	0	1	02	01	H5652_006_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	006	0	1	02	01	H5652_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5652	006	0	1	02	01	H5652_006_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				370.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5656	001	0	1	01	01	H5656_001_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5656	001	0	1	01	01	H5656_001_0	8	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5656	001	0	1	01	01	H5656_001_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.17		1.50	1.17	1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5656	001	0	1	01	01	H5656_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5656	001	0	1	01	01	H5656_001_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5746	016	0	1	01	01	H5746_016_0	10	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5746	016	0	1	01	01	H5746_016_0	10	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								12.00	24.00	36.00					12.00	24.00	36.00					12.00	36.00	36.00																12.00				12.00			0.40	0.40	0.40			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5746	016	0	1	01	01	H5746_016_0	10	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5746	016	0	1	01	01	H5746_016_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5746	016	0	1	01	01	H5746_016_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5746	016	0	1	01	01	H5746_016_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5746	016	0	1	01	01	H5746_016_0	10	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5774	005	0	1	01	01	H5774_005_0	7	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	005	0	1	01	01	H5774_005_0	7	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5774	005	0	1	01	01	H5774_005_0	7	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	005	0	1	01	01	H5774_005_0	7	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5774	005	0	1	01	01	H5774_005_0	7	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	005	0	1	01	01	H5774_005_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								75.00		150.00					50.00		100.00							100.00																75.00				50.00			2.50	1.67				1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	005	0	1	01	01	H5774_005_0	7	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	022	0	1	01	01	H5774_022_0	7	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	022	0	1	01	01	H5774_022_0	7	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5774	022	0	1	01	01	H5774_022_0	7	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	022	0	1	01	01	H5774_022_0	7	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5774	022	0	1	01	01	H5774_022_0	7	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	022	0	1	01	01	H5774_022_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								75.00		150.00					50.00		100.00							100.00																75.00				50.00			2.50	1.67				1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	022	0	1	01	01	H5774_022_0	7	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	023	0	1	02	01	H5774_023_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	023	0	1	02	01	H5774_023_0	6	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5774	023	0	1	02	01	H5774_023_0	6	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	023	0	1	02	01	H5774_023_0	6	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5774	023	0	1	02	01	H5774_023_0	6	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	023	0	1	02	01	H5774_023_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								75.00		150.00					50.00		100.00							100.00																75.00				50.00			2.50	1.67				1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	023	0	1	02	01	H5774_023_0	6	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	024	0	1	01	01	H5774_024_0	7	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					4.00		8.00							8.00																10.00				4.00			0.33	0.13				0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	024	0	1	01	01	H5774_024_0	7	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	024	0	1	01	01	H5774_024_0	7	Preferred Brand	2	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	024	0	1	01	01	H5774_024_0	7	Non-Preferred Brand	2	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		190.00					50.00		100.00							100																95.00				50.00			3.17	1.67				1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	024	0	1	01	01	H5774_024_0	7	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											15.00	25		25				15.00	25		25						25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	025	0	1	01	01	H5774_025_0	7	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					4.00		8.00							8.00																10.00				4.00			0.33	0.13				0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	025	0	1	01	01	H5774_025_0	7	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	025	0	1	01	01	H5774_025_0	7	Preferred Brand	2	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	025	0	1	01	01	H5774_025_0	7	Non-Preferred Brand	2	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		190.00					50.00		100.00							100																95.00				50.00			3.17	1.67				1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	025	0	1	01	01	H5774_025_0	7	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											15.00	25		25				15.00	25		25						25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	026	0	1	01	01	H5774_026_0	7	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					4.00		8.00							8.00																10.00				4.00			0.33	0.13				0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	026	0	1	01	01	H5774_026_0	7	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	026	0	1	01	01	H5774_026_0	7	Preferred Brand	2	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	026	0	1	01	01	H5774_026_0	7	Non-Preferred Brand	2	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		190.00					50.00		100.00							100																95.00				50.00			3.17	1.67				1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5774	026	0	1	01	01	H5774_026_0	7	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											15.00	25		25				15.00	25		25						25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5779	002	0	1	01	01	H5779_002_0	8	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	002	0	1	01	01	H5779_002_0	8	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	002	0	1	01	01	H5779_002_0	8	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	002	0	1	01	01	H5779_002_0	8	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	002	0	1	01	01	H5779_002_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	002	0	1	01	01	H5779_002_0	8	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	50.00																																							50.00				50.00		1.67						1.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	003	0	1	01	01	H5779_003_0	8	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	003	0	1	01	01	H5779_003_0	8	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	003	0	1	01	01	H5779_003_0	8	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		70.00																					70.00																35.00				35.00		1.17						1.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	003	0	1	01	01	H5779_003_0	8	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	85.00		255.00																					225.00																85.00				85.00		2.83						2.74	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	003	0	1	01	01	H5779_003_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	003	0	1	01	01	H5779_003_0	8	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	40.00																																							40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	005	0	1	01	01	H5779_005_0	8	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	005	0	1	01	01	H5779_005_0	8	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	12.00		24.00																					24.00																12.00				12.00		0.40						0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	005	0	1	01	01	H5779_005_0	8	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	005	0	1	01	01	H5779_005_0	8	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	005	0	1	01	01	H5779_005_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	005	0	1	01	01	H5779_005_0	8	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	65.00																																							65.00				65.00		2.17						2.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	006	0	1	01	01	H5779_006_0	9	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				1.97	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	006	0	1	01	01	H5779_006_0	9	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				6.32	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	006	0	1	01	01	H5779_006_0	9	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				65.03	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	006	0	1	01	01	H5779_006_0	9	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				55.80	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	006	0	1	01	01	H5779_006_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5779	006	0	1	01	01	H5779_006_0	9	Supplemental Drugs	4	10	2	1	6	1	010		01			1	30														30		31				0.00	0																																					0			0									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs													
H5793	001	0	1	01	01	H5793_001_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	001	0	1	01	01	H5793_001_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5793	001	0	1	01	01	H5793_001_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	001	0	1	01	01	H5793_001_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5793	001	0	1	01	01	H5793_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	001	0	1	01	01	H5793_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	001	0	1	01	01	H5793_001_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	008	0	1	01	01	H5793_008_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	008	0	1	01	01	H5793_008_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5793	008	0	1	01	01	H5793_008_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	008	0	1	01	01	H5793_008_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5793	008	0	1	01	01	H5793_008_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	008	0	1	01	01	H5793_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	008	0	1	01	01	H5793_008_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	010	0	1	01	01	H5793_010_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	010	0	1	01	01	H5793_010_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5793	010	0	1	01	01	H5793_010_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	010	0	1	01	01	H5793_010_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5793	010	0	1	01	01	H5793_010_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	010	0	1	01	01	H5793_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	010	0	1	01	01	H5793_010_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	011	0	1	01	01	H5793_011_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	011	0	1	01	01	H5793_011_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5793	011	0	1	01	01	H5793_011_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	011	0	1	01	01	H5793_011_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5793	011	0	1	01	01	H5793_011_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	011	0	1	01	01	H5793_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5793	011	0	1	01	01	H5793_011_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5810	001	0	1	01	01	H5810_001_0	5	Preferred Generic	3	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5810	001	0	1	01	01	H5810_001_0	5	Generic	3	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.26			0.26			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5810	001	0	1	01	01	H5810_001_0	5	Preferred Brand	3	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5810	001	0	1	01	01	H5810_001_0	5	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.58	48	48	48																		48	48	48															48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5810	001	0	1	01	01	H5810_001_0	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5817	018	0	1	01	01	H5817_018_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	018	0	1	01	01	H5817_018_0	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	018	0	1	01	01	H5817_018_0	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	018	0	1	01	01	H5817_018_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	018	0	1	01	01	H5817_018_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	018	0	1	01	01	H5817_018_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	018	0	1	01	01	H5817_018_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	019	0	1	01	01	H5817_019_0	10	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	019	0	1	01	01	H5817_019_0	10	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	019	0	1	01	01	H5817_019_0	10	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	019	0	1	01	01	H5817_019_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	019	0	1	01	01	H5817_019_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	019	0	1	01	01	H5817_019_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	019	0	1	01	01	H5817_019_0	10	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	020	1	1	01	01	H5817_020_1	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	1	1	01	01	H5817_020_1	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	1	1	01	01	H5817_020_1	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	1	1	01	01	H5817_020_1	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	1	1	01	01	H5817_020_1	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	1	1	01	01	H5817_020_1	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	1	1	01	01	H5817_020_1	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	020	2	1	01	01	H5817_020_2	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	2	1	01	01	H5817_020_2	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	2	1	01	01	H5817_020_2	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	2	1	01	01	H5817_020_2	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	2	1	01	01	H5817_020_2	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	2	1	01	01	H5817_020_2	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	2	1	01	01	H5817_020_2	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	020	3	1	01	01	H5817_020_3	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	3	1	01	01	H5817_020_3	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	3	1	01	01	H5817_020_3	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	3	1	01	01	H5817_020_3	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	3	1	01	01	H5817_020_3	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	3	1	01	01	H5817_020_3	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	3	1	01	01	H5817_020_3	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	020	4	1	01	01	H5817_020_4	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	4	1	01	01	H5817_020_4	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	4	1	01	01	H5817_020_4	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	4	1	01	01	H5817_020_4	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	4	1	01	01	H5817_020_4	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	4	1	01	01	H5817_020_4	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	4	1	01	01	H5817_020_4	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	020	5	1	01	01	H5817_020_5	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	5	1	01	01	H5817_020_5	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	5	1	01	01	H5817_020_5	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	5	1	01	01	H5817_020_5	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	5	1	01	01	H5817_020_5	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	5	1	01	01	H5817_020_5	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	5	1	01	01	H5817_020_5	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	020	6	1	01	01	H5817_020_6	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	6	1	01	01	H5817_020_6	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	6	1	01	01	H5817_020_6	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	6	1	01	01	H5817_020_6	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	6	1	01	01	H5817_020_6	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	6	1	01	01	H5817_020_6	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	020	6	1	01	01	H5817_020_6	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	022	0	1	01	01	H5817_022_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	022	0	1	01	01	H5817_022_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	022	0	1	01	01	H5817_022_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	022	0	1	01	01	H5817_022_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	022	0	1	01	01	H5817_022_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	022	0	1	01	01	H5817_022_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	022	0	1	01	01	H5817_022_0	8	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	023	0	1	01	01	H5817_023_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	023	0	1	01	01	H5817_023_0	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	023	0	1	01	01	H5817_023_0	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	023	0	1	01	01	H5817_023_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	023	0	1	01	01	H5817_023_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	023	0	1	01	01	H5817_023_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	023	0	1	01	01	H5817_023_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	1	1	01	01	H5817_024_1	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	1	1	01	01	H5817_024_1	9	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	1	1	01	01	H5817_024_1	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	1	1	01	01	H5817_024_1	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	1	1	01	01	H5817_024_1	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	1	1	01	01	H5817_024_1	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	1	1	01	01	H5817_024_1	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	1	1	01	01	H5817_024_1	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	2	1	01	01	H5817_024_2	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	2	1	01	01	H5817_024_2	9	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	2	1	01	01	H5817_024_2	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	2	1	01	01	H5817_024_2	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	2	1	01	01	H5817_024_2	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	2	1	01	01	H5817_024_2	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	2	1	01	01	H5817_024_2	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	2	1	01	01	H5817_024_2	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	3	1	01	01	H5817_024_3	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	3	1	01	01	H5817_024_3	9	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	3	1	01	01	H5817_024_3	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	3	1	01	01	H5817_024_3	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	3	1	01	01	H5817_024_3	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	3	1	01	01	H5817_024_3	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	3	1	01	01	H5817_024_3	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	3	1	01	01	H5817_024_3	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	5	1	01	01	H5817_024_5	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	5	1	01	01	H5817_024_5	9	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	5	1	01	01	H5817_024_5	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	5	1	01	01	H5817_024_5	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	5	1	01	01	H5817_024_5	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	5	1	01	01	H5817_024_5	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	5	1	01	01	H5817_024_5	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	5	1	01	01	H5817_024_5	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	6	1	01	01	H5817_024_6	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	6	1	01	01	H5817_024_6	9	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	6	1	01	01	H5817_024_6	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	6	1	01	01	H5817_024_6	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	6	1	01	01	H5817_024_6	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	6	1	01	01	H5817_024_6	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	6	1	01	01	H5817_024_6	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	6	1	01	01	H5817_024_6	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	7	1	01	01	H5817_024_7	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	7	1	01	01	H5817_024_7	9	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	024	7	1	01	01	H5817_024_7	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	7	1	01	01	H5817_024_7	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	7	1	01	01	H5817_024_7	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	7	1	01	01	H5817_024_7	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	7	1	01	01	H5817_024_7	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	024	7	1	01	01	H5817_024_7	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	025	0	1	02	01	H5817_025_0	9	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	025	0	1	02	01	H5817_025_0	9	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	025	0	1	02	01	H5817_025_0	9	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	025	0	1	02	01	H5817_025_0	9	Non-Preferred Drug	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								98.00	196.00	294.00					93.00	186.00	279.00					93.00	279.00	279.00																98.00				98.00			3.27	3.10	3.10			2.88		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	025	0	1	02	01	H5817_025_0	9	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	025	0	1	02	01	H5817_025_0	9	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	026	0	1	01	01	H5817_026_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	026	0	1	01	01	H5817_026_0	9	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5817	026	0	1	01	01	H5817_026_0	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	026	0	1	01	01	H5817_026_0	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	026	0	1	01	01	H5817_026_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	026	0	1	01	01	H5817_026_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	026	0	1	01	01	H5817_026_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5817	026	0	1	01	01	H5817_026_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5823	006	0	1	01	01	H5823_006_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	006	0	1	01	01	H5823_006_0	5	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	006	0	1	01	01	H5823_006_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	29.00	58.00	87.00																			29.00	58.00	87.00																29.00				29.00		0.94			0.94			0.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	006	0	1	01	01	H5823_006_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				76.67	45	45	45																		45	45	45															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	006	0	1	01	01	H5823_006_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	007	0	1	01	01	H5823_007_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	007	0	1	01	01	H5823_007_0	5	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	007	0	1	01	01	H5823_007_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	37.00	74.00	111.00																			37.00	74.00	111.00																37.00				37.00		1.19			1.19			1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	007	0	1	01	01	H5823_007_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				74.28	44	44	44																		44	44	44															44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	007	0	1	01	01	H5823_007_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	008	0	1	01	01	H5823_008_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.06	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	008	0	1	01	01	H5823_008_0	5	Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								17.00	34.00	51.00					12.00	24.00	36.00					17.00	34.00	34.00																17.00				17.00			0.55	0.39	0.55			0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	008	0	1	01	01	H5823_008_0	5	Preferred Brand	4	10	1	2	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	94.00																47.00				47.00			1.52	1.19	1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	008	0	1	01	01	H5823_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.23	3.23	3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5823	008	0	1	01	01	H5823_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31												29							29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	008	0	1	01	01	H5826_008_0	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	34		90				1	2			90				34		34	2.00		5.00																					5.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	008	0	1	01	01	H5826_008_0	4	Generic	4	01	1	2	2	1	110		01	100		1	34		90				1	2			90				34		34	20.00		50.00																					50.00																20.00				20.00		0.59						0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	008	0	1	01	01	H5826_008_0	4	Preferred Brand	4	10	1	2	3	1	110		01	100		1	34		90				1	2			90				34		34	47.00		135.00																					135.00																47.00				47.00		1.38						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	008	0	1	01	01	H5826_008_0	4	Non-Preferred Drug	4	11	1	1	4	1	010		01	010		1	34								34						34		34				100.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	008	0	1	01	01	H5826_008_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	34								34						34		34				100.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	009	0	1	01	01	H5826_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01	100		1	34		90				1	2			90				34		34	2.00		5.00																					5.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	009	0	1	01	01	H5826_009_0	3	Generic	4	01	1	2	2	1	110		01	100		1	34		90				1	2			90				34		34	20.00		50.00																					50.00																20.00				20.00		0.59						0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	009	0	1	01	01	H5826_009_0	3	Preferred Brand	4	10	1	2	3	1	110		01	100		1	34		90				1	2			90				34		34	47.00		135.00																					135.00																47.00				47.00		1.38						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	009	0	1	01	01	H5826_009_0	3	Non-Preferred Drug	4	11	1	1	4	1	010		01	010		1	34								34						34		34				100.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	009	0	1	01	01	H5826_009_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	34								34						34		34				100.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	010	0	1	01	01	H5826_010_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	34		90				1	2			90				34		34	2.00		5.00																					5.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	010	0	1	01	01	H5826_010_0	5	Generic	4	01	1	2	2	1	110		01	100		1	34		90				1	2			90				34		34	20.00		50.00																					50.00																20.00				20.00		0.59						0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	010	0	1	01	01	H5826_010_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	34		90				1	2			90				34		34	47.00		135.00																					135.00																47.00				47.00		1.38						1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	010	0	1	01	01	H5826_010_0	5	Non-Preferred Drug	4	11	1	1	4	1	010		01	010		1	34								34						34		34				100.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5826	010	0	1	01	01	H5826_010_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	34								34						34		34				100.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5852	001	0	1	01	01	H5852_001_0	4	Generic	2	01	1	1	1	1	110		10			1	30		90				1	2								29	34				8.84	25		25																																				25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5852	001	0	1	01	01	H5852_001_0	4	Preferred Brand	2	11	1	1	2	1	110		10			1	30		90				1	2								29	34				70.78	25		25																																				25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5852	001	0	1	01	01	H5852_001_0	4	Non-Preferred Brand	2	10	1	1	3	1	010		10			1	30															29	34				90.54	25																																						25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5852	001	0	1	01	01	H5852_001_0	4	Specialty Tier	2	10	1	1	4	1	010		10			1	30															29	34				348.23	25																																						25		25									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5854	007	0	1	01	01	H5854_007_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	007	0	1	01	01	H5854_007_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					14.00	28.00	42.00					14.00	42.00	42.00																19.00				19.00			0.63	0.47	0.47			0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	007	0	1	01	01	H5854_007_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00	123.00	123.00																46.00				46.00			1.53	1.37	1.37			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	007	0	1	01	01	H5854_007_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	007	0	1	01	01	H5854_007_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	007	0	1	01	01	H5854_007_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	007	0	1	01	01	H5854_007_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5854	008	0	1	01	01	H5854_008_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								3.00	6.00	9.00					3.00	6.00	9.00					3.00	9.00	9.00																3.00				3.00			0.10	0.10	0.10			0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	008	0	1	01	01	H5854_008_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	008	0	1	01	01	H5854_008_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	008	0	1	01	01	H5854_008_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	008	0	1	01	01	H5854_008_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	008	0	1	01	01	H5854_008_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	008	0	1	01	01	H5854_008_0	8	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5854	009	0	1	01	01	H5854_009_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	009	0	1	01	01	H5854_009_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	009	0	1	01	01	H5854_009_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	009	0	1	01	01	H5854_009_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	009	0	1	01	01	H5854_009_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	009	0	1	01	01	H5854_009_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	009	0	1	01	01	H5854_009_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5854	010	0	1	01	01	H5854_010_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	010	0	1	01	01	H5854_010_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					14.00	28.00	42.00					14.00	42.00	42.00																19.00				19.00			0.63	0.47	0.47			0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	010	0	1	01	01	H5854_010_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00	123.00	123.00																46.00				46.00			1.53	1.37	1.37			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	010	0	1	01	01	H5854_010_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	010	0	1	01	01	H5854_010_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	010	0	1	01	01	H5854_010_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5854	010	0	1	01	01	H5854_010_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5859	003	0	1	01	01	H5859_003_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H5859	003	0	1	01	01	H5859_003_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H5859	003	0	1	01	01	H5859_003_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H5859	003	0	1	01	01	H5859_003_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H5859	003	0	1	01	01	H5859_003_0	6	Injectable Drugs	4	11	1	2	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H5859	003	0	1	01	01	H5859_003_0	6	Specialty Tier	4	11	1	1	6	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				561.13	25	25	25																		25	25	25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier													
H5883	002	1	1	02	01	H5883_002_1	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	1	1	02	01	H5883_002_1	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	1	1	02	01	H5883_002_1	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	1	1	02	01	H5883_002_1	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											52.00	45		45				51.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	1	1	02	01	H5883_002_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	2	1	02	01	H5883_002_2	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	2	1	02	01	H5883_002_2	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	2	1	02	01	H5883_002_2	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	2	1	02	01	H5883_002_2	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											52.00	45		45				51.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	2	1	02	01	H5883_002_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	3	1	02	01	H5883_002_3	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	3	1	02	01	H5883_002_3	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	3	1	02	01	H5883_002_3	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	3	1	02	01	H5883_002_3	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											52.00	45		45				51.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	3	1	02	01	H5883_002_3	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	4	1	02	01	H5883_002_4	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	4	1	02	01	H5883_002_4	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	4	1	02	01	H5883_002_4	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	4	1	02	01	H5883_002_4	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											52.00	45		45				51.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	4	1	02	01	H5883_002_4	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	7	1	02	01	H5883_002_7	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	7	1	02	01	H5883_002_7	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	7	1	02	01	H5883_002_7	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	7	1	02	01	H5883_002_7	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											52.00	45		45				51.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	002	7	1	02	01	H5883_002_7	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	1	1	02	01	H5883_003_1	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	1	1	02	01	H5883_003_1	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	1	1	02	01	H5883_003_1	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	1	1	02	01	H5883_003_1	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											43.00	45		45				43.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	1	1	02	01	H5883_003_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	2	1	02	01	H5883_003_2	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	2	1	02	01	H5883_003_2	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	2	1	02	01	H5883_003_2	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	2	1	02	01	H5883_003_2	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											43.00	45		45				43.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	2	1	02	01	H5883_003_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	3	1	02	01	H5883_003_3	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	3	1	02	01	H5883_003_3	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	3	1	02	01	H5883_003_3	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	3	1	02	01	H5883_003_3	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											43.00	45		45				43.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	3	1	02	01	H5883_003_3	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	4	1	02	01	H5883_003_4	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	4	1	02	01	H5883_003_4	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	4	1	02	01	H5883_003_4	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	4	1	02	01	H5883_003_4	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											43.00	45		45				43.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	4	1	02	01	H5883_003_4	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	5	1	02	01	H5883_003_5	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	5	1	02	01	H5883_003_5	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	5	1	02	01	H5883_003_5	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	5	1	02	01	H5883_003_5	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											43.00	45		45				43.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	003	5	1	02	01	H5883_003_5	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	1	1	02	01	H5883_004_1	4	Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					3.00		9.00											9.00		27.00				3.00		9.00				9.00				9.00			0.29	0.10		0.29	0.10	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	1	1	02	01	H5883_004_1	4	Generic	3	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	1	1	02	01	H5883_004_1	4	Preferred Brand	3	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	1	1	02	01	H5883_004_1	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											74.00	50		50				69.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	1	1	02	01	H5883_004_1	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	2	1	02	01	H5883_004_2	4	Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					3.00		9.00											9.00		27.00				3.00		9.00				9.00				9.00			0.29	0.10		0.29	0.10	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	2	1	02	01	H5883_004_2	4	Generic	3	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	2	1	02	01	H5883_004_2	4	Preferred Brand	3	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	2	1	02	01	H5883_004_2	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											74.00	50		50				69.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	2	1	02	01	H5883_004_2	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	3	1	02	01	H5883_004_3	4	Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					3.00		9.00											9.00		27.00				3.00		9.00				9.00				9.00			0.29	0.10		0.29	0.10	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	3	1	02	01	H5883_004_3	4	Generic	3	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	3	1	02	01	H5883_004_3	4	Preferred Brand	3	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	3	1	02	01	H5883_004_3	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											74.00	50		50				69.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	3	1	02	01	H5883_004_3	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	4	1	02	01	H5883_004_4	4	Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					3.00		9.00											9.00		27.00				3.00		9.00				9.00				9.00			0.29	0.10		0.29	0.10	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	4	1	02	01	H5883_004_4	4	Generic	3	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	4	1	02	01	H5883_004_4	4	Preferred Brand	3	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	4	1	02	01	H5883_004_4	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											74.00	50		50				69.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	4	1	02	01	H5883_004_4	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	5	1	02	01	H5883_004_5	4	Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					3.00		9.00											9.00		27.00				3.00		9.00				9.00				9.00			0.29	0.10		0.29	0.10	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	5	1	02	01	H5883_004_5	4	Generic	3	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	5	1	02	01	H5883_004_5	4	Preferred Brand	3	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	5	1	02	01	H5883_004_5	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											74.00	50		50				69.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	004	5	1	02	01	H5883_004_5	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	007	0	1	01	01	H5883_007_0	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		3.00											7.00		21.00				1.00		3.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	007	0	1	01	01	H5883_007_0	5	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		30.00											18.00		54.00				10.00		30.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	007	0	1	01	01	H5883_007_0	5	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	007	0	1	01	01	H5883_007_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											55.00	48		48				52.00	48		48										48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	007	0	1	01	01	H5883_007_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	008	1	1	01	01	H5883_008_1	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		3.00											7.00		21.00				1.00		3.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	008	1	1	01	01	H5883_008_1	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		30.00											18.00		54.00				10.00		30.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	008	1	1	01	01	H5883_008_1	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	008	1	1	01	01	H5883_008_1	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											51.00	48		48				50.00	48		48										48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	008	1	1	01	01	H5883_008_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	008	2	1	01	01	H5883_008_2	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		3.00											7.00		21.00				1.00		3.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	008	2	1	01	01	H5883_008_2	4	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		30.00											18.00		54.00				10.00		30.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	008	2	1	01	01	H5883_008_2	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	008	2	1	01	01	H5883_008_2	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											51.00	48		48				50.00	48		48										48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	008	2	1	01	01	H5883_008_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	1	1	01	01	H5883_009_1	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	1	1	01	01	H5883_009_1	5	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	1	1	01	01	H5883_009_1	5	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	1	1	01	01	H5883_009_1	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											59.00	50		50				57.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	1	1	01	01	H5883_009_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	2	1	01	01	H5883_009_2	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	2	1	01	01	H5883_009_2	5	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	2	1	01	01	H5883_009_2	5	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	2	1	01	01	H5883_009_2	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											59.00	50		50				57.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	2	1	01	01	H5883_009_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	3	1	01	01	H5883_009_3	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	3	1	01	01	H5883_009_3	5	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	3	1	01	01	H5883_009_3	5	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	3	1	01	01	H5883_009_3	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											59.00	50		50				57.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	009	3	1	01	01	H5883_009_3	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	1	1	01	01	H5883_011_1	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	1	1	01	01	H5883_011_1	5	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	1	1	01	01	H5883_011_1	5	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	1	1	01	01	H5883_011_1	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											63.00	50		50				60.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	1	1	01	01	H5883_011_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	28						1.00	28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	2	1	01	01	H5883_011_2	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	2	1	01	01	H5883_011_2	5	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	2	1	01	01	H5883_011_2	5	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	2	1	01	01	H5883_011_2	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											63.00	50		50				60.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	2	1	01	01	H5883_011_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	28						1.00	28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	3	1	01	01	H5883_011_3	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	3	1	01	01	H5883_011_3	5	Generic	4	11	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	3	1	01	01	H5883_011_3	5	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	3	1	01	01	H5883_011_3	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											63.00	50		50				60.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5883	011	3	1	01	01	H5883_011_3	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	28						1.00	28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5926	001	0	1	01	01	H5926_001_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5926	001	0	1	01	01	H5926_001_0	5	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5926	001	0	1	01	01	H5926_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	38.00	76.00	114.00																			38.00	76.00	114.00																38.00				38.00		1.23			1.23			1.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5926	001	0	1	01	01	H5926_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				88.29	47	47	47																		47	47	47															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5926	001	0	1	01	01	H5926_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	004	0	1	01	01	H5928_004_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	004	0	1	01	01	H5928_004_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5928	004	0	1	01	01	H5928_004_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	004	0	1	01	01	H5928_004_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5928	004	0	1	01	01	H5928_004_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	004	0	1	01	01	H5928_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	004	0	1	01	01	H5928_004_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				900.52	33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	010	0	1	01	01	H5928_010_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	010	0	1	01	01	H5928_010_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5928	010	0	1	01	01	H5928_010_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	7.00		17.50																					17.50																7.00				7.00		0.23						0.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	010	0	1	01	01	H5928_010_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	7.00		17.50																					17.50																7.00				7.00		0.23						0.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5928	010	0	1	01	01	H5928_010_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	010	0	1	01	01	H5928_010_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	90.00		225.00																					225.00																90.00				90.00		3.00						2.90	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	010	0	1	01	01	H5928_010_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1351.35	33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	016	0	1	01	01	H5928_016_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	016	0	1	01	01	H5928_016_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5928	016	0	1	01	01	H5928_016_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	016	0	1	01	01	H5928_016_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5928	016	0	1	01	01	H5928_016_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	016	0	1	01	01	H5928_016_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	016	0	1	01	01	H5928_016_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				999.29	33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	037	0	1	01	01	H5928_037_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	037	0	1	01	01	H5928_037_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5928	037	0	1	01	01	H5928_037_0	5	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				5.23	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	037	0	1	01	01	H5928_037_0	5	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				66.96	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	037	0	1	01	01	H5928_037_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				58.95	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	037	0	1	01	01	H5928_037_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				595.21	25		25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	038	0	1	01	01	H5928_038_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	038	0	1	01	01	H5928_038_0	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5928	038	0	1	01	01	H5928_038_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	038	0	1	01	01	H5928_038_0	7	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5928	038	0	1	01	01	H5928_038_0	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	30.00		75.00																					75.00																30.00				30.00		1.00						0.97	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	038	0	1	01	01	H5928_038_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	75.00		187.50																					187.50																75.00				75.00		2.50						2.42	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	038	0	1	01	01	H5928_038_0	7	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1805.81	33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	044	0	1	01	01	H5928_044_0	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	044	0	1	01	01	H5928_044_0	9	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5928	044	0	1	01	01	H5928_044_0	9	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	044	0	1	01	01	H5928_044_0	9	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5928	044	0	1	01	01	H5928_044_0	9	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	044	0	1	01	01	H5928_044_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5928	044	0	1	01	01	H5928_044_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				2219.94	33		33																				33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5932	010	0	1	01	01	H5932_010_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5932	010	0	1	01	01	H5932_010_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	15.00	30.00	45.00																					45.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5932	010	0	1	01	01	H5932_010_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5932	010	0	1	01	01	H5932_010_0	9	Non-Preferred Drug	4	10	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5932	010	0	1	01	01	H5932_010_0	9	Specialty Tier	4	11	1	1	5	1	111		01			1	30	60	90				1	1							30		31					25	25	25																																			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5932	011	0	1	02	01	H5932_011_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5932	011	0	1	02	01	H5932_011_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	15.00	30.00	45.00																					45.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5932	011	0	1	02	01	H5932_011_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5932	011	0	1	02	01	H5932_011_0	5	Non-Preferred Drug	4	10	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5932	011	0	1	02	01	H5932_011_0	5	Specialty Tier	4	11	1	1	5	1	111		01			1	30	60	90				1	1							30		31					28	28	28																																			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5938	001	0	1	01	01	H5938_001_0	12	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5938	001	0	1	01	01	H5938_001_0	12	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5938	001	0	1	01	01	H5938_001_0	12	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5938	001	0	1	01	01	H5938_001_0	12	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5938	001	0	1	01	01	H5938_001_0	12	Specialty Tier	4	11	1	4	5	1	010		01			1	30														30		31	250.00				25																																			250.00		25		250.00	25	8.33						8.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5938	006	0	1	01	01	H5938_006_0	12	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5938	006	0	1	01	01	H5938_006_0	12	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5938	006	0	1	01	01	H5938_006_0	12	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5938	006	0	1	01	01	H5938_006_0	12	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H5938	006	0	1	01	01	H5938_006_0	12	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5938	006	0	1	01	01	H5938_006_0	12	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5938	006	0	1	01	01	H5938_006_0	12	Specialty Tier	4	11	1	4	5	1	010		01			1	30														30		31	250.00				25																																			250.00		25		250.00	25	8.33						8.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H5943	001	0	1	02	01	H5943_001_0	7	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	9.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5943	001	0	1	02	01	H5943_001_0	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.37	0.20	0.20			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5943	001	0	1	02	01	H5943_001_0	7	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											164.11	25	25	25				164.11	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5943	001	0	1	02	01	H5943_001_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											71.01	25	25	25				71.01	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5943	001	0	1	02	01	H5943_001_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5943	002	0	1	02	01	H5943_002_0	6	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								2.00	4.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																2.00				2.00			0.07	0.00	0.00			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5943	002	0	1	02	01	H5943_002_0	6	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											6.52	25	25	25				6.52	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5943	002	0	1	02	01	H5943_002_0	6	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											171.55	25	25	25				171.55	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5943	002	0	1	02	01	H5943_002_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											70.68	25	25	25				70.68	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5943	002	0	1	02	01	H5943_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5945	001	0	1	01	01	H5945_001_0	18	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	6.00																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	001	0	1	01	01	H5945_001_0	18	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	6.00																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5945	001	0	1	01	01	H5945_001_0	18	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	001	0	1	01	01	H5945_001_0	18	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5945	001	0	1	01	01	H5945_001_0	18	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	001	0	1	01	01	H5945_001_0	18	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	001	0	1	01	01	H5945_001_0	18	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				670.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	001	0	1	01	01	H5945_001_0	18	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	001	0	1	01	01	H5945_001_0	18	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5945	002	0	1	01	01	H5945_002_0	14	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	6.00																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	002	0	1	01	01	H5945_002_0	14	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	6.00																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5945	002	0	1	01	01	H5945_002_0	14	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	002	0	1	01	01	H5945_002_0	14	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5945	002	0	1	01	01	H5945_002_0	14	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	002	0	1	01	01	H5945_002_0	14	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	002	0	1	01	01	H5945_002_0	14	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				670.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	002	0	1	01	01	H5945_002_0	14	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	002	0	1	01	01	H5945_002_0	14	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5945	005	0	1	01	01	H5945_005_0	12	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	4.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	005	0	1	01	01	H5945_005_0	12	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	4.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5945	005	0	1	01	01	H5945_005_0	12	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	005	0	1	01	01	H5945_005_0	12	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5945	005	0	1	01	01	H5945_005_0	12	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	005	0	1	01	01	H5945_005_0	12	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	005	0	1	01	01	H5945_005_0	12	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				670.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	005	0	1	01	01	H5945_005_0	12	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	005	0	1	01	01	H5945_005_0	12	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5945	006	0	1	01	01	H5945_006_0	12	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	4.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	006	0	1	01	01	H5945_006_0	12	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	4.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5945	006	0	1	01	01	H5945_006_0	12	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	006	0	1	01	01	H5945_006_0	12	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5945	006	0	1	01	01	H5945_006_0	12	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	006	0	1	01	01	H5945_006_0	12	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	006	0	1	01	01	H5945_006_0	12	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				670.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	006	0	1	01	01	H5945_006_0	12	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H5945	006	0	1	01	01	H5945_006_0	12	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H5959	001	0	1	04	01	H5959_001_0	6	Preferred Generic	2	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	0.00	0.00																15.00				15.00			0.48	0.26	0.26			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5959	001	0	1	04	01	H5959_001_0	6	Generic	2	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.65	0.42	0.42			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5959	001	0	1	04	01	H5959_001_0	6	Preferred Brand	2	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											28.67	21	21	21				21.21	16	16	16				16	16	16															21			21									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5959	001	0	1	04	01	H5959_001_0	6	Non-Preferred Brand	2	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											53.56	50	50	50				46.45	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5959	001	0	1	04	01	H5959_001_0	6	Specialty Tier	2	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5959	001	0	1	04	01	H5959_001_0	6	Select Care Drugs	2	01	1	2	6	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								5.00	10.00	10.00					0.00	0.00	0.00					8.00	0.00	0.00																5.00				5.00			0.16	0.00	0.26			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5959	003	0	1	04	01	H5959_003_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	0.00	0.00																12.00				12.00			0.39	0.16	0.16			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5959	003	0	1	04	01	H5959_003_0	6	Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								17.00	34.00	34.00					10.00	20.00	20.00					10.00	20.00	20.00																17.00				17.00			0.55	0.32	0.32			0.55		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5959	003	0	1	04	01	H5959_003_0	6	Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											34.11	25	25	25				26.50	20	20	20				20	20	20															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5959	003	0	1	04	01	H5959_003_0	6	Non-Preferred Brand	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											56.99	50	50	50				49.46	45	45	45				45	45	45															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5959	003	0	1	04	01	H5959_003_0	6	Specialty Tier	4	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5959	003	0	1	04	01	H5959_003_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								5.00	10.00	10.00					0.00	0.00	0.00					5.00	0.00	0.00																5.00				5.00			0.16	0.00	0.16			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H5970	001	0	1	04	01	H5970_001_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	001	0	1	04	01	H5970_001_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	001	0	1	04	01	H5970_001_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	001	0	1	04	01	H5970_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	001	0	1	04	01	H5970_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	008	0	1	04	01	H5970_008_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	008	0	1	04	01	H5970_008_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	008	0	1	04	01	H5970_008_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	008	0	1	04	01	H5970_008_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	008	0	1	04	01	H5970_008_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	015	0	1	04	01	H5970_015_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	015	0	1	04	01	H5970_015_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	015	0	1	04	01	H5970_015_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	015	0	1	04	01	H5970_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	015	0	1	04	01	H5970_015_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	017	0	1	04	01	H5970_017_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	017	0	1	04	01	H5970_017_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	017	0	1	04	01	H5970_017_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	017	0	1	04	01	H5970_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	017	0	1	04	01	H5970_017_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	018	0	1	04	01	H5970_018_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	018	0	1	04	01	H5970_018_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	018	0	1	04	01	H5970_018_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	018	0	1	04	01	H5970_018_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	018	0	1	04	01	H5970_018_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	019	0	1	04	01	H5970_019_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	019	0	1	04	01	H5970_019_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	019	0	1	04	01	H5970_019_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	019	0	1	04	01	H5970_019_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5970	019	0	1	04	01	H5970_019_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5989	002	0	1	01	01	H5989_002_0	8	Generic	3	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	10.25		30.75																					30.75																10.25				10.25		0.34						0.33	1	Generic, Brand													
H5989	002	0	1	01	01	H5989_002_0	8	Brand	3	10	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				54.20	25		25																				25															25			25								1	Generic, Brand													
H5991	001	0	1	01	01	H5991_001_0	3	Preferred Generic	3	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	001	0	1	01	01	H5991_001_0	3	Generic	3	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	7.50																					7.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	001	0	1	01	01	H5991_001_0	3	Preferred Brand	3	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	112.50																					112.50																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	001	0	1	01	01	H5991_001_0	3	Non-Preferred Drug	3	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	237.50																					237.50																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	001	0	1	01	01	H5991_001_0	3	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				562.50	25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	002	0	1	01	01	H5991_002_0	5	Preferred Generic	3	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	002	0	1	01	01	H5991_002_0	5	Generic	3	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	5.00																					5.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	002	0	1	01	01	H5991_002_0	5	Preferred Brand	3	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	002	0	1	01	01	H5991_002_0	5	Non-Preferred Drug	3	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	99.00	198.00	247.50																					247.50																99.00				99.00		3.30						3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	002	0	1	01	01	H5991_002_0	5	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				562.50	25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	003	0	1	01	01	H5991_003_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	003	0	1	01	01	H5991_003_0	3	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5991	003	0	1	01	01	H5991_003_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	25.00																					25.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	003	0	1	01	01	H5991_003_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	003	0	1	01	01	H5991_003_0	3	Non-Preferred Drug	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	003	0	1	01	01	H5991_003_0	3	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				585.00	28																																					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	006	0	1	01	01	H5991_006_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	006	0	1	01	01	H5991_006_0	3	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H5991	006	0	1	01	01	H5991_006_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	25.00																					25.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	006	0	1	01	01	H5991_006_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	006	0	1	01	01	H5991_006_0	3	Non-Preferred Drug	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	250.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H5991	006	0	1	01	01	H5991_006_0	3	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				652.50	28																																					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6080	001	0	1	48	05	H6080_001_0	4	Generic Drugs	4	01			1	1	110		01	100		1	30		90				2	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	3.35	0.00	3.35			0.00	3.35			
H6080	001	0	1	48	05	H6080_001_0	4	Brand Drugs	4	10			2	1	110		01	100		1	30		90				2	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	8.35	0.00	8.35			0.00	8.35			
H6080	001	0	1	48	05	H6080_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01	100		1	30		90				1	1			90				30		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6154	001	0	1	02	01	H6154_001_0	7	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6154	001	0	1	02	01	H6154_001_0	7	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6154	001	0	1	02	01	H6154_001_0	7	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6154	001	0	1	02	01	H6154_001_0	7	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				57.95	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6154	001	0	1	02	01	H6154_001_0	7	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					28		28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6229	005	0	1	48	05	H6229_005_0	6	Generic Drugs	4	01			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	6	Brand Drugs	4	10			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	6	Non-Medicare Rx Drugs	4	11			3	1	010		10			1	31															10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	6	Non-Medicare OTC Drugs	4	11			4	1	010		10			1	31															10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H6229	006	0	1	48	05	H6229_006_0	7	Generic Drugs	4	11			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	006	0	1	48	05	H6229_006_0	7	Brand Drugs	4	11			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	8.35			0.00	8.35	0.00	8.35			
H6229	006	0	1	48	05	H6229_006_0	7	Non-Medicare Rx Drugs	4	11			3	1	010		10			1	31															10	31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H6229	006	0	1	48	05	H6229_006_0	7	Non-Medicare OTC Drugs	4	11			4	1	010		10			1	31															10	31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H6237	004	0	1	01	01	H6237_004_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6237	004	0	1	01	01	H6237_004_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6237	004	0	1	01	01	H6237_004_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6237	004	0	1	01	01	H6237_004_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6237	004	0	1	01	01	H6237_004_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1329.94	29						1329.94	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6237	004	0	1	01	01	H6237_004_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6237	005	0	1	01	01	H6237_005_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					3.00	6.00	6.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6237	005	0	1	01	01	H6237_005_0	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6237	005	0	1	01	01	H6237_005_0	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6237	005	0	1	01	01	H6237_005_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											101.70	45	45	45				90.40	40	40	40				40	40	40															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6237	005	0	1	01	01	H6237_005_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1513.38	33						1513.38	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6237	005	0	1	01	01	H6237_005_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	002	0	1	01	01	H6306_002_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	002	0	1	01	01	H6306_002_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H6306	002	0	1	01	01	H6306_002_0	5	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	002	0	1	01	01	H6306_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	002	0	1	01	01	H6306_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	002	0	1	01	01	H6306_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				410.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	002	0	1	01	01	H6306_002_0	5	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	6.00	0.00																			6.00	6.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	002	0	1	01	01	H6306_002_0	5	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	6.00	0.00																			6.00	6.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H6306	003	0	1	01	01	H6306_003_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	0.00	0.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	003	0	1	01	01	H6306_003_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	0.00	0.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H6306	003	0	1	01	01	H6306_003_0	5	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	003	0	1	01	01	H6306_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	003	0	1	01	01	H6306_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	003	0	1	01	01	H6306_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				310.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	003	0	1	01	01	H6306_003_0	5	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	10.00	0.00																			10.00	10.00	0.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	003	0	1	01	01	H6306_003_0	5	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	10.00	0.00																			10.00	10.00	0.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H6306	005	0	1	02	01	H6306_005_0	8	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	005	0	1	02	01	H6306_005_0	8	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H6306	005	0	1	02	01	H6306_005_0	8	Generic	4	11	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	10.00	20.00	30.00																			10.00	20.00	30.00																	10.00			10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	005	0	1	02	01	H6306_005_0	8	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	005	0	1	02	01	H6306_005_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	005	0	1	02	01	H6306_005_0	8	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				750.00	33																				33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	005	0	1	02	01	H6306_005_0	8	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	10.00	10.00	0.00																			10.00	10.00	0.00																	10.00			10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	005	0	1	02	01	H6306_005_0	8	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	10.00	10.00	0.00																			10.00	10.00	0.00																	10.00			10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H6306	007	0	1	01	01	H6306_007_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	007	0	1	01	01	H6306_007_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H6306	007	0	1	01	01	H6306_007_0	4	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	007	0	1	01	01	H6306_007_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	007	0	1	01	01	H6306_007_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	225.00																90.00				90.00		3.00			3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	007	0	1	01	01	H6306_007_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				410.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	007	0	1	01	01	H6306_007_0	4	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	6.00	0.00																			6.00	6.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	007	0	1	01	01	H6306_007_0	4	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	6.00	0.00																			6.00	6.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H6306	010	0	1	01	01	H6306_010_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	010	0	1	01	01	H6306_010_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H6306	010	0	1	01	01	H6306_010_0	4	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	010	0	1	01	01	H6306_010_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	010	0	1	01	01	H6306_010_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	225.00																90.00				90.00		3.00			3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	010	0	1	01	01	H6306_010_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				360.00	29																				29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	010	0	1	01	01	H6306_010_0	4	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	6.00	0.00																			6.00	6.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6306	010	0	1	01	01	H6306_010_0	4	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	6.00	0.00																			6.00	6.00	0.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H6308	001	0	1	48	05	H6308_001_0	4	Generic Drugs	4	01			1	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6308	001	0	1	48	05	H6308_001_0	4	Brand Drugs	4	10			2	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6308	001	0	1	48	05	H6308_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6320	001	0	1	01	01	H6320_001_0	6	Preferred Generic	4	01	1	2	1	1	110		10	100		1	31		90				1	2			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6320	001	0	1	01	01	H6320_001_0	6	Generic	4	01	1	1	2	1	110		10	100		1	31		90				1	2			90					10	31				11.82	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6320	001	0	1	01	01	H6320_001_0	6	Preferred Brand	4	10	1	1	3	1	110		10	100		1	31		90				1	2			90					10	31				157.67	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6320	001	0	1	01	01	H6320_001_0	6	Non-Preferred Brand	4	10	1	1	4	1	110		10	100		1	31		90				1	2			90					10	31				77.35	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6320	001	0	1	01	01	H6320_001_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	31								30							10	31				1.00	25																				25																		25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6328	001	0	1	04	01	H6328_001_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	001	0	1	04	01	H6328_001_0	5	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	10.00	20.00	20.00																			10.00	20.00	20.00																	10.00			10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	001	0	1	04	01	H6328_001_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	001	0	1	04	01	H6328_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	85.00	170.00	170.00																			85.00	170.00	170.00																	85.00			85.00		2.83			2.83			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	001	0	1	04	01	H6328_001_0	5	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1098.30	33	33	33																		33	33	33																33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	002	0	1	04	01	H6328_002_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	2.00	4.00	4.00																			2.00	4.00	4.00																	2.00			2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	002	0	1	04	01	H6328_002_0	4	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	12.00	24.00	24.00																			12.00	24.00	24.00																	12.00			12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	002	0	1	04	01	H6328_002_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	002	0	1	04	01	H6328_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	90.00	180.00	180.00																			90.00	180.00	180.00																	90.00			90.00		3.00			3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	002	0	1	04	01	H6328_002_0	4	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1103.63	33	33	33																		33	33	33																33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	003	0	1	04	01	H6328_003_0	4	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5.00	10.00	10.00																			5.00	10.00	10.00																	5.00			5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	003	0	1	04	01	H6328_003_0	4	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15.00	30.00	30.00																			15.00	30.00	30.00																	15.00			15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	003	0	1	04	01	H6328_003_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	47.00	94.00	94.00																			47.00	94.00	94.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	003	0	1	04	01	H6328_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	100.00	200.00	200.00																			100.00	200.00	200.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6328	003	0	1	04	01	H6328_003_0	4	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				942.51	33	33	33																		33	33	33																33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6348	001	0	1	04	01	H6348_001_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	001	0	1	04	01	H6348_001_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	001	0	1	04	01	H6348_001_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	001	0	1	04	01	H6348_001_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	001	0	1	04	01	H6348_001_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	001	0	1	04	01	H6348_001_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	002	0	1	04	01	H6348_002_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	002	0	1	04	01	H6348_002_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	002	0	1	04	01	H6348_002_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	002	0	1	04	01	H6348_002_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	002	0	1	04	01	H6348_002_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	002	0	1	04	01	H6348_002_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	003	0	1	04	01	H6348_003_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	003	0	1	04	01	H6348_003_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	45.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	003	0	1	04	01	H6348_003_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	003	0	1	04	01	H6348_003_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	003	0	1	04	01	H6348_003_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6348	003	0	1	04	01	H6348_003_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6396	001	0	1	01	01	H6396_001_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					10.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	001	0	1	01	01	H6396_001_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	001	0	1	01	01	H6396_001_0	8	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	001	0	1	01	01	H6396_001_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	001	0	1	01	01	H6396_001_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	002	0	1	01	01	H6396_002_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	002	0	1	01	01	H6396_002_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	002	0	1	01	01	H6396_002_0	8	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	002	0	1	01	01	H6396_002_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	002	0	1	01	01	H6396_002_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	004	0	1	01	01	H6396_004_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		18.00																					0.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	004	0	1	01	01	H6396_004_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	004	0	1	01	01	H6396_004_0	8	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	004	0	1	01	01	H6396_004_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6396	004	0	1	01	01	H6396_004_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					28																																					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6435	001	0	1	48	05	H6435_001_0	3	Generic Drugs	4	01			1	1	110		01	100		1	31		90				2	2			90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6435	001	0	1	48	05	H6435_001_0	3	Brand Drugs	4	10			2	1	110		01	100		1	31		90				2	2			90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6435	001	0	1	48	05	H6435_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01	100		1	31		90				2	2			90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6453	001	0	1	01	01	H6453_001_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	001	0	1	01	01	H6453_001_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6453	001	0	1	01	01	H6453_001_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	0.00	0.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	001	0	1	01	01	H6453_001_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	0.00	0.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6453	001	0	1	01	01	H6453_001_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	001	0	1	01	01	H6453_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	001	0	1	01	01	H6453_001_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	002	0	1	01	01	H6453_002_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	002	0	1	01	01	H6453_002_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6453	002	0	1	01	01	H6453_002_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	0.00	0.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	002	0	1	01	01	H6453_002_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	0.00	0.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6453	002	0	1	01	01	H6453_002_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	002	0	1	01	01	H6453_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	002	0	1	01	01	H6453_002_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	003	0	1	01	01	H6453_003_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	003	0	1	01	01	H6453_003_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6453	003	0	1	01	01	H6453_003_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	0.00	0.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	003	0	1	01	01	H6453_003_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	0.00	0.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6453	003	0	1	01	01	H6453_003_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	003	0	1	01	01	H6453_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	003	0	1	01	01	H6453_003_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	004	0	1	01	01	H6453_004_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	004	0	1	01	01	H6453_004_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6453	004	0	1	01	01	H6453_004_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	0.00	0.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	004	0	1	01	01	H6453_004_0	6	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	0.00	0.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6453	004	0	1	01	01	H6453_004_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	004	0	1	01	01	H6453_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6453	004	0	1	01	01	H6453_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6502	001	0	1	04	01	H6502_001_0	7	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	9.00							0.00																8.00				8.00			0.27	0.10				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6502	001	0	1	04	01	H6502_001_0	7	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								13.00	26.00	39.00					8.00	16.00	24.00							0.00																13.00				13.00			0.43	0.27				0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6502	001	0	1	04	01	H6502_001_0	7	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					35.00	70.00	105.00							90.00																47.00				47.00			1.57	1.17				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6502	001	0	1	04	01	H6502_001_0	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								100.00	200.00	300.00					90.00	180.00	270.00							225.00																100.00				100.00			3.33	3.00				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6502	001	0	1	04	01	H6502_001_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6526	001	0	1	01	01	H6526_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6526	001	0	1	01	01	H6526_001_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6526	001	0	1	01	01	H6526_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6526	001	0	1	01	01	H6526_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6526	001	0	1	01	01	H6526_001_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				747.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6526	002	0	1	01	01	H6526_002_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6526	002	0	1	01	01	H6526_002_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6526	002	0	1	01	01	H6526_002_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6526	002	0	1	01	01	H6526_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6526	002	0	1	01	01	H6526_002_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				747.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6528	006	0	1	04	01	H6528_006_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6528	006	0	1	04	01	H6528_006_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6528	006	0	1	04	01	H6528_006_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6528	006	0	1	04	01	H6528_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6528	006	0	1	04	01	H6528_006_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				836.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6550	001	0	1	01	01	H6550_001_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6550	001	0	1	01	01	H6550_001_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					9.00	18.00	27.00					9.00	18.00	27.00																15.00				15.00			0.50	0.30	0.30			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6550	001	0	1	01	01	H6550_001_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6550	001	0	1	01	01	H6550_001_0	2	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6550	001	0	1	01	01	H6550_001_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6550	001	0	1	01	01	H6550_001_0	2	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6622	001	0	1	01	01	H6622_001_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	001	0	1	01	01	H6622_001_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	001	0	1	01	01	H6622_001_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	001	0	1	01	01	H6622_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	001	0	1	01	01	H6622_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	002	0	1	01	01	H6622_002_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	002	0	1	01	01	H6622_002_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	002	0	1	01	01	H6622_002_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	002	0	1	01	01	H6622_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	002	0	1	01	01	H6622_002_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	004	0	1	01	01	H6622_004_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	004	0	1	01	01	H6622_004_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	004	0	1	01	01	H6622_004_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	004	0	1	01	01	H6622_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	004	0	1	01	01	H6622_004_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	005	0	1	01	01	H6622_005_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	005	0	1	01	01	H6622_005_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	005	0	1	01	01	H6622_005_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	005	0	1	01	01	H6622_005_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	005	0	1	01	01	H6622_005_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	007	0	1	01	01	H6622_007_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	007	0	1	01	01	H6622_007_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	007	0	1	01	01	H6622_007_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	007	0	1	01	01	H6622_007_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	50		50				70.00	50		50										50		50				50		50			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	007	0	1	01	01	H6622_007_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	008	0	1	01	01	H6622_008_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	008	0	1	01	01	H6622_008_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	008	0	1	01	01	H6622_008_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	008	0	1	01	01	H6622_008_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	008	0	1	01	01	H6622_008_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	010	0	1	01	01	H6622_010_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	010	0	1	01	01	H6622_010_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	010	0	1	01	01	H6622_010_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	010	0	1	01	01	H6622_010_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	010	0	1	01	01	H6622_010_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	011	0	1	01	01	H6622_011_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	011	0	1	01	01	H6622_011_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	011	0	1	01	01	H6622_011_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	011	0	1	01	01	H6622_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	011	0	1	01	01	H6622_011_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	012	0	1	01	01	H6622_012_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	012	0	1	01	01	H6622_012_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	012	0	1	01	01	H6622_012_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	012	0	1	01	01	H6622_012_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	012	0	1	01	01	H6622_012_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	013	0	1	01	01	H6622_013_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	013	0	1	01	01	H6622_013_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	013	0	1	01	01	H6622_013_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	013	0	1	01	01	H6622_013_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	013	0	1	01	01	H6622_013_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	014	0	1	01	01	H6622_014_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	014	0	1	01	01	H6622_014_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	014	0	1	01	01	H6622_014_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	014	0	1	01	01	H6622_014_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	014	0	1	01	01	H6622_014_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	015	0	1	01	01	H6622_015_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	015	0	1	01	01	H6622_015_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	015	0	1	01	01	H6622_015_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	015	0	1	01	01	H6622_015_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	015	0	1	01	01	H6622_015_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	016	0	1	01	01	H6622_016_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	016	0	1	01	01	H6622_016_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	016	0	1	01	01	H6622_016_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	016	0	1	01	01	H6622_016_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	016	0	1	01	01	H6622_016_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	017	0	1	01	01	H6622_017_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6622	017	0	1	01	01	H6622_017_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6622	017	0	1	01	01	H6622_017_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6622	017	0	1	01	01	H6622_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6622	017	0	1	01	01	H6622_017_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6622	017	0	1	01	01	H6622_017_0	4	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					7.00		21.00											11.00		33.00				7.00		0.00				11.00				11.00			0.37	0.23		0.37	0.23	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6622	018	0	1	01	01	H6622_018_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	018	0	1	01	01	H6622_018_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	018	0	1	01	01	H6622_018_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	018	0	1	01	01	H6622_018_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	018	0	1	01	01	H6622_018_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	019	0	1	01	01	H6622_019_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	019	0	1	01	01	H6622_019_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	019	0	1	01	01	H6622_019_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	019	0	1	01	01	H6622_019_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	019	0	1	01	01	H6622_019_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	020	0	1	01	01	H6622_020_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	020	0	1	01	01	H6622_020_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	020	0	1	01	01	H6622_020_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	020	0	1	01	01	H6622_020_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	020	0	1	01	01	H6622_020_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	021	1	1	01	01	H6622_021_1	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	021	1	1	01	01	H6622_021_1	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	021	1	1	01	01	H6622_021_1	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	021	1	1	01	01	H6622_021_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	021	1	1	01	01	H6622_021_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	021	2	1	01	01	H6622_021_2	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	021	2	1	01	01	H6622_021_2	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	021	2	1	01	01	H6622_021_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	021	2	1	01	01	H6622_021_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	021	2	1	01	01	H6622_021_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	022	0	1	01	01	H6622_022_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	022	0	1	01	01	H6622_022_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	022	0	1	01	01	H6622_022_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	022	0	1	01	01	H6622_022_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	022	0	1	01	01	H6622_022_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	023	0	1	01	01	H6622_023_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	023	0	1	01	01	H6622_023_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	023	0	1	01	01	H6622_023_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	023	0	1	01	01	H6622_023_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	023	0	1	01	01	H6622_023_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	024	0	1	01	01	H6622_024_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	024	0	1	01	01	H6622_024_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	024	0	1	01	01	H6622_024_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	024	0	1	01	01	H6622_024_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	024	0	1	01	01	H6622_024_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	025	0	1	01	01	H6622_025_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	025	0	1	01	01	H6622_025_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	025	0	1	01	01	H6622_025_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	025	0	1	01	01	H6622_025_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	025	0	1	01	01	H6622_025_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	026	0	1	01	01	H6622_026_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	026	0	1	01	01	H6622_026_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	026	0	1	01	01	H6622_026_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	026	0	1	01	01	H6622_026_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	026	0	1	01	01	H6622_026_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	027	0	1	01	01	H6622_027_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	027	0	1	01	01	H6622_027_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	027	0	1	01	01	H6622_027_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	027	0	1	01	01	H6622_027_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	027	0	1	01	01	H6622_027_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	028	0	1	01	01	H6622_028_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	028	0	1	01	01	H6622_028_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	028	0	1	01	01	H6622_028_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	028	0	1	01	01	H6622_028_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	028	0	1	01	01	H6622_028_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	029	0	1	01	01	H6622_029_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	029	0	1	01	01	H6622_029_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H6622	029	0	1	01	01	H6622_029_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	029	0	1	01	01	H6622_029_0	3	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H6622	029	0	1	01	01	H6622_029_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	029	0	1	01	01	H6622_029_0	3	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H6622	029	0	1	01	01	H6622_029_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	029	0	1	01	01	H6622_029_0	3	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H6622	029	0	1	01	01	H6622_029_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	029	0	1	01	01	H6622_029_0	3	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												24							24												24						24					24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H6622	030	0	1	01	01	H6622_030_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	030	0	1	01	01	H6622_030_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H6622	030	0	1	01	01	H6622_030_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	030	0	1	01	01	H6622_030_0	3	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H6622	030	0	1	01	01	H6622_030_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	030	0	1	01	01	H6622_030_0	3	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H6622	030	0	1	01	01	H6622_030_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	030	0	1	01	01	H6622_030_0	3	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H6622	030	0	1	01	01	H6622_030_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	030	0	1	01	01	H6622_030_0	3	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												24							24												24						24					24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
H6622	031	0	1	01	01	H6622_031_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	031	0	1	01	01	H6622_031_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		0.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	031	0	1	01	01	H6622_031_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	031	0	1	01	01	H6622_031_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	031	0	1	01	01	H6622_031_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	032	0	1	01	01	H6622_032_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	032	0	1	01	01	H6622_032_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	032	0	1	01	01	H6622_032_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	032	0	1	01	01	H6622_032_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	032	0	1	01	01	H6622_032_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	033	0	1	01	01	H6622_033_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	033	0	1	01	01	H6622_033_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	033	0	1	01	01	H6622_033_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	033	0	1	01	01	H6622_033_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	033	0	1	01	01	H6622_033_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	034	0	1	01	01	H6622_034_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	034	0	1	01	01	H6622_034_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	034	0	1	01	01	H6622_034_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	034	0	1	01	01	H6622_034_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	034	0	1	01	01	H6622_034_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	035	0	1	01	01	H6622_035_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	035	0	1	01	01	H6622_035_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	035	0	1	01	01	H6622_035_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	035	0	1	01	01	H6622_035_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	035	0	1	01	01	H6622_035_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	036	0	1	01	01	H6622_036_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	036	0	1	01	01	H6622_036_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	036	0	1	01	01	H6622_036_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	036	0	1	01	01	H6622_036_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	036	0	1	01	01	H6622_036_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	037	0	1	01	01	H6622_037_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	037	0	1	01	01	H6622_037_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	037	0	1	01	01	H6622_037_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	037	0	1	01	01	H6622_037_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	037	0	1	01	01	H6622_037_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	038	0	1	01	01	H6622_038_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	038	0	1	01	01	H6622_038_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	038	0	1	01	01	H6622_038_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	038	0	1	01	01	H6622_038_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	038	0	1	01	01	H6622_038_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	039	0	1	01	01	H6622_039_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	039	0	1	01	01	H6622_039_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	039	0	1	01	01	H6622_039_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	039	0	1	01	01	H6622_039_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	039	0	1	01	01	H6622_039_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	040	0	1	01	01	H6622_040_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	040	0	1	01	01	H6622_040_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	040	0	1	01	01	H6622_040_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	040	0	1	01	01	H6622_040_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	040	0	1	01	01	H6622_040_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	041	0	1	01	01	H6622_041_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	041	0	1	01	01	H6622_041_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	041	0	1	01	01	H6622_041_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	041	0	1	01	01	H6622_041_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	041	0	1	01	01	H6622_041_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	042	0	1	01	01	H6622_042_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	042	0	1	01	01	H6622_042_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	042	0	1	01	01	H6622_042_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	042	0	1	01	01	H6622_042_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	042	0	1	01	01	H6622_042_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	043	0	1	01	01	H6622_043_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	043	0	1	01	01	H6622_043_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	043	0	1	01	01	H6622_043_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	043	0	1	01	01	H6622_043_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	043	0	1	01	01	H6622_043_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	044	0	1	01	01	H6622_044_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	044	0	1	01	01	H6622_044_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	044	0	1	01	01	H6622_044_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	044	0	1	01	01	H6622_044_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	044	0	1	01	01	H6622_044_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	045	0	1	01	01	H6622_045_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	045	0	1	01	01	H6622_045_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	045	0	1	01	01	H6622_045_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	045	0	1	01	01	H6622_045_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	045	0	1	01	01	H6622_045_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	046	0	1	01	01	H6622_046_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	046	0	1	01	01	H6622_046_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	046	0	1	01	01	H6622_046_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	046	0	1	01	01	H6622_046_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	046	0	1	01	01	H6622_046_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	047	0	1	01	01	H6622_047_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	047	0	1	01	01	H6622_047_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	047	0	1	01	01	H6622_047_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	047	0	1	01	01	H6622_047_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		260.00				100.00				100.00			3.33	3		3.33	3	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	047	0	1	01	01	H6622_047_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	048	0	1	01	01	H6622_048_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	048	0	1	01	01	H6622_048_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	048	0	1	01	01	H6622_048_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	048	0	1	01	01	H6622_048_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	048	0	1	01	01	H6622_048_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	049	0	1	01	01	H6622_049_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	049	0	1	01	01	H6622_049_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	049	0	1	01	01	H6622_049_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	049	0	1	01	01	H6622_049_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6622	049	0	1	01	01	H6622_049_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6672	003	0	1	01	01	H6672_003_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6672	003	0	1	01	01	H6672_003_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6672	003	0	1	01	01	H6672_003_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6672	003	0	1	01	01	H6672_003_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6672	003	0	1	01	01	H6672_003_0	9	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				721.19	28	28	28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6672	003	0	1	01	01	H6672_003_0	9	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	11.00	22.00	33.00																					22.00																11.00				11.00		0.37						0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6672	004	0	1	01	01	H6672_004_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6672	004	0	1	01	01	H6672_004_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6672	004	0	1	01	01	H6672_004_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6672	004	0	1	01	01	H6672_004_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6672	004	0	1	01	01	H6672_004_0	9	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				746.26	28	28	28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	001	1	1	01	01	H6723_001_1	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	5.00		10.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	001	1	1	01	01	H6723_001_1	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	5.00		10.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	001	1	1	01	01	H6723_001_1	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	19.00		38.00																			19.00		38.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	001	1	1	01	01	H6723_001_1	7	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	19.00		38.00																			19.00		38.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	001	1	1	01	01	H6723_001_1	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	001	1	1	01	01	H6723_001_1	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				54.78	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	001	1	1	01	01	H6723_001_1	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				54.78	29																				29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	001	2	1	01	01	H6723_001_2	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	5.00		10.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	001	2	1	01	01	H6723_001_2	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	5.00		10.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	001	2	1	01	01	H6723_001_2	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	19.00		38.00																			19.00		38.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	001	2	1	01	01	H6723_001_2	7	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	19.00		38.00																			19.00		38.00																19.00				19.00		0.63			0.63			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	001	2	1	01	01	H6723_001_2	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	001	2	1	01	01	H6723_001_2	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				54.78	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	001	2	1	01	01	H6723_001_2	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				54.78	29																				29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	002	1	1	01	01	H6723_002_1	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	002	1	1	01	01	H6723_002_1	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	002	1	1	01	01	H6723_002_1	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	002	1	1	01	01	H6723_002_1	7	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	002	1	1	01	01	H6723_002_1	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	002	1	1	01	01	H6723_002_1	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				41.85	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	002	1	1	01	01	H6723_002_1	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				41.85	31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	002	2	1	01	01	H6723_002_2	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	002	2	1	01	01	H6723_002_2	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	002	2	1	01	01	H6723_002_2	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	002	2	1	01	01	H6723_002_2	7	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	002	2	1	01	01	H6723_002_2	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	002	2	1	01	01	H6723_002_2	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				41.85	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	002	2	1	01	01	H6723_002_2	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				41.85	31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	003	1	1	01	01	H6723_003_1	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	003	1	1	01	01	H6723_003_1	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	003	1	1	01	01	H6723_003_1	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	003	1	1	01	01	H6723_003_1	7	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	003	1	1	01	01	H6723_003_1	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	003	1	1	01	01	H6723_003_1	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				58.99	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	003	1	1	01	01	H6723_003_1	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				58.99	31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	003	2	1	01	01	H6723_003_2	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	003	2	1	01	01	H6723_003_2	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	003	2	1	01	01	H6723_003_2	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	003	2	1	01	01	H6723_003_2	7	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	14.00		28.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H6723	003	2	1	01	01	H6723_003_2	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		118.00																			47.00		118.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	003	2	1	01	01	H6723_003_2	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				58.99	50		50																		50		50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6723	003	2	1	01	01	H6723_003_2	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				58.99	31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6743	001	0	1	04	01	H6743_001_0	10	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	001	0	1	04	01	H6743_001_0	10	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		40.00																					40.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	001	0	1	04	01	H6743_001_0	10	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	001	0	1	04	01	H6743_001_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		190.00																					190.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	001	0	1	04	01	H6743_001_0	10	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1254.02	31																																					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	001	0	1	04	01	H6743_001_0	10	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	003	0	1	04	01	H6743_003_0	10	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	003	0	1	04	01	H6743_003_0	10	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	003	0	1	04	01	H6743_003_0	10	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		80.00																					80.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	003	0	1	04	01	H6743_003_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	003	0	1	04	01	H6743_003_0	10	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				834.10	29																																					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	003	0	1	04	01	H6743_003_0	10	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	004	0	1	04	01	H6743_004_0	10	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	004	0	1	04	01	H6743_004_0	10	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	004	0	1	04	01	H6743_004_0	10	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		70.00																					70.00																35.00				35.00		1.17						1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	004	0	1	04	01	H6743_004_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		150.00																					150.00																75.00				75.00		2.50						2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	004	0	1	04	01	H6743_004_0	10	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1296.62	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	004	0	1	04	01	H6743_004_0	10	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	007	0	1	04	01	H6743_007_0	10	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	007	0	1	04	01	H6743_007_0	10	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		40.00																					40.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	007	0	1	04	01	H6743_007_0	10	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	007	0	1	04	01	H6743_007_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		190.00																					190.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	007	0	1	04	01	H6743_007_0	10	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				895.85	31																																					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	007	0	1	04	01	H6743_007_0	10	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	014	0	1	04	01	H6743_014_0	10	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	014	0	1	04	01	H6743_014_0	10	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		40.00																					40.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	014	0	1	04	01	H6743_014_0	10	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	014	0	1	04	01	H6743_014_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		190.00																					190.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	014	0	1	04	01	H6743_014_0	10	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				903.26	29																																					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	014	0	1	04	01	H6743_014_0	10	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	016	0	1	04	01	H6743_016_0	10	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	016	0	1	04	01	H6743_016_0	10	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	016	0	1	04	01	H6743_016_0	10	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		80.00																					80.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	016	0	1	04	01	H6743_016_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	016	0	1	04	01	H6743_016_0	10	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				808.11	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6743	016	0	1	04	01	H6743_016_0	10	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6750	001	0	1	01	01	H6750_001_0	4	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	001	0	1	01	01	H6750_001_0	4	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		3
H6750	001	0	1	01	01	H6750_001_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	001	0	1	01	01	H6750_001_0	4	Preferred Brand	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	001	0	1	01	01	H6750_001_0	4	Non-Preferred Brand	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	001	0	1	01	01	H6750_001_0	4	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	29	29	29																		29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	002	0	1	01	01	H6750_002_0	4	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	002	0	1	01	01	H6750_002_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	002	0	1	01	01	H6750_002_0	4	Preferred Brand	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	002	0	1	01	01	H6750_002_0	4	Non-Preferred Brand	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	002	0	1	01	01	H6750_002_0	4	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	27	27	27																		27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	005	0	1	01	01	H6750_005_0	4	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	005	0	1	01	01	H6750_005_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	005	0	1	01	01	H6750_005_0	4	Preferred Brand	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	005	0	1	01	01	H6750_005_0	4	Non-Preferred Brand	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6750	005	0	1	01	01	H6750_005_0	4	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				227.00	25	25	25																		25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6786	002	0	1	04	01	H6786_002_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6786	002	0	1	04	01	H6786_002_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6786	002	0	1	04	01	H6786_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6786	002	0	1	04	01	H6786_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6786	002	0	1	04	01	H6786_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6786	002	0	1	04	01	H6786_002_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H6815	003	1	1	01	01	H6815_003_1	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	003	1	1	01	01	H6815_003_1	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	003	1	1	01	01	H6815_003_1	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	003	1	1	01	01	H6815_003_1	4	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	003	1	1	01	01	H6815_003_1	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	003	1	1	01	01	H6815_003_1	4	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	003	2	1	01	01	H6815_003_2	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	003	2	1	01	01	H6815_003_2	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	003	2	1	01	01	H6815_003_2	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	003	2	1	01	01	H6815_003_2	4	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	003	2	1	01	01	H6815_003_2	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	003	2	1	01	01	H6815_003_2	4	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	005	0	1	01	01	H6815_005_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	005	0	1	01	01	H6815_005_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	005	0	1	01	01	H6815_005_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	005	0	1	01	01	H6815_005_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	005	0	1	01	01	H6815_005_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6815	005	0	1	01	01	H6815_005_0	3	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H6864	001	0	1	01	01	H6864_001_0	11	Preferred Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6864	001	0	1	01	01	H6864_001_0	11	Generic	2	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	7.00	14.00	21.00																					14.00																7.00				7.00		0.23						0.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6864	001	0	1	01	01	H6864_001_0	11	Preferred Brand	2	10	1	1	3	1	111		01	100		1	30	60	90				2	2			90				30		31				76.17	25	25	25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6864	001	0	1	01	01	H6864_001_0	11	Non-Preferred Drug	2	11	1	1	4	1	111		01	100		1	30	60	90				2	2			90				30		31				53.99	25	25	25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6864	001	0	1	01	01	H6864_001_0	11	Specialty Tier	2	11	1	1	5	1	111		01	100		1	30	60	90				2	2			90				30		31				611.25	25	25	25																				25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6870	001	0	1	48	05	H6870_001_0	4	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6870	001	0	1	48	05	H6870_001_0	4	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6870	001	0	1	48	05	H6870_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6947	001	0	1	01	01	H6947_001_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	2.00	4.00	5.00																					5.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6947	001	0	1	01	01	H6947_001_0	4	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	12.00	24.00	30.00																					30.00																12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6947	001	0	1	01	01	H6947_001_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6947	001	0	1	01	01	H6947_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				67.19	50	50	50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6947	001	0	1	01	01	H6947_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H6988	001	0	1	01	01	H6988_001_0	10	Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	1			90				30		31	3.00		9.00																					5.00																3.00				3.00		0.10						0.10		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6988	001	0	1	01	01	H6988_001_0	10	Preferred Brand	4	10	1	2	2	1	110		01	100		1	30		90				1	1			90				30		31	35.00		105.00																					87.50																35.00				35.00		1.17						1.13		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6988	001	0	1	01	01	H6988_001_0	10	Non-Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H6988	001	0	1	01	01	H6988_001_0	10	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31					33																																					33			33									Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H7006	001	0	1	04	01	H7006_001_0	10	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7006	001	0	1	04	01	H7006_001_0	10	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7006	001	0	1	04	01	H7006_001_0	10	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		70.00																					70.00																35.00				35.00		1.17						1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7006	001	0	1	04	01	H7006_001_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		150.00																					150.00																75.00				75.00		2.50						2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7006	001	0	1	04	01	H7006_001_0	10	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				892.25	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7006	001	0	1	04	01	H7006_001_0	10	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7006	003	0	1	04	01	H7006_003_0	10	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7006	003	0	1	04	01	H7006_003_0	10	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7006	003	0	1	04	01	H7006_003_0	10	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		80.00																					80.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7006	003	0	1	04	01	H7006_003_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7006	003	0	1	04	01	H7006_003_0	10	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1248.44	31																																					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7006	003	0	1	04	01	H7006_003_0	10	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7020	004	0	1	01	01	H7020_004_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	3.00					10.00	20.00	20.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7020	004	0	1	01	01	H7020_004_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					13.00	26.00	26.00					20.00	40.00	40.00																20.00				20.00			0.67	0.43	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7020	004	0	1	01	01	H7020_004_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7020	004	0	1	01	01	H7020_004_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											71.20	50	50	50				58.99	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7020	004	0	1	01	01	H7020_004_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											433.61	27						363.02	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7115	001	0	1	01	01	H7115_001_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H7115	001	0	1	01	01	H7115_001_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H7115	001	0	1	01	01	H7115_001_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H7115	001	0	1	01	01	H7115_001_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	99.00	198.00	247.50																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H7115	001	0	1	01	01	H7115_001_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H7149	001	0	1	01	01	H7149_001_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7149	001	0	1	01	01	H7149_001_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7149	001	0	1	01	01	H7149_001_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7149	001	0	1	01	01	H7149_001_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7149	001	0	1	01	01	H7149_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7149	001	0	1	01	01	H7149_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7149	001	0	1	01	01	H7149_001_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7149	004	0	1	01	01	H7149_004_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7149	004	0	1	01	01	H7149_004_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7149	004	0	1	01	01	H7149_004_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7149	004	0	1	01	01	H7149_004_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7149	004	0	1	01	01	H7149_004_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7149	004	0	1	01	01	H7149_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7149	004	0	1	01	01	H7149_004_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	32						1.00	32												32						32						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7165	001	0	1	01	01	H7165_001_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	6.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7165	001	0	1	01	01	H7165_001_0	3	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	6.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7165	001	0	1	01	01	H7165_001_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	37.50				20.00				15.00			0.67	0.50		0.67	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7165	001	0	1	01	01	H7165_001_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	92.50				47.00				37.00			1.57	1.23		1.57	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7165	001	0	1	01	01	H7165_001_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.71	50	50	50				41.14	45	45	45										50	50	50				45	45	45			50			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7165	001	0	1	01	01	H7165_001_0	3	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												29	29	29					29	29	29										29	29	29				29	29	29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7165	002	0	1	01	01	H7165_002_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	6.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7165	002	0	1	01	01	H7165_002_0	3	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	6.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7165	002	0	1	01	01	H7165_002_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	37.50				20.00				15.00			0.67	0.50		0.67	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7165	002	0	1	01	01	H7165_002_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	92.50				47.00				37.00			1.57	1.23		1.57	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7165	002	0	1	01	01	H7165_002_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.71	50	50	50				41.14	45	45	45										50	50	50				45	45	45			50			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7165	002	0	1	01	01	H7165_002_0	3	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												29	29	29					29	29	29										29	29	29				29	29	29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7172	001	0	1	48	05	H7172_001_0	4	Generic Drugs	4	01			1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7172	001	0	1	48	05	H7172_001_0	4	Brand Drugs	4	11			2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7172	001	0	1	48	05	H7172_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		10			1	30	60	90				1	2								29	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H7173	001	0	1	01	01	H7173_001_0	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7173	001	0	1	01	01	H7173_001_0	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7173	001	0	1	01	01	H7173_001_0	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7173	001	0	1	01	01	H7173_001_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7173	001	0	1	01	01	H7173_001_0	4	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7173	001	0	1	01	01	H7173_001_0	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7173	002	0	1	01	01	H7173_002_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7173	002	0	1	01	01	H7173_002_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7173	002	0	1	01	01	H7173_002_0	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7173	002	0	1	01	01	H7173_002_0	3	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7173	002	0	1	01	01	H7173_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7173	002	0	1	01	01	H7173_002_0	3	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7173	003	0	1	01	01	H7173_003_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7173	003	0	1	01	01	H7173_003_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	16.00	32.00	48.00																			16.00	32.00	48.00																16.00				16.00		0.53			0.53			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7173	003	0	1	01	01	H7173_003_0	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.40			1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7173	003	0	1	01	01	H7173_003_0	3	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	258.00																86.00				86.00		2.87			2.87			2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7173	003	0	1	01	01	H7173_003_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7173	003	0	1	01	01	H7173_003_0	3	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7200	006	0	1	01	01	H7200_006_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	006	0	1	01	01	H7200_006_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	006	0	1	01	01	H7200_006_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	006	0	1	01	01	H7200_006_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	006	0	1	01	01	H7200_006_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	006	0	1	01	01	H7200_006_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	006	0	1	01	01	H7200_006_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7200	007	0	1	01	01	H7200_007_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	007	0	1	01	01	H7200_007_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	007	0	1	01	01	H7200_007_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	007	0	1	01	01	H7200_007_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	007	0	1	01	01	H7200_007_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	007	0	1	01	01	H7200_007_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	007	0	1	01	01	H7200_007_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7200	013	0	1	01	01	H7200_013_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	013	0	1	01	01	H7200_013_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	013	0	1	01	01	H7200_013_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	013	0	1	01	01	H7200_013_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	013	0	1	01	01	H7200_013_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	013	0	1	01	01	H7200_013_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	013	0	1	01	01	H7200_013_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7200	014	0	1	01	01	H7200_014_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	014	0	1	01	01	H7200_014_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	014	0	1	01	01	H7200_014_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	014	0	1	01	01	H7200_014_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	014	0	1	01	01	H7200_014_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	014	0	1	01	01	H7200_014_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7200	014	0	1	01	01	H7200_014_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7220	004	0	1	02	01	H7220_004_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	6.00		18.00																			6.00		18.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	004	0	1	02	01	H7220_004_0	6	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H7220	004	0	1	02	01	H7220_004_0	6	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	12.00		36.00																			12.00		36.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	004	0	1	02	01	H7220_004_0	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	004	0	1	02	01	H7220_004_0	6	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	004	0	1	02	01	H7220_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	004	0	1	02	01	H7220_004_0	6	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	1	1	01	01	H7220_009_1	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	6.00		18.00																			6.00		18.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	1	1	01	01	H7220_009_1	6	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	15.00		45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	1	1	01	01	H7220_009_1	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	1	1	01	01	H7220_009_1	6	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	1	1	01	01	H7220_009_1	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	1	1	01	01	H7220_009_1	6	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	2	1	01	01	H7220_009_2	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	6.00		18.00																			6.00		18.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	2	1	01	01	H7220_009_2	6	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	15.00		45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	2	1	01	01	H7220_009_2	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	2	1	01	01	H7220_009_2	6	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	2	1	01	01	H7220_009_2	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	2	1	01	01	H7220_009_2	6	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	3	1	01	01	H7220_009_3	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	6.00		18.00																			6.00		18.00																6.00				6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	3	1	01	01	H7220_009_3	6	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	15.00		45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	3	1	01	01	H7220_009_3	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	3	1	01	01	H7220_009_3	6	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	3	1	01	01	H7220_009_3	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7220	009	3	1	01	01	H7220_009_3	6	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H7245	001	0	1	01	01	H7245_001_0	17	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					5.00	10.00	15.00					5.00	10.00	15.00																15.00				15.00			0.50	0.17	0.17			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	001	0	1	01	01	H7245_001_0	17	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	45.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	001	0	1	01	01	H7245_001_0	17	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	001	0	1	01	01	H7245_001_0	17	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											70.28	35	35	35				70.28	35	35	35				35	35	35															35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	001	0	1	01	01	H7245_001_0	17	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	26						1.00	26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	002	0	1	01	01	H7245_002_0	15	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					4.00	8.00	12.00					4.00	8.00	12.00																12.00				12.00			0.40	0.13	0.13			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	002	0	1	01	01	H7245_002_0	15	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					12.00	24.00	36.00																20.00				20.00			0.67	0.40	0.40			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	002	0	1	01	01	H7245_002_0	15	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	002	0	1	01	01	H7245_002_0	15	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											61.46	35	35	35				61.46	35	35	35				35	35	35															35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	002	0	1	01	01	H7245_002_0	15	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	27						1.00	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	003	0	1	01	01	H7245_003_0	15	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					4.00	8.00	12.00					4.00	8.00	12.00																12.00				12.00			0.40	0.13	0.13			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	003	0	1	01	01	H7245_003_0	15	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					12.00	24.00	36.00																20.00				20.00			0.67	0.40	0.40			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	003	0	1	01	01	H7245_003_0	15	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	003	0	1	01	01	H7245_003_0	15	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											61.33	35	35	35				61.33	35	35	35				35	35	35															35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	003	0	1	01	01	H7245_003_0	15	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	29						1.00	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	005	0	1	01	01	H7245_005_0	14	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					2.00	4.00	6.00					2.00	4.00	6.00																12.00				12.00			0.40	0.07	0.07			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	005	0	1	01	01	H7245_005_0	14	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	30.00																20.00				20.00			0.67	0.33	0.33			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	005	0	1	01	01	H7245_005_0	14	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	005	0	1	01	01	H7245_005_0	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											51.48	35	35	35				51.48	35	35	35				35	35	35															35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7245	005	0	1	01	01	H7245_005_0	14	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	29						1.00	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	002	0	1	04	01	H7301_002_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	002	0	1	04	01	H7301_002_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7301	002	0	1	04	01	H7301_002_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	002	0	1	04	01	H7301_002_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7301	002	0	1	04	01	H7301_002_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	002	0	1	04	01	H7301_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	002	0	1	04	01	H7301_002_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	006	0	1	04	01	H7301_006_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	006	0	1	04	01	H7301_006_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7301	006	0	1	04	01	H7301_006_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	006	0	1	04	01	H7301_006_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7301	006	0	1	04	01	H7301_006_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	006	0	1	04	01	H7301_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	006	0	1	04	01	H7301_006_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	007	0	1	04	01	H7301_007_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	007	0	1	04	01	H7301_007_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7301	007	0	1	04	01	H7301_007_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	007	0	1	04	01	H7301_007_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7301	007	0	1	04	01	H7301_007_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	007	0	1	04	01	H7301_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7301	007	0	1	04	01	H7301_007_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7317	001	0	1	01	01	H7317_001_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.50	9.00	13.50																			4.50	4.50	4.50																4.50				4.50		0.15			0.15			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7317	001	0	1	01	01	H7317_001_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	12.00	12.00																12.00				12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7317	001	0	1	01	01	H7317_001_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			94.00	94.00	94.00																47.00				47.00		1.57			3.13			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7317	001	0	1	01	01	H7317_001_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			200.00	200.00	200.00																100.00				100.00		3.33			6.67			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7317	001	0	1	01	01	H7317_001_0	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7326	001	0	1	04	01	H7326_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7326	001	0	1	04	01	H7326_001_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7326	001	0	1	04	01	H7326_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7326	001	0	1	04	01	H7326_001_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				42.83	35		35																								35		35				35		35			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7326	001	0	1	04	01	H7326_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				582.28	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7326	002	0	1	04	01	H7326_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7326	002	0	1	04	01	H7326_002_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7326	002	0	1	04	01	H7326_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7326	002	0	1	04	01	H7326_002_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				42.64	35		35																								35		35				35		35			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7326	002	0	1	04	01	H7326_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				768.66	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7419	001	0	1	48	05	H7419_001_0	5	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7419	001	0	1	48	05	H7419_001_0	5	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7419	001	0	1	48	05	H7419_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7522	001	0	1	04	01	H7522_001_0	14	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H7522	001	0	1	04	01	H7522_001_0	14	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H7522	001	0	1	04	01	H7522_001_0	14	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H7522	001	0	1	04	01	H7522_001_0	14	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2		
H7522	001	0	1	04	01	H7522_001_0	14	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H7522	001	0	1	04	01	H7522_001_0	14	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	50.00		150.00																					100.00																50.00				50.00		1.67						1.61	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H7522	001	0	1	04	01	H7522_001_0	14	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H7678	001	0	1	01	01	H7678_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7678	001	0	1	01	01	H7678_001_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7678	001	0	1	01	01	H7678_001_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.16			0.16			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7678	001	0	1	01	01	H7678_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	43.00	86.00	129.00																			43.00	86.00	129.00																43.00				43.00		1.39			1.39			1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7678	001	0	1	01	01	H7678_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				96.39	50	50	50																		50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7678	001	0	1	01	01	H7678_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7680	001	0	1	01	01	H7680_001_0	13	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	6.00																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	001	0	1	01	01	H7680_001_0	13	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	6.00																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7680	001	0	1	01	01	H7680_001_0	13	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	001	0	1	01	01	H7680_001_0	13	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7680	001	0	1	01	01	H7680_001_0	13	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	001	0	1	01	01	H7680_001_0	13	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	001	0	1	01	01	H7680_001_0	13	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				670.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	001	0	1	01	01	H7680_001_0	13	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	001	0	1	01	01	H7680_001_0	13	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7680	002	0	1	01	01	H7680_002_0	8	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	6.00																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	002	0	1	01	01	H7680_002_0	8	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	6.00																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7680	002	0	1	01	01	H7680_002_0	8	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	002	0	1	01	01	H7680_002_0	8	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7680	002	0	1	01	01	H7680_002_0	8	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	002	0	1	01	01	H7680_002_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	002	0	1	01	01	H7680_002_0	8	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				670.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	002	0	1	01	01	H7680_002_0	8	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	002	0	1	01	01	H7680_002_0	8	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7680	005	0	1	01	01	H7680_005_0	13	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	4.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	005	0	1	01	01	H7680_005_0	13	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	4.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7680	005	0	1	01	01	H7680_005_0	13	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	005	0	1	01	01	H7680_005_0	13	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7680	005	0	1	01	01	H7680_005_0	13	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	005	0	1	01	01	H7680_005_0	13	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	005	0	1	01	01	H7680_005_0	13	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				670.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	005	0	1	01	01	H7680_005_0	13	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	005	0	1	01	01	H7680_005_0	13	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7680	006	0	1	01	01	H7680_006_0	11	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	4.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	006	0	1	01	01	H7680_006_0	11	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	4.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7680	006	0	1	01	01	H7680_006_0	11	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	006	0	1	01	01	H7680_006_0	11	Generic	4	01	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	20.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7680	006	0	1	01	01	H7680_006_0	11	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	006	0	1	01	01	H7680_006_0	11	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	006	0	1	01	01	H7680_006_0	11	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				670.00	33																																					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	006	0	1	01	01	H7680_006_0	11	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7680	006	0	1	01	01	H7680_006_0	11	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7728	002	0	1	04	01	H7728_002_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	002	0	1	04	01	H7728_002_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	002	0	1	04	01	H7728_002_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00	123.00	123.00																46.00				46.00			1.53	1.37	1.37			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	002	0	1	04	01	H7728_002_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	002	0	1	04	01	H7728_002_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	002	0	1	04	01	H7728_002_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	002	0	1	04	01	H7728_002_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7728	004	1	1	04	01	H7728_004_1	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	1	1	04	01	H7728_004_1	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	1	1	04	01	H7728_004_1	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	1	1	04	01	H7728_004_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	1	1	04	01	H7728_004_1	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	1	1	04	01	H7728_004_1	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	1	1	04	01	H7728_004_1	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7728	004	2	1	04	01	H7728_004_2	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	2	1	04	01	H7728_004_2	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	2	1	04	01	H7728_004_2	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	2	1	04	01	H7728_004_2	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	2	1	04	01	H7728_004_2	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	2	1	04	01	H7728_004_2	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	004	2	1	04	01	H7728_004_2	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7728	005	0	1	04	01	H7728_005_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	005	0	1	04	01	H7728_005_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	39.00	39.00																18.00				18.00			0.60	0.43	0.43			0.53		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	005	0	1	04	01	H7728_005_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	005	0	1	04	01	H7728_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	005	0	1	04	01	H7728_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	005	0	1	04	01	H7728_005_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H7728	005	0	1	04	01	H7728_005_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H7787	001	0	1	04	01	H7787_001_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	12.50					0.00	0.00	0.00					5.00	10.00	12.50																5.00				5.00			0.17	0.00	0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7787	001	0	1	04	01	H7787_001_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					4.00	8.00	10.00					9.00	18.00	22.50																9.00				9.00			0.30	0.13	0.30			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7787	001	0	1	04	01	H7787_001_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	135.00																45.00				45.00			1.50	1.33	1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7787	001	0	1	04	01	H7787_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								85.00	170.00	255.00					80.00	160.00	240.00					85.00	170.00	255.00																85.00				85.00			2.83	2.67	2.83			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7787	001	0	1	04	01	H7787_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											381.21	29						363.15	29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7802	001	0	1	01	01	H7802_001_0	3	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H7802	001	0	1	01	01	H7802_001_0	3	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H7802	002	0	1	01	01	H7802_002_0	3	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H7802	002	0	1	01	01	H7802_002_0	3	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H7802	003	0	1	01	01	H7802_003_0	4	Generic	4	11	1	1	1	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H7802	003	0	1	01	01	H7802_003_0	4	Brand	4	11	1	1	2	1	111		10			1	30	60	90				1	2								10	31					25	25	25																																				25		25									Generic, Brand													
H7833	001	0	1	48	05	H7833_001_0	2	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	3.35	0.00	3.35	0.00	3.35	0.00	3.35			
H7833	001	0	1	48	05	H7833_001_0	2	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	8.35	0.00	8.35	0.00	8.35	0.00	8.35			
H7833	001	0	1	48	05	H7833_001_0	2	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_001_0	6	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_001_0	6	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_001_0	6	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7853	001	0	1	01	01	H7853_001_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7853	001	0	1	01	01	H7853_001_0	6	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7853	001	0	1	01	01	H7853_001_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7853	001	0	1	01	01	H7853_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7853	001	0	1	01	01	H7853_001_0	6	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				733.18	29		29																				29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7853	002	0	1	01	01	H7853_002_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7853	002	0	1	01	01	H7853_002_0	6	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7853	002	0	1	01	01	H7853_002_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7853	002	0	1	01	01	H7853_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7853	002	0	1	01	01	H7853_002_0	6	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				805.12	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7885	001	0	1	48	05	H7885_001_0	7	Generic Drugs	4	01			1	1	110		01			1	31		93				2	2							31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	3.35	0.00	3.35			0.00	3.35			
H7885	001	0	1	48	05	H7885_001_0	7	Brand Drugs	4	10			2	1	110		01			1	31		93				2	2							31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	8.35	0.00	8.35			0.00	8.35			
H7885	001	0	1	48	05	H7885_001_0	7	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01			1	31		93				1	2							31		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	5	Generic Drugs	4	11			1	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																														0.11			0.11			0.11		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	3.35	0.00	3.35	0.00	3.35	0.00	3.35			
H7890	001	0	1	48	05	H7890_001_0	5	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																														0.27			0.27			0.27		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	8.35	0.00	8.35	0.00	8.35	0.00	8.35			
H7890	001	0	1	48	05	H7890_001_0	5	Non-Medicare Rx Drugs	4	11			3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	5	Non-Medicare OTC Drugs	4	11			4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7917	008	0	1	04	01	H7917_008_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	008	0	1	04	01	H7917_008_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	008	0	1	04	01	H7917_008_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	10.00	12.50											10.00	20.00	25.00				5.00	10.00	12.50					10.00			10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	008	0	1	04	01	H7917_008_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	008	0	1	04	01	H7917_008_0	5	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	008	0	1	04	01	H7917_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55.00	110.00	137.50					50.00	100.00	125.00											55.00	110.00	137.50				50.00	100.00	125.00					55.00			55.00			1.83	1.67		1.83	1.67	1.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	008	0	1	04	01	H7917_008_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	009	0	1	04	01	H7917_009_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	009	0	1	04	01	H7917_009_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	009	0	1	04	01	H7917_009_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	10.00	12.50											10.00	20.00	25.00				5.00	10.00	12.50					10.00			10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	009	0	1	04	01	H7917_009_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	009	0	1	04	01	H7917_009_0	7	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	009	0	1	04	01	H7917_009_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55.00	110.00	137.50					50.00	100.00	125.00											55.00	110.00	137.50				50.00	100.00	125.00					55.00			55.00			1.83	1.67		1.83	1.67	1.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	009	0	1	04	01	H7917_009_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	010	0	1	04	01	H7917_010_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	010	0	1	04	01	H7917_010_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	010	0	1	04	01	H7917_010_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	10.00	12.50											10.00	20.00	25.00				5.00	10.00	12.50					10.00			10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	010	0	1	04	01	H7917_010_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	010	0	1	04	01	H7917_010_0	7	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	010	0	1	04	01	H7917_010_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55.00	110.00	137.50					50.00	100.00	125.00											55.00	110.00	137.50				50.00	100.00	125.00					55.00			55.00			1.83	1.67		1.83	1.67	1.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	010	0	1	04	01	H7917_010_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	011	0	1	04	01	H7917_011_0	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	011	0	1	04	01	H7917_011_0	8	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	011	0	1	04	01	H7917_011_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	10.00	12.50											10.00	20.00	25.00				5.00	10.00	12.50					10.00			10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	011	0	1	04	01	H7917_011_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	011	0	1	04	01	H7917_011_0	8	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	011	0	1	04	01	H7917_011_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55.00	110.00	137.50					50.00	100.00	125.00											55.00	110.00	137.50				50.00	100.00	125.00					55.00			55.00			1.83	1.67		1.83	1.67	1.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	011	0	1	04	01	H7917_011_0	8	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	012	0	1	04	01	H7917_012_0	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	012	0	1	04	01	H7917_012_0	8	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	012	0	1	04	01	H7917_012_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	10.00	12.50											10.00	20.00	25.00				5.00	10.00	12.50					10.00			10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	012	0	1	04	01	H7917_012_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	012	0	1	04	01	H7917_012_0	8	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	012	0	1	04	01	H7917_012_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	175.00					65.00	130.00	162.50											70.00	140.00	175.00				65.00	130.00	162.50					70.00			70.00			2.33	2.17		2.33	2.17	2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	012	0	1	04	01	H7917_012_0	8	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	013	0	1	04	01	H7917_013_0	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	013	0	1	04	01	H7917_013_0	8	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	013	0	1	04	01	H7917_013_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	10.00	12.50											10.00	20.00	25.00				5.00	10.00	12.50					10.00			10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	013	0	1	04	01	H7917_013_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	013	0	1	04	01	H7917_013_0	8	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	013	0	1	04	01	H7917_013_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	175.00					65.00	130.00	162.50											70.00	140.00	175.00				65.00	130.00	162.50					70.00			70.00			2.33	2.17		2.33	2.17	2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	013	0	1	04	01	H7917_013_0	8	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	014	0	1	04	01	H7917_014_0	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	014	0	1	04	01	H7917_014_0	8	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	014	0	1	04	01	H7917_014_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	10.00	12.50											10.00	20.00	25.00				5.00	10.00	12.50					10.00			10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	014	0	1	04	01	H7917_014_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	014	0	1	04	01	H7917_014_0	8	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	014	0	1	04	01	H7917_014_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	175.00					65.00	130.00	162.50											70.00	140.00	175.00				65.00	130.00	162.50					70.00			70.00			2.33	2.17		2.33	2.17	2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	014	0	1	04	01	H7917_014_0	8	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	015	0	1	04	01	H7917_015_0	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	015	0	1	04	01	H7917_015_0	8	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	015	0	1	04	01	H7917_015_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	10.00	12.50											10.00	20.00	25.00				5.00	10.00	12.50					10.00			10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	015	0	1	04	01	H7917_015_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	015	0	1	04	01	H7917_015_0	8	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	82.50					28.00	56.00	70.00											33.00	66.00	82.50				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	015	0	1	04	01	H7917_015_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	175.00					65.00	130.00	162.50											70.00	140.00	175.00				65.00	130.00	162.50					70.00			70.00			2.33	2.17		2.33	2.17	2.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	015	0	1	04	01	H7917_015_0	8	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	030	0	1	04	01	H7917_030_0	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	030	0	1	04	01	H7917_030_0	8	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	030	0	1	04	01	H7917_030_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	25.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	030	0	1	04	01	H7917_030_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	030	0	1	04	01	H7917_030_0	8	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	030	0	1	04	01	H7917_030_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								95.00	190.00	237.50					90.00	180.00	225.00											95.00	190.00	237.50				90.00	180.00	225.00					95.00			95.00			3.17	3.00		3.17	3.00	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	030	0	1	04	01	H7917_030_0	8	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	031	0	1	04	01	H7917_031_0	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	031	0	1	04	01	H7917_031_0	8	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	031	0	1	04	01	H7917_031_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	25.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	031	0	1	04	01	H7917_031_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	031	0	1	04	01	H7917_031_0	8	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	031	0	1	04	01	H7917_031_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								95.00	190.00	237.50					90.00	180.00	225.00											95.00	190.00	237.50				90.00	180.00	225.00					95.00			95.00			3.17	3.00		3.17	3.00	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	031	0	1	04	01	H7917_031_0	8	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	032	0	1	04	01	H7917_032_0	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	032	0	1	04	01	H7917_032_0	8	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	032	0	1	04	01	H7917_032_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	25.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	032	0	1	04	01	H7917_032_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	032	0	1	04	01	H7917_032_0	8	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	032	0	1	04	01	H7917_032_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								95.00	190.00	237.50					90.00	180.00	225.00											95.00	190.00	237.50				90.00	180.00	225.00					95.00			95.00			3.17	3.00		3.17	3.00	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	032	0	1	04	01	H7917_032_0	8	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	033	0	1	04	01	H7917_033_0	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	033	0	1	04	01	H7917_033_0	8	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	2.00	2.50											6.00	12.00	15.00				1.00	2.00	2.50					6.00			6.00			0.20	0.03		0.20	0.03	.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H7917	033	0	1	04	01	H7917_033_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	25.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	033	0	1	04	01	H7917_033_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	033	0	1	04	01	H7917_033_0	8	Preferred Brand	4	11	1	2	3	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
H7917	033	0	1	04	01	H7917_033_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								95.00	190.00	237.50					90.00	180.00	225.00											95.00	190.00	237.50				90.00	180.00	225.00					95.00			95.00			3.17	3.00		3.17	3.00	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H7917	033	0	1	04	01	H7917_033_0	8	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	001	0	1	04	01	H8003_001_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	6.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	001	0	1	04	01	H8003_001_0	3	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	6.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H8003	001	0	1	04	01	H8003_001_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	37.50				20.00				15.00			0.67	0.50		0.67	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	001	0	1	04	01	H8003_001_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	92.50				47.00				37.00			1.57	1.23		1.57	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	001	0	1	04	01	H8003_001_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.71	50	50	50				41.14	45	45	45										50	50	50				45	45	45			50			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	001	0	1	04	01	H8003_001_0	3	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												29	29	29					29	29	29										29	29	29				29	29	29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	002	0	1	04	01	H8003_002_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	6.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	002	0	1	04	01	H8003_002_0	3	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	6.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H8003	002	0	1	04	01	H8003_002_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	37.50				20.00				15.00			0.67	0.50		0.67	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	002	0	1	04	01	H8003_002_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	92.50				47.00				37.00			1.57	1.23		1.57	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	002	0	1	04	01	H8003_002_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.71	50	50	50				41.14	45	45	45										50	50	50				45	45	45			50			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	002	0	1	04	01	H8003_002_0	3	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												29	29	29					29	29	29										29	29	29				29	29	29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	003	0	1	04	01	H8003_003_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	6.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	003	0	1	04	01	H8003_003_0	3	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	6.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H8003	003	0	1	04	01	H8003_003_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	37.50				20.00				15.00			0.67	0.50		0.67	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	003	0	1	04	01	H8003_003_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	92.50				47.00				37.00			1.57	1.23		1.57	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	003	0	1	04	01	H8003_003_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.71	50	50	50				41.14	45	45	45										50	50	50				45	45	45			50			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8003	003	0	1	04	01	H8003_003_0	3	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												29	29	29					29	29	29										29	29	29				29	29	29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8016	001	0	1	48	05	H8016_001_0	7	Generic Drugs	4	01			1	1	111		01			1	30	60	90				1	2							30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	3.35	0.00	3.35			0.00	3.35			
H8016	001	0	1	48	05	H8016_001_0	7	Brand Drugs	4	10			2	1	111		01			1	30	60	90				1	2							30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	8.35	0.00	8.35			0.00	8.35			
H8016	001	0	1	48	05	H8016_001_0	7	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01			1	30	60	90				1	2							30		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H8026	001	0	1	48	05	H8026_001_0	5	Generic Drugs	4	01			1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8026	001	0	1	48	05	H8026_001_0	5	Brand Drugs	4	11			2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8026	001	0	1	48	05	H8026_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		10			1	30	60	90				1	2								29	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H8029	001	0	1	48	05	H8029_001_0	3	Generic Drugs	4	01			1	1	111		01	100		1	30	60	90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8029	001	0	1	48	05	H8029_001_0	3	Brand Drugs	4	11			2	1	111		01	100		1	30	60	90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8029	001	0	1	48	05	H8029_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	5	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	5	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8064	002	0	1	04	01	H8064_002_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	0.00	0.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8064	002	0	1	04	01	H8064_002_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	0.00	0.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8064	002	0	1	04	01	H8064_002_0	4	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8064	002	0	1	04	01	H8064_002_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8064	002	0	1	04	01	H8064_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8064	002	0	1	04	01	H8064_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				410.00	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8064	002	0	1	04	01	H8064_002_0	4	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	8.00	0.00																			8.00	8.00	0.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8064	002	0	1	04	01	H8064_002_0	4	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	8.00	0.00																			8.00	8.00	0.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8130	001	0	1	01	01	H8130_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8130	001	0	1	01	01	H8130_001_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H8130	001	0	1	01	01	H8130_001_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8130	001	0	1	01	01	H8130_001_0	5	Generic	4	11	1	2	2	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H8130	001	0	1	01	01	H8130_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8130	001	0	1	01	01	H8130_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				90.66	47	47	47																		47	47	47															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8130	001	0	1	01	01	H8130_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8133	001	0	1	01	01	H8133_001_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	001	0	1	01	01	H8133_001_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	001	0	1	01	01	H8133_001_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	001	0	1	01	01	H8133_001_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	001	0	1	01	01	H8133_001_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	001	0	1	01	01	H8133_001_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	001	0	1	01	01	H8133_001_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											578.51	33		33				641.19	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	003	0	1	01	01	H8133_003_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	003	0	1	01	01	H8133_003_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	003	0	1	01	01	H8133_003_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	003	0	1	01	01	H8133_003_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	003	0	1	01	01	H8133_003_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	003	0	1	01	01	H8133_003_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	003	0	1	01	01	H8133_003_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											578.89	33		33				579.80	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	004	0	1	01	01	H8133_004_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	004	0	1	01	01	H8133_004_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	004	0	1	01	01	H8133_004_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	004	0	1	01	01	H8133_004_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	004	0	1	01	01	H8133_004_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	004	0	1	01	01	H8133_004_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	004	0	1	01	01	H8133_004_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											556.10	33		33				554.32	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	005	0	1	01	01	H8133_005_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	005	0	1	01	01	H8133_005_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	005	0	1	01	01	H8133_005_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	005	0	1	01	01	H8133_005_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	005	0	1	01	01	H8133_005_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	005	0	1	01	01	H8133_005_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	005	0	1	01	01	H8133_005_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											452.83	33		33				499.92	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	006	0	1	01	01	H8133_006_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	006	0	1	01	01	H8133_006_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	006	0	1	01	01	H8133_006_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	006	0	1	01	01	H8133_006_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	006	0	1	01	01	H8133_006_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	006	0	1	01	01	H8133_006_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	006	0	1	01	01	H8133_006_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											550.64	33		33				561.42	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	007	0	1	01	01	H8133_007_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	007	0	1	01	01	H8133_007_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	007	0	1	01	01	H8133_007_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	007	0	1	01	01	H8133_007_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	007	0	1	01	01	H8133_007_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	007	0	1	01	01	H8133_007_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	007	0	1	01	01	H8133_007_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											589.44	33		33				531.93	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	008	0	1	01	01	H8133_008_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	008	0	1	01	01	H8133_008_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	008	0	1	01	01	H8133_008_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	008	0	1	01	01	H8133_008_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	008	0	1	01	01	H8133_008_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	008	0	1	01	01	H8133_008_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	008	0	1	01	01	H8133_008_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											447.56	33		33				452.36	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	011	0	1	01	01	H8133_011_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	011	0	1	01	01	H8133_011_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	011	0	1	01	01	H8133_011_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	011	0	1	01	01	H8133_011_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	011	0	1	01	01	H8133_011_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	011	0	1	01	01	H8133_011_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	011	0	1	01	01	H8133_011_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											516.84	33		33				518.15	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	012	0	1	02	01	H8133_012_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	012	0	1	02	01	H8133_012_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	012	0	1	02	01	H8133_012_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	012	0	1	02	01	H8133_012_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	012	0	1	02	01	H8133_012_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	012	0	1	02	01	H8133_012_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	012	0	1	02	01	H8133_012_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											468.36	33		33				474.23	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	013	0	1	02	01	H8133_013_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	013	0	1	02	01	H8133_013_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	013	0	1	02	01	H8133_013_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	013	0	1	02	01	H8133_013_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	013	0	1	02	01	H8133_013_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	013	0	1	02	01	H8133_013_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	013	0	1	02	01	H8133_013_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											487.46	33		33				487.46	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	014	0	1	02	01	H8133_014_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	014	0	1	02	01	H8133_014_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	014	0	1	02	01	H8133_014_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	014	0	1	02	01	H8133_014_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8133	014	0	1	02	01	H8133_014_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	014	0	1	02	01	H8133_014_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8133	014	0	1	02	01	H8133_014_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											463.41	33		33				469.11	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8142	001	0	1	01	01	H8142_001_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8142	001	0	1	01	01	H8142_001_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	28.00																14.00				14.00		0.47			0.47			0.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8142	001	0	1	01	01	H8142_001_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8142	001	0	1	01	01	H8142_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8142	001	0	1	01	01	H8142_001_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	003	0	1	09	04	H8145_003_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	003	0	1	09	04	H8145_003_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	003	0	1	09	04	H8145_003_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	003	0	1	09	04	H8145_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	003	0	1	09	04	H8145_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	004	0	1	09	04	H8145_004_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	004	0	1	09	04	H8145_004_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	004	0	1	09	04	H8145_004_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	004	0	1	09	04	H8145_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	004	0	1	09	04	H8145_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	006	0	1	09	04	H8145_006_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	006	0	1	09	04	H8145_006_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	006	0	1	09	04	H8145_006_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	006	0	1	09	04	H8145_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	006	0	1	09	04	H8145_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	008	0	1	09	04	H8145_008_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	008	0	1	09	04	H8145_008_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	008	0	1	09	04	H8145_008_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	008	0	1	09	04	H8145_008_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	008	0	1	09	04	H8145_008_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	011	0	1	09	04	H8145_011_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	011	0	1	09	04	H8145_011_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	011	0	1	09	04	H8145_011_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	011	0	1	09	04	H8145_011_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	011	0	1	09	04	H8145_011_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	021	0	1	09	04	H8145_021_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	021	0	1	09	04	H8145_021_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	021	0	1	09	04	H8145_021_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	021	0	1	09	04	H8145_021_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	021	0	1	09	04	H8145_021_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	032	0	1	09	04	H8145_032_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	032	0	1	09	04	H8145_032_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	032	0	1	09	04	H8145_032_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	032	0	1	09	04	H8145_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	032	0	1	09	04	H8145_032_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	051	0	1	09	04	H8145_051_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	051	0	1	09	04	H8145_051_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	051	0	1	09	04	H8145_051_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	051	0	1	09	04	H8145_051_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	051	0	1	09	04	H8145_051_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	052	0	1	09	04	H8145_052_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	052	0	1	09	04	H8145_052_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	052	0	1	09	04	H8145_052_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	052	0	1	09	04	H8145_052_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	052	0	1	09	04	H8145_052_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	061	0	1	09	04	H8145_061_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	061	0	1	09	04	H8145_061_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	061	0	1	09	04	H8145_061_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	061	0	1	09	04	H8145_061_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	061	0	1	09	04	H8145_061_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	063	0	1	09	04	H8145_063_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	063	0	1	09	04	H8145_063_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	063	0	1	09	04	H8145_063_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	063	0	1	09	04	H8145_063_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	063	0	1	09	04	H8145_063_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	069	0	1	09	04	H8145_069_0	7	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	069	0	1	09	04	H8145_069_0	7	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	069	0	1	09	04	H8145_069_0	7	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	069	0	1	09	04	H8145_069_0	7	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	069	0	1	09	04	H8145_069_0	7	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	075	0	1	09	04	H8145_075_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	075	0	1	09	04	H8145_075_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	075	0	1	09	04	H8145_075_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	075	0	1	09	04	H8145_075_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	075	0	1	09	04	H8145_075_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	084	0	1	09	04	H8145_084_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	084	0	1	09	04	H8145_084_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	084	0	1	09	04	H8145_084_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	084	0	1	09	04	H8145_084_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	084	0	1	09	04	H8145_084_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	087	0	1	09	04	H8145_087_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	087	0	1	09	04	H8145_087_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	087	0	1	09	04	H8145_087_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	087	0	1	09	04	H8145_087_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	087	0	1	09	04	H8145_087_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	089	0	1	09	04	H8145_089_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	089	0	1	09	04	H8145_089_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	089	0	1	09	04	H8145_089_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	089	0	1	09	04	H8145_089_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	089	0	1	09	04	H8145_089_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	091	0	1	09	04	H8145_091_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	091	0	1	09	04	H8145_091_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	091	0	1	09	04	H8145_091_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	091	0	1	09	04	H8145_091_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	091	0	1	09	04	H8145_091_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	103	0	1	09	04	H8145_103_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	103	0	1	09	04	H8145_103_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	103	0	1	09	04	H8145_103_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	103	0	1	09	04	H8145_103_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	103	0	1	09	04	H8145_103_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	122	0	1	09	04	H8145_122_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	122	0	1	09	04	H8145_122_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	122	0	1	09	04	H8145_122_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	122	0	1	09	04	H8145_122_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	122	0	1	09	04	H8145_122_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	123	0	1	09	04	H8145_123_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	123	0	1	09	04	H8145_123_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	123	0	1	09	04	H8145_123_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	123	0	1	09	04	H8145_123_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	123	0	1	09	04	H8145_123_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	125	0	1	09	04	H8145_125_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	125	0	1	09	04	H8145_125_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	125	0	1	09	04	H8145_125_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	125	0	1	09	04	H8145_125_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8145	125	0	1	09	04	H8145_125_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8170	001	0	1	01	01	H8170_001_0	6	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8170	001	0	1	01	01	H8170_001_0	6	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		112.50																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8170	001	0	1	01	01	H8170_001_0	6	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		237.50																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8170	001	0	1	01	01	H8170_001_0	6	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8170	002	0	1	01	01	H8170_002_0	6	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8170	002	0	1	01	01	H8170_002_0	6	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		112.50																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8170	002	0	1	01	01	H8170_002_0	6	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		237.50																95.00				95.00		3.17			3.17			3.06	1	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8170	002	0	1	01	01	H8170_002_0	6	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8189	001	0	1	01	01	H8189_001_0	4	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8189	001	0	1	01	01	H8189_001_0	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8189	001	0	1	01	01	H8189_001_0	4	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8189	001	0	1	01	01	H8189_001_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8189	001	0	1	01	01	H8189_001_0	4	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8189	001	0	1	01	01	H8189_001_0	4	Select Care Drugs	3	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8197	001	0	1	48	05	H8197_001_0	6	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	001	0	1	48	05	H8197_001_0	6	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	001	0	1	48	05	H8197_001_0	6	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8211	001	0	1	04	01	H8211_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	001	0	1	04	01	H8211_001_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	001	0	1	04	01	H8211_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	001	0	1	04	01	H8211_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	001	0	1	04	01	H8211_001_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				870.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	002	0	1	04	01	H8211_002_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	002	0	1	04	01	H8211_002_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	002	0	1	04	01	H8211_002_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	002	0	1	04	01	H8211_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	002	0	1	04	01	H8211_002_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				964.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	003	0	1	04	01	H8211_003_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	003	0	1	04	01	H8211_003_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	003	0	1	04	01	H8211_003_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	003	0	1	04	01	H8211_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	003	0	1	04	01	H8211_003_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				870.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	004	0	1	04	01	H8211_004_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	004	0	1	04	01	H8211_004_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	004	0	1	04	01	H8211_004_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	004	0	1	04	01	H8211_004_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8211	004	0	1	04	01	H8211_004_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1010.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8213	001	0	1	48	05	H8213_001_0	4	Generic Drugs	4	01			1	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8213	001	0	1	48	05	H8213_001_0	4	Brand Drugs	4	10			2	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8213	001	0	1	48	05	H8213_001_0	4	Non-Medicare Rx/OTC Drugs	4	10			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8237	001	0	1	01	01	H8237_001_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8237	001	0	1	01	01	H8237_001_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8237	001	0	1	01	01	H8237_001_0	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8237	001	0	1	01	01	H8237_001_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8237	001	0	1	01	01	H8237_001_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8258	001	0	1	48	05	H8258_001_0	7	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8258	001	0	1	48	05	H8258_001_0	7	Brand Drugs	4	10			2	1	111		10	111		1	30	60	90				2	2	30	60	90					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	8.35			0.00	8.35	0.00	8.35			
H8258	001	0	1	48	05	H8258_001_0	7	Non-Medicare Rx Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8258	001	0	1	48	05	H8258_001_0	7	Non-Medicare OTC Drugs	4	11			4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8266	001	0	1	01	01	H8266_001_0	8	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8266	001	0	1	01	01	H8266_001_0	8	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8266	001	0	1	01	01	H8266_001_0	8	Preferred Brand	4	10	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	47.00	94.00	141.00																					150.00																47.00				47.00		1.57						1.52	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8266	001	0	1	01	01	H8266_001_0	8	Non-Preferred Brand	4	10	3	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	75.00	150.00	225.00																					225.00																75.00				75.00		2.50						2.42	3	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8266	001	0	1	01	01	H8266_001_0	8	Specialty Tier	4	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				1123.34	33	33	33																				33															33			33								1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8266	002	0	1	01	01	H8266_002_0	7	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8266	002	0	1	01	01	H8266_002_0	7	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8266	002	0	1	01	01	H8266_002_0	7	Preferred Brand	4	10	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	25.00	50.00	75.00																					75.00																25.00				25.00		0.83						0.81	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8266	002	0	1	01	01	H8266_002_0	7	Non-Preferred Brand	4	10	3	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	3	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8266	002	0	1	01	01	H8266_002_0	7	Specialty Tier	4	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				1540.11	33	33	33																				33															33			33								1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8266	004	0	1	01	01	H8266_004_0	7	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8266	004	0	1	01	01	H8266_004_0	7	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8266	004	0	1	01	01	H8266_004_0	7	Preferred Brand	4	10	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8266	004	0	1	01	01	H8266_004_0	7	Non-Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	75.00	150.00	225.00																					225.00																75.00				75.00		2.50						2.42	1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8266	004	0	1	01	01	H8266_004_0	7	Specialty Tier	4	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				1123.34	33	33	33																				33															33			33								1	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8280	001	0	1	01	01	H8280_001_0	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8280	001	0	1	01	01	H8280_001_0	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8280	001	0	1	01	01	H8280_001_0	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					125.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8280	001	0	1	01	01	H8280_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8280	001	0	1	01	01	H8280_001_0	7	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				733.18	31		31																				31															31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8280	002	0	1	01	01	H8280_002_0	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8280	002	0	1	01	01	H8280_002_0	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	15.00		45.00																			15.00		0.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8280	002	0	1	01	01	H8280_002_0	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					125.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8280	002	0	1	01	01	H8280_002_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8280	002	0	1	01	01	H8280_002_0	7	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				805.12	33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8423	001	0	1	48	05	H8423_001_0	4	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs	3	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8423	001	0	1	48	05	H8423_001_0	4	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8432	002	0	1	01	01	H8432_002_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	002	0	1	01	01	H8432_002_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	002	0	1	01	01	H8432_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	002	0	1	01	01	H8432_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	002	0	1	01	01	H8432_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	002	0	1	01	01	H8432_002_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	002	0	1	01	01	H8432_002_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	003	0	1	01	01	H8432_003_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	003	0	1	01	01	H8432_003_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00	21.00	21.00																12.00				12.00			0.40	0.23	0.23			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	003	0	1	01	01	H8432_003_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	003	0	1	01	01	H8432_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	003	0	1	01	01	H8432_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	003	0	1	01	01	H8432_003_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	003	0	1	01	01	H8432_003_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	004	0	1	01	01	H8432_004_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	004	0	1	01	01	H8432_004_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	39.00	39.00																18.00				18.00			0.60	0.43	0.43			0.53		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	004	0	1	01	01	H8432_004_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	004	0	1	01	01	H8432_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	004	0	1	01	01	H8432_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	004	0	1	01	01	H8432_004_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	004	0	1	01	01	H8432_004_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	005	0	1	02	01	H8432_005_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	005	0	1	02	01	H8432_005_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	005	0	1	02	01	H8432_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	005	0	1	02	01	H8432_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	005	0	1	02	01	H8432_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	005	0	1	02	01	H8432_005_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	006	0	1	02	01	H8432_006_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	006	0	1	02	01	H8432_006_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	006	0	1	02	01	H8432_006_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	006	0	1	02	01	H8432_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	006	0	1	02	01	H8432_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	006	0	1	02	01	H8432_006_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	007	0	1	01	01	H8432_007_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	007	0	1	01	01	H8432_007_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	007	0	1	01	01	H8432_007_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	007	0	1	01	01	H8432_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	007	0	1	01	01	H8432_007_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	007	0	1	01	01	H8432_007_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	007	0	1	01	01	H8432_007_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	008	5	1	01	01	H8432_008_5	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	5	1	01	01	H8432_008_5	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	5	1	01	01	H8432_008_5	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	5	1	01	01	H8432_008_5	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	5	1	01	01	H8432_008_5	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	5	1	01	01	H8432_008_5	3	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	5	1	01	01	H8432_008_5	3	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	008	6	1	01	01	H8432_008_6	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	6	1	01	01	H8432_008_6	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	6	1	01	01	H8432_008_6	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	6	1	01	01	H8432_008_6	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	6	1	01	01	H8432_008_6	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	6	1	01	01	H8432_008_6	3	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	6	1	01	01	H8432_008_6	3	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	008	7	1	01	01	H8432_008_7	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	7	1	01	01	H8432_008_7	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	7	1	01	01	H8432_008_7	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	7	1	01	01	H8432_008_7	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	7	1	01	01	H8432_008_7	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	7	1	01	01	H8432_008_7	3	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	008	7	1	01	01	H8432_008_7	3	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	009	0	1	01	01	H8432_009_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	009	0	1	01	01	H8432_009_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	009	0	1	01	01	H8432_009_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	009	0	1	01	01	H8432_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	009	0	1	01	01	H8432_009_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	009	0	1	01	01	H8432_009_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	010	0	1	01	01	H8432_010_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	010	0	1	01	01	H8432_010_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	010	0	1	01	01	H8432_010_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	010	0	1	01	01	H8432_010_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	010	0	1	01	01	H8432_010_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	010	0	1	01	01	H8432_010_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	010	0	1	01	01	H8432_010_0	4	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	011	0	1	01	01	H8432_011_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	011	0	1	01	01	H8432_011_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	011	0	1	01	01	H8432_011_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	011	0	1	01	01	H8432_011_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	011	0	1	01	01	H8432_011_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	011	0	1	01	01	H8432_011_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	011	0	1	01	01	H8432_011_0	4	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	013	0	1	01	01	H8432_013_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	013	0	1	01	01	H8432_013_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	013	0	1	01	01	H8432_013_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	013	0	1	01	01	H8432_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	013	0	1	01	01	H8432_013_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	013	0	1	01	01	H8432_013_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	013	0	1	01	01	H8432_013_0	4	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	014	0	1	02	01	H8432_014_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	014	0	1	02	01	H8432_014_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	014	0	1	02	01	H8432_014_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	014	0	1	02	01	H8432_014_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	014	0	1	02	01	H8432_014_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	014	0	1	02	01	H8432_014_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	014	0	1	02	01	H8432_014_0	4	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	015	0	1	02	01	H8432_015_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	015	0	1	02	01	H8432_015_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	015	0	1	02	01	H8432_015_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	015	0	1	02	01	H8432_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								98.00	196.00	294.00					93.00	186.00	279.00					93.00	279.00	279.00																98.00				98.00			3.27	3.10	3.10			2.88		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	015	0	1	02	01	H8432_015_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	015	0	1	02	01	H8432_015_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	015	0	1	02	01	H8432_015_0	4	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8432	016	0	1	01	01	H8432_016_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	016	0	1	01	01	H8432_016_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	016	0	1	01	01	H8432_016_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	016	0	1	01	01	H8432_016_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	016	0	1	01	01	H8432_016_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	016	0	1	01	01	H8432_016_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	017	0	1	01	01	H8432_017_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	017	0	1	01	01	H8432_017_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	017	0	1	01	01	H8432_017_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	017	0	1	01	01	H8432_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	017	0	1	01	01	H8432_017_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	017	0	1	01	01	H8432_017_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	018	0	1	01	01	H8432_018_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								2.00	4.00	6.00					2.00	4.00	6.00					2.00	6.00	6.00																2.00				2.00			0.07	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	018	0	1	01	01	H8432_018_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					17.00	34.00	51.00					17.00	51.00	51.00																17.00				17.00			0.57	0.57	0.57			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	018	0	1	01	01	H8432_018_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	018	0	1	01	01	H8432_018_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	018	0	1	01	01	H8432_018_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	018	0	1	01	01	H8432_018_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8432	018	0	1	01	01	H8432_018_0	4	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8452	001	0	1	48	05	H8452_001_0	8	Generic Drugs	4	01			1	1	110		01	100		1	30		90				2	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8452	001	0	1	48	05	H8452_001_0	8	Brand Drugs	4	11			2	1	110		01	100		1	30		90				2	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8452	001	0	1	48	05	H8452_001_0	8	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01	100		1	30		90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8490	001	0	1	48	05	H8490_001_0	4	Generic Drugs	4	01			1	1	111		01	100		1	30	60	90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8490	001	0	1	48	05	H8490_001_0	4	Brand Drugs	4	10			2	1	111		01	100		1	30	60	90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8490	001	0	1	48	05	H8490_001_0	4	Non-Medicare Rx Drugs	4	11			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8490	001	0	1	48	05	H8490_001_0	4	Non-Medicare OTC Drugs	4	11			4	1	111		01	100		1	30	60	90				1	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8506	001	0	1	01	01	H8506_001_0	10	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8506	001	0	1	01	01	H8506_001_0	10	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.32						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8506	001	0	1	01	01	H8506_001_0	10	Preferred Brand	4	10	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.45						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8506	001	0	1	01	01	H8506_001_0	10	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	31	62	93				1	2			93				31		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.06						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8506	001	0	1	01	01	H8506_001_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				300.00	30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8552	020	0	1	04	01	H8552_020_0	7	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	020	0	1	04	01	H8552_020_0	7	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								16.00	32.00	48.00					11.00	22.00	33.00					11.00	33.00	33.00																16.00				16.00			0.53	0.37	0.37			0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	020	0	1	04	01	H8552_020_0	7	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	020	0	1	04	01	H8552_020_0	7	Non-Preferred Drug	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	020	0	1	04	01	H8552_020_0	7	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	020	0	1	04	01	H8552_020_0	7	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	028	0	1	04	01	H8552_028_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					14.00	28.00	42.00					14.00	42.00	42.00																19.00				19.00			0.63	0.47	0.47			0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	028	0	1	04	01	H8552_028_0	9	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	028	0	1	04	01	H8552_028_0	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	028	0	1	04	01	H8552_028_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	028	0	1	04	01	H8552_028_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	028	0	1	04	01	H8552_028_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H8552	028	0	1	04	01	H8552_028_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H8554	001	0	1	01	01	H8554_001_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8554	001	0	1	01	01	H8554_001_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8554	001	0	1	01	01	H8554_001_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8554	001	0	1	01	01	H8554_001_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8554	001	0	1	01	01	H8554_001_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8554	001	0	1	01	01	H8554_001_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8554	001	0	1	01	01	H8554_001_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											684.82	33		33				702.27	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8554	002	0	1	01	01	H8554_002_0	8	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8554	002	0	1	01	01	H8554_002_0	8	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8554	002	0	1	01	01	H8554_002_0	8	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8554	002	0	1	01	01	H8554_002_0	8	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													57.00						24.00				19.00				19.00			0.63	0.27				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8554	002	0	1	01	01	H8554_002_0	8	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8554	002	0	1	01	01	H8554_002_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8554	002	0	1	01	01	H8554_002_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											565.32	33		33				562.85	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	001	0	1	01	01	H8578_001_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	001	0	1	01	01	H8578_001_0	5	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8578	001	0	1	01	01	H8578_001_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	001	0	1	01	01	H8578_001_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	001	0	1	01	01	H8578_001_0	5	Non-Preferred Brand	4	10	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	001	0	1	01	01	H8578_001_0	5	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	004	0	1	01	01	H8578_004_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	004	0	1	01	01	H8578_004_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	004	0	1	01	01	H8578_004_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	004	0	1	01	01	H8578_004_0	5	Non-Preferred Brand	4	10	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	004	0	1	01	01	H8578_004_0	5	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	012	0	1	01	01	H8578_012_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	012	0	1	01	01	H8578_012_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	012	0	1	01	01	H8578_012_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	012	0	1	01	01	H8578_012_0	5	Non-Preferred Brand	4	10	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8578	012	0	1	01	01	H8578_012_0	5	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1.00	26																																					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8604	010	0	1	04	01	H8604_010_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	010	0	1	04	01	H8604_010_0	6	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	010	0	1	04	01	H8604_010_0	6	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	010	0	1	04	01	H8604_010_0	6	Non-Preferred Drug	4	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	010	0	1	04	01	H8604_010_0	6	Specialty Tier	4	10	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	011	0	1	04	01	H8604_011_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	011	0	1	04	01	H8604_011_0	6	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	011	0	1	04	01	H8604_011_0	6	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	011	0	1	04	01	H8604_011_0	6	Non-Preferred Drug	4	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	011	0	1	04	01	H8604_011_0	6	Specialty Tier	4	10	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	013	0	1	04	01	H8604_013_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	013	0	1	04	01	H8604_013_0	6	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	013	0	1	04	01	H8604_013_0	6	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	013	0	1	04	01	H8604_013_0	6	Non-Preferred Drug	4	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8604	013	0	1	04	01	H8604_013_0	6	Specialty Tier	4	10	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8634	002	0	1	04	01	H8634_002_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	002	0	1	04	01	H8634_002_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8634	002	0	1	04	01	H8634_002_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	002	0	1	04	01	H8634_002_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8634	002	0	1	04	01	H8634_002_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	002	0	1	04	01	H8634_002_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	002	0	1	04	01	H8634_002_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											570.79	25		25				615.21	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	003	0	1	04	01	H8634_003_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	003	0	1	04	01	H8634_003_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8634	003	0	1	04	01	H8634_003_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	003	0	1	04	01	H8634_003_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8634	003	0	1	04	01	H8634_003_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	003	0	1	04	01	H8634_003_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	003	0	1	04	01	H8634_003_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											611.99	33		33				616.34	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	004	0	1	04	01	H8634_004_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	004	0	1	04	01	H8634_004_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8634	004	0	1	04	01	H8634_004_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	004	0	1	04	01	H8634_004_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.47				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8634	004	0	1	04	01	H8634_004_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	004	0	1	04	01	H8634_004_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					95.00		285.00													300.00						285.00				100.00				100.00			3.33	3.17				3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8634	004	0	1	04	01	H8634_004_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											527.74	33		33				575.36	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8649	003	0	1	01	01	H8649_003_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8649	003	0	1	01	01	H8649_003_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H8649	003	0	1	01	01	H8649_003_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8649	003	0	1	01	01	H8649_003_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H8649	003	0	1	01	01	H8649_003_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8649	003	0	1	01	01	H8649_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8649	003	0	1	01	01	H8649_003_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8649	008	0	1	01	01	H8649_008_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8649	008	0	1	01	01	H8649_008_0	3	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H8649	008	0	1	01	01	H8649_008_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8649	008	0	1	01	01	H8649_008_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	21.00																			7.00	14.00	16.00																	7.00			7.00		0.23			0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H8649	008	0	1	01	01	H8649_008_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	136.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8649	008	0	1	01	01	H8649_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8649	008	0	1	01	01	H8649_008_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	30																				30																		30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8677	001	0	1	48	05	H8677_001_0	6	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	001	0	1	48	05	H8677_001_0	6	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	001	0	1	48	05	H8677_001_0	6	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	7	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	7	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	7	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8748	002	0	1	01	01	H8748_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	002	0	1	01	01	H8748_002_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	002	0	1	01	01	H8748_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	002	0	1	01	01	H8748_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	002	0	1	01	01	H8748_002_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				964.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	008	0	1	02	01	H8748_008_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	008	0	1	02	01	H8748_008_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	008	0	1	02	01	H8748_008_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	008	0	1	02	01	H8748_008_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	008	0	1	02	01	H8748_008_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				823.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	009	0	1	02	01	H8748_009_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	009	0	1	02	01	H8748_009_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	009	0	1	02	01	H8748_009_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	009	0	1	02	01	H8748_009_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	009	0	1	02	01	H8748_009_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				905.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	010	0	1	02	01	H8748_010_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	010	0	1	02	01	H8748_010_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	010	0	1	02	01	H8748_010_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	010	0	1	02	01	H8748_010_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	010	0	1	02	01	H8748_010_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				817.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	011	0	1	02	01	H8748_011_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	011	0	1	02	01	H8748_011_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	011	0	1	02	01	H8748_011_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	011	0	1	02	01	H8748_011_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	011	0	1	02	01	H8748_011_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				905.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	012	0	1	01	01	H8748_012_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	012	0	1	01	01	H8748_012_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	012	0	1	01	01	H8748_012_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	012	0	1	01	01	H8748_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	012	0	1	01	01	H8748_012_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				949.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	013	0	1	01	01	H8748_013_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	013	0	1	01	01	H8748_013_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	013	0	1	01	01	H8748_013_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	013	0	1	01	01	H8748_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	013	0	1	01	01	H8748_013_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				944.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	014	0	1	01	01	H8748_014_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	014	0	1	01	01	H8748_014_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	014	0	1	01	01	H8748_014_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	014	0	1	01	01	H8748_014_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	014	0	1	01	01	H8748_014_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				945.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	015	0	1	01	01	H8748_015_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	015	0	1	01	01	H8748_015_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	015	0	1	01	01	H8748_015_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	015	0	1	01	01	H8748_015_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	015	0	1	01	01	H8748_015_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				944.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	017	0	1	01	01	H8748_017_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	017	0	1	01	01	H8748_017_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	017	0	1	01	01	H8748_017_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	017	0	1	01	01	H8748_017_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	017	0	1	01	01	H8748_017_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				944.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	018	0	1	01	01	H8748_018_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	018	0	1	01	01	H8748_018_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	018	0	1	01	01	H8748_018_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	018	0	1	01	01	H8748_018_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	018	0	1	01	01	H8748_018_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				948.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	020	0	1	01	01	H8748_020_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	020	0	1	01	01	H8748_020_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	020	0	1	01	01	H8748_020_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	020	0	1	01	01	H8748_020_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	020	0	1	01	01	H8748_020_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				944.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	022	0	1	02	01	H8748_022_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	022	0	1	02	01	H8748_022_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	022	0	1	02	01	H8748_022_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	022	0	1	02	01	H8748_022_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	022	0	1	02	01	H8748_022_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				817.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	023	0	1	02	01	H8748_023_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	023	0	1	02	01	H8748_023_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	023	0	1	02	01	H8748_023_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	023	0	1	02	01	H8748_023_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8748	023	0	1	02	01	H8748_023_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				906.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8764	001	0	1	01	01	H8764_001_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		4.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	001	0	1	01	01	H8764_001_0	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	2.00		4.00																					4.00																2.00				2.00		0.07						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8764	001	0	1	01	01	H8764_001_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		16.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	001	0	1	01	01	H8764_001_0	7	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	8.00		16.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8764	001	0	1	01	01	H8764_001_0	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	001	0	1	01	01	H8764_001_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		190.00																					190.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	001	0	1	01	01	H8764_001_0	7	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					30		30																				30															30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	002	0	1	02	01	H8764_002_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	002	0	1	02	01	H8764_002_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8764	002	0	1	02	01	H8764_002_0	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		16.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	002	0	1	02	01	H8764_002_0	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	8.00		16.00																					16.00																8.00				8.00		0.27						0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H8764	002	0	1	02	01	H8764_002_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	42.00		84.00																					84.00																42.00				42.00		1.40						1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	002	0	1	02	01	H8764_002_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		180.00																					180.00																90.00				90.00		3.00						2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	002	0	1	02	01	H8764_002_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	003	0	1	01	01	H8764_003_0	8	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		6.00																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	003	0	1	01	01	H8764_003_0	8	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	13.00		26.00																					26.00																13.00				13.00		0.43						0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	003	0	1	01	01	H8764_003_0	8	Preferred Brand	3	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		94.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	003	0	1	01	01	H8764_003_0	8	Non-Preferred Brand	3	10	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				71.20	50		50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8764	003	0	1	01	01	H8764_003_0	8	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				965.12	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H8768	001	0	1	04	01	H8768_001_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	001	0	1	04	01	H8768_001_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	001	0	1	04	01	H8768_001_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	001	0	1	04	01	H8768_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	001	0	1	04	01	H8768_001_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				501.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	002	0	1	04	01	H8768_002_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	002	0	1	04	01	H8768_002_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	002	0	1	04	01	H8768_002_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	002	0	1	04	01	H8768_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	002	0	1	04	01	H8768_002_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				513.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	003	0	1	04	01	H8768_003_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	003	0	1	04	01	H8768_003_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	003	0	1	04	01	H8768_003_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	003	0	1	04	01	H8768_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	003	0	1	04	01	H8768_003_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				681.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	004	0	1	04	01	H8768_004_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	004	0	1	04	01	H8768_004_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	004	0	1	04	01	H8768_004_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	004	0	1	04	01	H8768_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8768	004	0	1	04	01	H8768_004_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				681.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8786	001	0	1	48	05	H8786_001_0	5	Generic Drugs	4	11			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																														0.00			0.00			0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8786	001	0	1	48	05	H8786_001_0	5	Brand Drugs	4	11			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	1	0.00	8.35			0.00	8.35	0.00	8.35			
H8786	001	0	1	48	05	H8786_001_0	5	Non-Medicare Rx Drugs	4	11			3	1	010		10			1	31															10	31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H8786	001	0	1	48	05	H8786_001_0	5	Non-Medicare OTC Drugs	4	11			4	1	010		10			1	31															10	31																																														0.00						0.00		Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H8851	001	0	1	48	05	H8851_001_0	2	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8851	001	0	1	48	05	H8851_001_0	2	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8851	001	0	1	48	05	H8851_001_0	2	Non-Medicare Rx Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8851	001	0	1	48	05	H8851_001_0	2	Non-Medicare OTC Drugs	4	11			4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8854	001	0	1	01	01	H8854_001_0	8	Preferred Generic	4	01	1	2	1	1	110		10	110		1	30		90				1	1	30		90					10	31	4.00		12.00																			4.00		12.00																	4.00			4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8854	001	0	1	01	01	H8854_001_0	8	Generic	4	01	1	2	2	1	110		10	110		1	30		90				1	1	30		90					10	31	15.00		45.00																			15.00		45.00																	15.00			15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8854	001	0	1	01	01	H8854_001_0	8	Preferred Brand	4	11	1	2	3	1	110		10	110		1	30		90				1	1	30		90					10	31	47.00		141.00																			47.00		141.00																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8854	001	0	1	01	01	H8854_001_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		10	110		1	30		90				1	1	30		90					10	31	100.00		300.00																			100.00		300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8854	001	0	1	01	01	H8854_001_0	8	Specialty Tier	4	11	1	1	5	1	110		10	110		1	30		90				1	1	30		90					10	31				198.00	33		33																		33		33																33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	001	0	1	01	01	H8908_001_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	001	0	1	01	01	H8908_001_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	001	0	1	01	01	H8908_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	001	0	1	01	01	H8908_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	001	0	1	01	01	H8908_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	002	0	1	01	01	H8908_002_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	002	0	1	01	01	H8908_002_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	002	0	1	01	01	H8908_002_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	002	0	1	01	01	H8908_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	002	0	1	01	01	H8908_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	004	0	1	01	01	H8908_004_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	004	0	1	01	01	H8908_004_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	004	0	1	01	01	H8908_004_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	004	0	1	01	01	H8908_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H8908	004	0	1	01	01	H8908_004_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9001	013	0	1	02	01	H9001_013_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	013	0	1	02	01	H9001_013_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	013	0	1	02	01	H9001_013_0	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	013	0	1	02	01	H9001_013_0	6	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	013	0	1	02	01	H9001_013_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	015	0	1	01	01	H9001_015_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	015	0	1	01	01	H9001_015_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	015	0	1	01	01	H9001_015_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	015	0	1	01	01	H9001_015_0	7	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	015	0	1	01	01	H9001_015_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	1	1	01	01	H9001_030_1	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	1	1	01	01	H9001_030_1	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	1	1	01	01	H9001_030_1	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	1	1	01	01	H9001_030_1	6	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	1	1	01	01	H9001_030_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	2	1	01	01	H9001_030_2	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	2	1	01	01	H9001_030_2	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	2	1	01	01	H9001_030_2	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	2	1	01	01	H9001_030_2	6	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	2	1	01	01	H9001_030_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	4	1	01	01	H9001_030_4	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	4	1	01	01	H9001_030_4	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	4	1	01	01	H9001_030_4	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	4	1	01	01	H9001_030_4	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	4	1	01	01	H9001_030_4	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	5	1	01	01	H9001_030_5	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	5	1	01	01	H9001_030_5	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	5	1	01	01	H9001_030_5	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	5	1	01	01	H9001_030_5	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	5	1	01	01	H9001_030_5	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	7	1	01	01	H9001_030_7	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	7	1	01	01	H9001_030_7	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	7	1	01	01	H9001_030_7	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	7	1	01	01	H9001_030_7	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	030	7	1	01	01	H9001_030_7	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	1	1	01	01	H9001_031_1	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	1	1	01	01	H9001_031_1	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	1	1	01	01	H9001_031_1	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	1	1	01	01	H9001_031_1	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	1	1	01	01	H9001_031_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	2	1	01	01	H9001_031_2	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	2	1	01	01	H9001_031_2	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	2	1	01	01	H9001_031_2	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	2	1	01	01	H9001_031_2	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	2	1	01	01	H9001_031_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	4	1	01	01	H9001_031_4	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	4	1	01	01	H9001_031_4	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	4	1	01	01	H9001_031_4	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	4	1	01	01	H9001_031_4	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	4	1	01	01	H9001_031_4	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	6	1	01	01	H9001_031_6	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	6	1	01	01	H9001_031_6	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	6	1	01	01	H9001_031_6	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	6	1	01	01	H9001_031_6	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	6	1	01	01	H9001_031_6	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	7	1	01	01	H9001_031_7	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	7	1	01	01	H9001_031_7	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	7	1	01	01	H9001_031_7	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	7	1	01	01	H9001_031_7	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	031	7	1	01	01	H9001_031_7	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	1	1	01	01	H9001_032_1	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				2.00				2.00			0.23	0.07		0.23	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	1	1	01	01	H9001_032_1	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	27.00				9.00				9.00			0.47	0.30		0.47	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	1	1	01	01	H9001_032_1	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	1	1	01	01	H9001_032_1	6	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	1	1	01	01	H9001_032_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	2	1	01	01	H9001_032_2	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				2.00				2.00			0.23	0.07		0.23	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	2	1	01	01	H9001_032_2	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	27.00				9.00				9.00			0.47	0.30		0.47	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	2	1	01	01	H9001_032_2	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	2	1	01	01	H9001_032_2	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	2	1	01	01	H9001_032_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	4	1	01	01	H9001_032_4	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				2.00				2.00			0.23	0.07		0.23	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	4	1	01	01	H9001_032_4	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	27.00				9.00				9.00			0.47	0.30		0.47	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	4	1	01	01	H9001_032_4	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	4	1	01	01	H9001_032_4	6	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	4	1	01	01	H9001_032_4	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	5	1	01	01	H9001_032_5	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				2.00				2.00			0.23	0.07		0.23	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	5	1	01	01	H9001_032_5	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	27.00				9.00				9.00			0.47	0.30		0.47	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	5	1	01	01	H9001_032_5	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	5	1	01	01	H9001_032_5	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	5	1	01	01	H9001_032_5	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	6	1	01	01	H9001_032_6	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				2.00				2.00			0.23	0.07		0.23	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	6	1	01	01	H9001_032_6	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	27.00				9.00				9.00			0.47	0.30		0.47	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	6	1	01	01	H9001_032_6	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	6	1	01	01	H9001_032_6	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	6	1	01	01	H9001_032_6	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	7	1	01	01	H9001_032_7	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				2.00				2.00			0.23	0.07		0.23	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	7	1	01	01	H9001_032_7	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	27.00				9.00				9.00			0.47	0.30		0.47	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	7	1	01	01	H9001_032_7	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	7	1	01	01	H9001_032_7	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	032	7	1	01	01	H9001_032_7	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	033	0	1	02	01	H9001_033_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	033	0	1	02	01	H9001_033_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	033	0	1	02	01	H9001_033_0	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	033	0	1	02	01	H9001_033_0	6	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	033	0	1	02	01	H9001_033_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	1	1	01	01	H9001_034_1	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	1	1	01	01	H9001_034_1	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	1	1	01	01	H9001_034_1	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	1	1	01	01	H9001_034_1	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	1	1	01	01	H9001_034_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	2	1	01	01	H9001_034_2	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	2	1	01	01	H9001_034_2	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	2	1	01	01	H9001_034_2	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	2	1	01	01	H9001_034_2	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	2	1	01	01	H9001_034_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	5	1	01	01	H9001_034_5	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	5	1	01	01	H9001_034_5	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	5	1	01	01	H9001_034_5	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	5	1	01	01	H9001_034_5	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	5	1	01	01	H9001_034_5	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	6	1	01	01	H9001_034_6	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				1.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	6	1	01	01	H9001_034_6	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	6	1	01	01	H9001_034_6	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	6	1	01	01	H9001_034_6	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9001	034	6	1	01	01	H9001_034_6	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9003	001	0	1	01	01	H9003_001_0	11	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	001	0	1	01	01	H9003_001_0	11	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H9003	001	0	1	01	01	H9003_001_0	11	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	001	0	1	01	01	H9003_001_0	11	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H9003	001	0	1	01	01	H9003_001_0	11	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	001	0	1	01	01	H9003_001_0	11	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	001	0	1	01	01	H9003_001_0	11	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				2067.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	001	0	1	01	01	H9003_001_0	11	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	001	0	1	01	01	H9003_001_0	11	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H9003	006	0	1	01	01	H9003_006_0	12	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	006	0	1	01	01	H9003_006_0	12	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H9003	006	0	1	01	01	H9003_006_0	12	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	006	0	1	01	01	H9003_006_0	12	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H9003	006	0	1	01	01	H9003_006_0	12	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	006	0	1	01	01	H9003_006_0	12	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	006	0	1	01	01	H9003_006_0	12	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				2003.00	33		33																		33		33															33			33								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	006	0	1	01	01	H9003_006_0	12	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines													
H9003	006	0	1	01	01	H9003_006_0	12	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines											1		
H9047	001	0	1	01	01	H9047_001_0	10	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								12.00	24.00	36.00					6.00	12.00	14.40					6.00	12.00	14.40																12.00				12.00			0.40	0.20	0.20			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	001	0	1	01	01	H9047_001_0	10	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	36.00					15.00	30.00	36.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	001	0	1	01	01	H9047_001_0	10	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								45.00	90.00	135.00					45.00	90.00	108.00					45.00	90.00	108.00																45.00				45.00			1.50	1.50	1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	001	0	1	01	01	H9047_001_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											76.84	25	25	25				73.19	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	001	0	1	01	01	H9047_001_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											2132.29	33						1715.83	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	013	0	2	01	01	H9047_013_0	11	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								12.00	24.00	36.00					6.00	12.00	14.40					6.00	12.00	14.40																12.00				12.00			0.40	0.20	0.20			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	013	0	2	01	01	H9047_013_0	11	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	36.00					15.00	30.00	36.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	013	0	2	01	01	H9047_013_0	11	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								45.00	90.00	135.00					45.00	90.00	108.00					45.00	90.00	108.00																45.00				45.00			1.50	1.50	1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	013	0	2	01	01	H9047_013_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											84.47	25	25	25				67.58	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	013	0	2	01	01	H9047_013_0	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											3200.22	33						2255.95	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	024	0	1	02	01	H9047_024_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								14.00	28.00	42.00					7.00	14.00	16.80					7.00	14.00	16.80																14.00				14.00			0.47	0.23	0.23			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	024	0	1	02	01	H9047_024_0	9	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					18.00	36.00	43.20					18.00	36.00	43.20																20.00				20.00			0.67	0.60	0.60			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	024	0	1	02	01	H9047_024_0	9	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	112.80					47.00	94.00	112.80																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	024	0	1	02	01	H9047_024_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	240.00					100.00	200.00	240.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	024	0	1	02	01	H9047_024_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											2595.90	28						2116.25	28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	037	0	1	02	01	H9047_037_0	12	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								16.00	32.00	48.00					8.00	16.00	19.20					8.00	16.00	19.20																16.00				16.00			0.53	0.27	0.27			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	037	0	1	02	01	H9047_037_0	12	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					18.00	36.00	43.20					18.00	36.00	43.20																20.00				20.00			0.67	0.60	0.60			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	037	0	1	02	01	H9047_037_0	12	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	112.80					47.00	94.00	112.80																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	037	0	1	02	01	H9047_037_0	12	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	240.00					100.00	200.00	240.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	037	0	1	02	01	H9047_037_0	12	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											2300.62	27						1814.52	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	038	0	1	02	01	H9047_038_0	10	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								10.00	20.00	30.00					4.00	8.00	9.60					4.00	8.00	9.60																10.00				10.00			0.33	0.13	0.13			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	038	0	1	02	01	H9047_038_0	10	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	28.80					12.00	24.00	28.80																20.00				20.00			0.67	0.40	0.40			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	038	0	1	02	01	H9047_038_0	10	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								45.00	90.00	135.00					45.00	90.00	108.00					45.00	90.00	108.00																45.00				45.00			1.50	1.50	1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	038	0	1	02	01	H9047_038_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											66.94	25	25	25				64.80	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	038	0	1	02	01	H9047_038_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											3484.96	33						2017.91	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	039	0	1	02	01	H9047_039_0	10	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								12.00	24.00	36.00					10.00	20.00	24.00					10.00	20.00	24.00																12.00				12.00			0.40	0.33	0.33			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	039	0	1	02	01	H9047_039_0	10	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					18.00	36.00	43.20					18.00	36.00	43.20																20.00				20.00			0.67	0.60	0.60			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	039	0	1	02	01	H9047_039_0	10	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	112.80					47.00	94.00	112.80																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	039	0	1	02	01	H9047_039_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											66.28	25	25	25				63.46	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	039	0	1	02	01	H9047_039_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											2287.51	28						1215.03	28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	045	0	1	01	01	H9047_045_0	12	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								14.00	28.00	42.00					7.00	14.00	16.80					7.00	14.00	16.80																14.00				14.00			0.47	0.23	0.23			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	045	0	1	01	01	H9047_045_0	12	Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					18.00	36.00	43.20					18.00	36.00	43.20																20.00				20.00			0.67	0.60	0.60			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	045	0	1	01	01	H9047_045_0	12	Preferred Brand	3	10	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	112.80					47.00	94.00	112.80																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	045	0	1	01	01	H9047_045_0	12	Non-Preferred Drug	3	11	1	2	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	240.00					100.00	200.00	240.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	045	0	1	01	01	H9047_045_0	12	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											2011.76	26						1674.21	26						26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	047	0	1	02	01	H9047_047_0	10	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								14.00	28.00	42.00					7.00	14.00	16.80					7.00	14.00	16.80																14.00				14.00			0.47	0.23	0.23			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	047	0	1	02	01	H9047_047_0	10	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					18.00	36.00	43.20					18.00	36.00	43.20																20.00				20.00			0.67	0.60	0.60			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	047	0	1	02	01	H9047_047_0	10	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	112.80					47.00	94.00	112.80																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	047	0	1	02	01	H9047_047_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	240.00					100.00	200.00	240.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	047	0	1	02	01	H9047_047_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											2176.25	28						1808.84	28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	049	0	1	01	01	H9047_049_0	15	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								16.00	32.00	48.00					8.00	16.00	19.20					8.00	16.00	19.20																16.00				16.00			0.53	0.27	0.27			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	049	0	1	01	01	H9047_049_0	15	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					18.00	36.00	43.20					18.00	36.00	43.20																20.00				20.00			0.67	0.60	0.60			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	049	0	1	01	01	H9047_049_0	15	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	112.80					47.00	94.00	112.80																47.00				47.00			1.57	1.57	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	049	0	1	01	01	H9047_049_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	240.00					100.00	200.00	240.00																100.00				100.00			3.33	3.33	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9047	049	0	1	01	01	H9047_049_0	15	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											2295.11	27						1816.01	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9082	007	0	1	01	01	H9082_007_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9082	007	0	1	01	01	H9082_007_0	5	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9082	007	0	1	01	01	H9082_007_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.48			1.48			1.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9082	007	0	1	01	01	H9082_007_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				89.03	50	50	50																		50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9082	007	0	1	01	01	H9082_007_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9082	008	0	1	01	01	H9082_008_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								8.00	16.00	24.00					3.00	6.00	9.00					8.00	16.00	16.00																8.00				8.00			0.26	0.10	0.26			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9082	008	0	1	01	01	H9082_008_0	6	Preferred Generic	4	01	1	2	1	3		111	01	111		1				31	60	90	1	2	31	60	90				31		31								8.00	16.00	24.00					3.00	6.00	9.00					8.00	16.00	16.00																8.00				8.00			0.26	0.10	0.26			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H9082	008	0	1	01	01	H9082_008_0	6	Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								16.00	32.00	48.00					11.00	22.00	33.00					16.00	32.00	32.00																16.00				16.00			0.52	0.35	0.52			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9082	008	0	1	01	01	H9082_008_0	6	Generic	4	01	1	2	2	3		111	01	111		1				31	60	90	1	2	31	60	90				31		31								16.00	32.00	48.00					11.00	22.00	33.00					16.00	32.00	32.00																16.00				16.00			0.52	0.35	0.52			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H9082	008	0	1	01	01	H9082_008_0	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	94.00																47.00				47.00			1.52	1.19	1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9082	008	0	1	01	01	H9082_008_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.23	3.23	3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9082	008	0	1	01	01	H9082_008_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9096	001	0	1	01	01	H9096_001_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	6.00	12.00	12.00																			6.00	12.00	12.00																	6.00			6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	001	0	1	01	01	H9096_001_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	14.00	28.00	28.00																			14.00	28.00	28.00																	14.00			14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	001	0	1	01	01	H9096_001_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47.00	94.00	117.50																			47.00	94.00	117.50																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	001	0	1	01	01	H9096_001_0	5	Non-Preferred Brand	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	001	0	1	01	01	H9096_001_0	5	Specialty Tier	4	10	1	1	5	1	010		10			1	30															29	31					26																																						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	002	0	1	01	01	H9096_002_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	3.00	6.00	6.00																			3.00	6.00	6.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	002	0	1	01	01	H9096_002_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	10.00	20.00	20.00																			10.00	20.00	20.00																	10.00			10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	002	0	1	01	01	H9096_002_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47.00	94.00	117.50																			47.00	94.00	117.50																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	002	0	1	01	01	H9096_002_0	5	Non-Preferred Brand	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	002	0	1	01	01	H9096_002_0	5	Specialty Tier	4	10	1	1	5	1	010		10			1	30															29	31					29																																						29		29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	003	0	1	02	01	H9096_003_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	3.00	6.00	6.00																			3.00	6.00	6.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	003	0	1	02	01	H9096_003_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	8.00	16.00	16.00																			8.00	16.00	16.00																	8.00			8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	003	0	1	02	01	H9096_003_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47.00	94.00	117.50																			47.00	94.00	117.50																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	003	0	1	02	01	H9096_003_0	5	Non-Preferred Brand	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	003	0	1	02	01	H9096_003_0	5	Specialty Tier	4	10	1	1	5	1	010		10			1	30															29	31					33																																						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	004	0	1	01	01	H9096_004_0	5	Preferred Generic	3	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	6.00	12.00	12.00																			6.00	12.00	12.00																	6.00			6.00		0.20			0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	004	0	1	01	01	H9096_004_0	5	Generic	3	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	14.00	28.00	28.00																			14.00	28.00	28.00																	14.00			14.00		0.47			0.47			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	004	0	1	01	01	H9096_004_0	5	Preferred Brand	3	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47.00	94.00	117.50																			47.00	94.00	117.50																	47.00			47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	004	0	1	01	01	H9096_004_0	5	Non-Preferred Brand	3	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	004	0	1	01	01	H9096_004_0	5	Specialty Tier	3	10	1	1	5	1	010		10			1	30															29	31					25																																						25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	005	0	1	01	01	H9096_005_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	3.00	6.00	6.00																			3.00	6.00	6.00																	3.00			3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	005	0	1	01	01	H9096_005_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	8.00	16.00	16.00																			8.00	16.00	16.00																	8.00			8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	005	0	1	01	01	H9096_005_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	005	0	1	01	01	H9096_005_0	5	Non-Preferred Brand	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9096	005	0	1	01	01	H9096_005_0	5	Specialty Tier	4	10	1	1	5	1	010		10			1	30															29	31					33																																						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9104	006	0	1	01	01	H9104_006_0	4	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	9.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9104	006	0	1	01	01	H9104_006_0	4	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	9.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H9104	006	0	1	01	01	H9104_006_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9104	006	0	1	01	01	H9104_006_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9104	006	0	1	01	01	H9104_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9104	006	0	1	01	01	H9104_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9115	001	0	1	48	05	H9115_001_0	3	Generic Drugs	4	01			1	1	110		10	110		1	30		90				1	2	30		90					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9115	001	0	1	48	05	H9115_001_0	3	Brand Drugs	4	10			2	1	110		10	110		1	30		90				1	2	30		90					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9115	001	0	1	48	05	H9115_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		10	110		1	30		90				1	2	30		90					10	31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9190	006	0	1	01	01	H9190_006_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	006	0	1	01	01	H9190_006_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	006	0	1	01	01	H9190_006_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	006	0	1	01	01	H9190_006_0	5	Non-Preferred Drug	4	10	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	006	0	1	01	01	H9190_006_0	5	Specialty Tier	4	11	1	1	5	1	111		01			1	30	60	90				1	1							30		31					28	28	28																																			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	012	0	1	01	01	H9190_012_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	012	0	1	01	01	H9190_012_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	012	0	1	01	01	H9190_012_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	012	0	1	01	01	H9190_012_0	5	Non-Preferred Drug	4	10	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	012	0	1	01	01	H9190_012_0	5	Specialty Tier	4	11	1	1	5	1	111		01			1	30	60	90				1	1							30		31					28	28	28																																			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	018	0	1	01	01	H9190_018_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	018	0	1	01	01	H9190_018_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	018	0	1	01	01	H9190_018_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	018	0	1	01	01	H9190_018_0	5	Non-Preferred Drug	4	10	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	018	0	1	01	01	H9190_018_0	5	Specialty Tier	4	11	1	1	5	1	111		01			1	30	60	90				1	1							30		31					28	28	28																																			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	019	0	1	01	01	H9190_019_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	1.00	2.00	3.00																					3.00																1.00				1.00		0.03						0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	019	0	1	01	01	H9190_019_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	16.00	32.00	48.00																					48.00																16.00				16.00		0.53						0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	019	0	1	01	01	H9190_019_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	019	0	1	01	01	H9190_019_0	5	Non-Preferred Drug	4	10	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	019	0	1	01	01	H9190_019_0	5	Specialty Tier	4	11	1	1	5	1	111		01			1	30	60	90				1	1							30		31					29	29	29																																			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	020	0	1	01	01	H9190_020_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	1.00	2.00	3.00																					3.00																1.00				1.00		0.03						0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	020	0	1	01	01	H9190_020_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	16.00	32.00	48.00																					48.00																16.00				16.00		0.53						0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	020	0	1	01	01	H9190_020_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	020	0	1	01	01	H9190_020_0	5	Non-Preferred Drug	4	10	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	020	0	1	01	01	H9190_020_0	5	Specialty Tier	4	11	1	1	5	1	111		01			1	30	60	90				1	1							30		31					29	29	29																																			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	021	0	1	01	01	H9190_021_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	1.00	2.00	3.00																					3.00																1.00				1.00		0.03						0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	021	0	1	01	01	H9190_021_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	16.00	32.00	48.00																					48.00																16.00				16.00		0.53						0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	021	0	1	01	01	H9190_021_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	021	0	1	01	01	H9190_021_0	5	Non-Preferred Drug	4	10	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9190	021	0	1	01	01	H9190_021_0	5	Specialty Tier	4	11	1	1	5	1	111		01			1	30	60	90				1	1							30		31					29	29	29																																			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	002	0	1	01	01	H9207_002_0	7	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	7.00	14.00	14.00																					14.00																7.00				7.00		0.23						0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	002	0	1	01	01	H9207_002_0	7	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	002	0	1	01	01	H9207_002_0	7	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	002	0	1	01	01	H9207_002_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				90.19	29	29	29																				29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	002	0	1	01	01	H9207_002_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1130.01	26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	005	0	1	01	01	H9207_005_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	7.00	14.00	14.00																					14.00																7.00				7.00		0.23						0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	005	0	1	01	01	H9207_005_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	005	0	1	01	01	H9207_005_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	005	0	1	01	01	H9207_005_0	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				89.52	29	29	29																				29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	005	0	1	01	01	H9207_005_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1153.39	26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	007	0	1	01	01	H9207_007_0	6	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	8.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	007	0	1	01	01	H9207_007_0	6	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	007	0	1	01	01	H9207_007_0	6	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	007	0	1	01	01	H9207_007_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				89.57	27	27	27																				27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	007	0	1	01	01	H9207_007_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1542.53	26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	008	0	1	01	01	H9207_008_0	6	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	8.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	008	0	1	01	01	H9207_008_0	6	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	008	0	1	01	01	H9207_008_0	6	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	008	0	1	01	01	H9207_008_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				89.57	27	27	27																				27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	008	0	1	01	01	H9207_008_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1542.53	26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	009	0	1	01	01	H9207_009_0	6	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	8.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	009	0	1	01	01	H9207_009_0	6	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	009	0	1	01	01	H9207_009_0	6	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	009	0	1	01	01	H9207_009_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				89.57	27	27	27																				27															27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	009	0	1	01	01	H9207_009_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1542.53	26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	010	0	1	01	01	H9207_010_0	7	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	7.00	14.00	14.00																					14.00																7.00				7.00		0.23						0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	010	0	1	01	01	H9207_010_0	7	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	010	0	1	01	01	H9207_010_0	7	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	010	0	1	01	01	H9207_010_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				89.91	29	29	29																				29															29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9207	010	0	1	01	01	H9207_010_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1176.72	26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9208	001	0	1	01	01	H9208_001_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	2.00	4.00	5.00																					5.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9208	001	0	1	01	01	H9208_001_0	4	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	12.00	24.00	30.00																					30.00																12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9208	001	0	1	01	01	H9208_001_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9208	001	0	1	01	01	H9208_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				21.04	50	50	50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9208	001	0	1	01	01	H9208_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9208	002	0	1	01	01	H9208_002_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	2.00	4.00	5.00																					5.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9208	002	0	1	01	01	H9208_002_0	4	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	12.00	24.00	30.00																					30.00																12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9208	002	0	1	01	01	H9208_002_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9208	002	0	1	01	01	H9208_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				13.39	50	50	50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9208	002	0	1	01	01	H9208_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9276	001	0	1	01	01	H9276_001_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	001	0	1	01	01	H9276_001_0	3	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	001	0	1	01	01	H9276_001_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	001	0	1	01	01	H9276_001_0	3	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	001	0	1	01	01	H9276_001_0	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	35.00	70.00	105.00																			35.00	70.00	105.00																35.00				35.00		1.17			1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	001	0	1	01	01	H9276_001_0	3	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	001	0	1	01	01	H9276_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	001	0	1	01	01	H9276_001_0	3	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	001	0	1	01	01	H9276_001_0	3	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	002	0	1	01	01	H9276_002_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	002	0	1	01	01	H9276_002_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	002	0	1	01	01	H9276_002_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	002	0	1	01	01	H9276_002_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	270.00																90.00				90.00		3.00			3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	002	0	1	01	01	H9276_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	002	0	1	01	01	H9276_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	003	0	1	01	01	H9276_003_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	003	0	1	01	01	H9276_003_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	003	0	1	01	01	H9276_003_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	003	0	1	01	01	H9276_003_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	003	0	1	01	01	H9276_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	003	0	1	01	01	H9276_003_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	004	0	1	01	01	H9276_004_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	004	0	1	01	01	H9276_004_0	3	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	004	0	1	01	01	H9276_004_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	004	0	1	01	01	H9276_004_0	3	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	004	0	1	01	01	H9276_004_0	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	004	0	1	01	01	H9276_004_0	3	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	35.00	70.00	105.00																			35.00	70.00	105.00																35.00				35.00		1.17			1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	004	0	1	01	01	H9276_004_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	004	0	1	01	01	H9276_004_0	3	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	004	0	1	01	01	H9276_004_0	3	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	005	0	1	01	01	H9276_005_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	005	0	1	01	01	H9276_005_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	005	0	1	01	01	H9276_005_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	005	0	1	01	01	H9276_005_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	60.00	120.00	180.00																			60.00	120.00	180.00																60.00				60.00		2.00			2.00			1.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	005	0	1	01	01	H9276_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	005	0	1	01	01	H9276_005_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	006	0	1	01	01	H9276_006_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	006	0	1	01	01	H9276_006_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	006	0	1	01	01	H9276_006_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	006	0	1	01	01	H9276_006_0	4	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	006	0	1	01	01	H9276_006_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	35.00	70.00	105.00																			35.00	70.00	105.00																35.00				35.00		1.17			1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	006	0	1	01	01	H9276_006_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	006	0	1	01	01	H9276_006_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	006	0	1	01	01	H9276_006_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	006	0	1	01	01	H9276_006_0	4	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	007	0	1	01	01	H9276_007_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	007	0	1	01	01	H9276_007_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	007	0	1	01	01	H9276_007_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	007	0	1	01	01	H9276_007_0	5	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	297.00																99.00				99.00		3.30			3.30			3.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	007	0	1	01	01	H9276_007_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	007	0	1	01	01	H9276_007_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	008	0	1	01	01	H9276_008_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	008	0	1	01	01	H9276_008_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	008	0	1	01	01	H9276_008_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	008	0	1	01	01	H9276_008_0	4	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	008	0	1	01	01	H9276_008_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	35.00	70.00	105.00																			35.00	70.00	105.00																35.00				35.00		1.17			1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	008	0	1	01	01	H9276_008_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	008	0	1	01	01	H9276_008_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	008	0	1	01	01	H9276_008_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	008	0	1	01	01	H9276_008_0	4	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	009	0	1	01	01	H9276_009_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	009	0	1	01	01	H9276_009_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	009	0	1	01	01	H9276_009_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	009	0	1	01	01	H9276_009_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	270.00																90.00				90.00		3.00			3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	009	0	1	01	01	H9276_009_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	009	0	1	01	01	H9276_009_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	010	0	1	01	01	H9276_010_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	010	0	1	01	01	H9276_010_0	4	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	010	0	1	01	01	H9276_010_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	010	0	1	01	01	H9276_010_0	4	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	010	0	1	01	01	H9276_010_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	35.00	70.00	105.00																			35.00	70.00	105.00																35.00				35.00		1.17			1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	010	0	1	01	01	H9276_010_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	010	0	1	01	01	H9276_010_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	010	0	1	01	01	H9276_010_0	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	010	0	1	01	01	H9276_010_0	4	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	011	0	1	01	01	H9276_011_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	011	0	1	01	01	H9276_011_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	011	0	1	01	01	H9276_011_0	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	011	0	1	01	01	H9276_011_0	3	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	270.00																90.00				90.00		3.00			3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	011	0	1	01	01	H9276_011_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	011	0	1	01	01	H9276_011_0	3	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	012	0	1	01	01	H9276_012_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	012	0	1	01	01	H9276_012_0	3	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	012	0	1	01	01	H9276_012_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	012	0	1	01	01	H9276_012_0	3	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	012	0	1	01	01	H9276_012_0	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	012	0	1	01	01	H9276_012_0	3	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	60.00	120.00	180.00																			60.00	120.00	180.00																60.00				60.00		2.00			2.00			1.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	012	0	1	01	01	H9276_012_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	012	0	1	01	01	H9276_012_0	3	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	012	0	1	01	01	H9276_012_0	3	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9276	013	0	1	01	01	H9276_013_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	013	0	1	01	01	H9276_013_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	013	0	1	01	01	H9276_013_0	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	90.00																30.00				30.00		1.00			1.00			0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	013	0	1	01	01	H9276_013_0	3	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	225.00																75.00				75.00		2.50			2.50			2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	013	0	1	01	01	H9276_013_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9276	013	0	1	01	01	H9276_013_0	3	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	001	0	1	01	01	H9287_001_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	001	0	1	01	01	H9287_001_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	18.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	001	0	1	01	01	H9287_001_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	001	0	1	01	01	H9287_001_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	001	0	1	01	01	H9287_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	001	0	1	01	01	H9287_001_0	3	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	004	0	1	01	01	H9287_004_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	12.00																10.00				10.00			0.33	0.17	0.17			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	004	0	1	01	01	H9287_004_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	42.00																20.00				20.00			0.67	0.50	0.50			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	004	0	1	01	01	H9287_004_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	101.00																47.00				47.00			1.57	1.23	1.23			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	004	0	1	01	01	H9287_004_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	260.00																100.00				100.00			3.33	3.00	3.00			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	004	0	1	01	01	H9287_004_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9287	004	0	1	01	01	H9287_004_0	3	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9302	003	0	1	01	01	H9302_003_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	2.00	4.00	5.00																					5.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	003	0	1	01	01	H9302_003_0	4	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	12.00	24.00	30.00																					30.00																12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	003	0	1	01	01	H9302_003_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	003	0	1	01	01	H9302_003_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				47.21	50	50	50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	003	0	1	01	01	H9302_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	007	0	1	01	01	H9302_007_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	2.00	4.00	5.00																					5.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	007	0	1	01	01	H9302_007_0	4	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	12.00	24.00	30.00																					30.00																12.00				12.00		0.39						0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	007	0	1	01	01	H9302_007_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	007	0	1	01	01	H9302_007_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				24.40	50	50	50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	007	0	1	01	01	H9302_007_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	011	0	1	01	01	H9302_011_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	3.00	6.00	7.50																					7.50																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	011	0	1	01	01	H9302_011_0	5	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	14.00	28.00	35.00																					35.00																14.00				14.00		0.45						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	011	0	1	01	01	H9302_011_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.52						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	011	0	1	01	01	H9302_011_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				35.02	50	50	50																				50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9302	011	0	1	01	01	H9302_011_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					30																				30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9312	001	0	1	04	01	H9312_001_0	6	Preferred Generic	4	01	1	2	1	1	110		10	100		1	31		90				1	2			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9312	001	0	1	04	01	H9312_001_0	6	Generic	4	01	1	1	2	1	110		10	100		1	31		90				1	2			90					10	31				11.11	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9312	001	0	1	04	01	H9312_001_0	6	Preferred Brand	4	10	1	1	3	1	110		10	100		1	31		90				1	2			90					10	31				162.81	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9312	001	0	1	04	01	H9312_001_0	6	Non-Preferred Brand	4	10	1	1	4	1	110		10	100		1	31		90				1	2			90					10	31				39.73	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9312	001	0	1	04	01	H9312_001_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	31								30							10	31				1.00	25																				25																		25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9312	002	0	1	04	01	H9312_002_0	6	Preferred Generic	4	01	1	2	1	1	110		10	100		1	31		90				1	2			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9312	002	0	1	04	01	H9312_002_0	6	Generic	4	01	1	1	2	1	110		10	100		1	31		90				1	2			90					10	31				12.28	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9312	002	0	1	04	01	H9312_002_0	6	Preferred Brand	4	10	1	1	3	1	110		10	100		1	31		90				1	2			90					10	31				156.67	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9312	002	0	1	04	01	H9312_002_0	6	Non-Preferred Brand	4	10	1	1	4	1	110		10	100		1	31		90				1	2			90					10	31				27.07	25		25																				25																25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9312	002	0	1	04	01	H9312_002_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	31								30							10	31				1.00	25																				25																		25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9345	001	0	1	48	05	H9345_001_0	3	Generic Drugs	4	01			1	1	111		01	110		1	30	60	90				1	2	30		90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9345	001	0	1	48	05	H9345_001_0	3	Brand Drugs	4	10			2	1	111		01	110		1	30	60	90				1	2	30		90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9345	001	0	1	48	05	H9345_001_0	3	Non-Medicare Rx Drugs	4	11			3	1	111		01	110		1	30	60	90				1	2	30		90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9345	001	0	1	48	05	H9345_001_0	3	Non-Medicare OTC Drugs	4	11			4	1	111		01	110		1	30	60	90				1	2	30		90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9403	003	0	1	01	01	H9403_003_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9403	003	0	1	01	01	H9403_003_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9403	003	0	1	01	01	H9403_003_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9403	003	0	1	01	01	H9403_003_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9403	003	0	1	01	01	H9403_003_0	9	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				720.24	28	28	28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9403	003	0	1	01	01	H9403_003_0	9	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	11.00	22.00	33.00																					22.00																11.00				11.00		0.37						0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9403	004	0	1	01	01	H9403_004_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9403	004	0	1	01	01	H9403_004_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9403	004	0	1	01	01	H9403_004_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9403	004	0	1	01	01	H9403_004_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9403	004	0	1	01	01	H9403_004_0	9	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				750.12	28	28	28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9408	001	0	1	04	01	H9408_001_0	7	Preferred Generic	4	01	1	2	1	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								15.00	26.25	30.00					0.00	0.00	0.00					0.00	0.00	0.00																	15.00			15.00			0.48	0.00	0.00			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	001	0	1	04	01	H9408_001_0	7	Preferred Generic	4	01	1	2	1	3		111	10	111		1				31	60	90	1	2	31	60	90					10	31								15.00	26.25	30.00					0.00	0.00	0.00					0.00	0.00	0.00																	15.00			15.00			0.48	0.00	0.00			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9408	001	0	1	04	01	H9408_001_0	7	Generic	4	01	1	2	2	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								20.00	35.00	40.00					15.00	26.25	30.00					15.00	26.25	30.00																	20.00			20.00			0.65	0.48	0.48			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	001	0	1	04	01	H9408_001_0	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								47.00	82.25	94.00					42.00	73.50	84.00					42.00	73.50	84.00																	47.00			47.00			1.52	1.35	1.35			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	001	0	1	04	01	H9408_001_0	7	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								100.00	175.00	250.00					95.00	166.25	237.50					95.00	166.25	237.50																	100.00			100.00			3.23	3.06	3.06			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	001	0	1	04	01	H9408_001_0	7	Specialty Tier	4	11	1	1	5	1		010	10	010		1				31					31							10	31											750.10	33						750.10	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	001	0	1	04	01	H9408_001_0	7	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								5.00	8.75	10.00					0.00	0.00	0.00					0.00	0.00	0.00																	5.00			5.00			0.16	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	001	0	1	04	01	H9408_001_0	7	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				31	60	90	1	2	31	60	90					10	31								5.00	8.75	10.00					0.00	0.00	0.00					0.00	0.00	0.00																	5.00			5.00			0.16	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9408	002	0	1	04	01	H9408_002_0	6	Preferred Generic	4	01	1	2	1	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								10.00	17.50	20.00					0.00	0.00	0.00					0.00	0.00	0.00																	10.00			10.00			0.32	0.00	0.00			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	002	0	1	04	01	H9408_002_0	6	Preferred Generic	4	01	1	2	1	3		111	10	111		1				31	60	90	1	2	31	60	90					10	31								10.00	17.50	20.00					0.00	0.00	0.00					0.00	0.00	0.00																	10.00			10.00			0.32	0.00	0.00			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9408	002	0	1	04	01	H9408_002_0	6	Generic	4	01	1	2	2	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								15.00	26.25	30.00					10.00	17.50	20.00					10.00	17.50	20.00																	15.00			15.00			0.48	0.32	0.32			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	002	0	1	04	01	H9408_002_0	6	Generic	4	01	1	2	2	3		111	10	111		1				31	60	90	1	2	31	60	90					10	31								15.00	26.25	30.00					10.00	17.50	20.00					10.00	17.50	20.00																	15.00			15.00			0.48	0.32	0.32			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9408	002	0	1	04	01	H9408_002_0	6	Preferred Brand	4	11	1	2	3	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								40.00	70.00	80.00					35.00	61.25	70.00					35.00	61.25	70.00																	40.00			40.00			1.29	1.13	1.13			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	002	0	1	04	01	H9408_002_0	6	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								95.00	166.25	237.50					90.00	157.50	225.00					90.00	157.50	225.00																	95.00			95.00			3.06	2.90	2.90			3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	002	0	1	04	01	H9408_002_0	6	Specialty Tier	4	11	1	1	5	1		010	10	010		1				31					31							10	31											694.21	33						694.21	33						33																		33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	002	0	1	04	01	H9408_002_0	6	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								5.00	8.75	10.00					0.00	0.00	0.00					0.00	0.00	0.00																	5.00			5.00			0.16	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9408	002	0	1	04	01	H9408_002_0	6	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				31	60	90	1	2	31	60	90					10	31								5.00	8.75	10.00					0.00	0.00	0.00					0.00	0.00	0.00																	5.00			5.00			0.16	0.00	0.00			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
H9460	001	0	1	01	01	H9460_001_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	0.00					7.00	14.00	21.00																7.00				7.00			0.23	0.07	0.23			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9460	001	0	1	01	01	H9460_001_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	10.00					10.00	20.00	30.00																10.00				10.00			0.33	0.17	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9460	001	0	1	01	01	H9460_001_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9460	001	0	1	01	01	H9460_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	300.00																100.00				100.00			3.33	3.17	3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9460	001	0	1	01	01	H9460_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											288.31	31						298.91	31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9487	001	0	1	48	05	H9487_001_0	4	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9487	001	0	1	48	05	H9487_001_0	4	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9487	001	0	1	48	05	H9487_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9525	003	0	1	01	01	H9525_003_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	003	0	1	01	01	H9525_003_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					6.00	12.00	18.00					6.00	18.00	18.00																6.00				6.00			0.20	0.20	0.20			0.18		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	003	0	1	01	01	H9525_003_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	003	0	1	01	01	H9525_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	003	0	1	01	01	H9525_003_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	003	0	1	01	01	H9525_003_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	003	0	1	01	01	H9525_003_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H9525	004	0	1	01	01	H9525_004_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	004	0	1	01	01	H9525_004_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	004	0	1	01	01	H9525_004_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	004	0	1	01	01	H9525_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	004	0	1	01	01	H9525_004_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	004	0	1	01	01	H9525_004_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	004	0	1	01	01	H9525_004_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H9525	006	0	1	01	01	H9525_006_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	006	0	1	01	01	H9525_006_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	006	0	1	01	01	H9525_006_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	006	0	1	01	01	H9525_006_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	006	0	1	01	01	H9525_006_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	006	0	1	01	01	H9525_006_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	006	0	1	01	01	H9525_006_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H9525	007	0	1	01	01	H9525_007_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	007	0	1	01	01	H9525_007_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	007	0	1	01	01	H9525_007_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								46.00	92.00	138.00					46.00	92.00	138.00					46.00	138.00	138.00																46.00				46.00			1.53	1.53	1.53			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	007	0	1	01	01	H9525_007_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	007	0	1	01	01	H9525_007_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	007	0	1	01	01	H9525_007_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	007	0	1	01	01	H9525_007_0	8	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H9525	008	0	1	01	01	H9525_008_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	008	0	1	01	01	H9525_008_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								16.00	32.00	48.00					11.00	22.00	33.00					11.00	33.00	33.00																16.00				16.00			0.53	0.37	0.37			0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	008	0	1	01	01	H9525_008_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	008	0	1	01	01	H9525_008_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	008	0	1	01	01	H9525_008_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	008	0	1	01	01	H9525_008_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9525	008	0	1	01	01	H9525_008_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H9572	001	1	1	04	01	H9572_001_1	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		3.00											7.00		21.00				1.00		3.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	1	1	04	01	H9572_001_1	6	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		30.00											18.00		54.00				10.00		30.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	1	1	04	01	H9572_001_1	6	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	1	1	04	01	H9572_001_1	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											46.00	48		48				46.00	48		48										48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	1	1	04	01	H9572_001_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	30						1.00	30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	2	1	04	01	H9572_001_2	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		3.00											7.00		21.00				1.00		3.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	2	1	04	01	H9572_001_2	6	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		30.00											18.00		54.00				10.00		30.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	2	1	04	01	H9572_001_2	6	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	2	1	04	01	H9572_001_2	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											46.00	48		48				46.00	48		48										48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	2	1	04	01	H9572_001_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	30						1.00	30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	3	1	04	01	H9572_001_3	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		3.00											7.00		21.00				1.00		3.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	3	1	04	01	H9572_001_3	6	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		30.00											18.00		54.00				10.00		30.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	3	1	04	01	H9572_001_3	6	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	3	1	04	01	H9572_001_3	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											46.00	48		48				46.00	48		48										48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	3	1	04	01	H9572_001_3	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	30						1.00	30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	4	1	04	01	H9572_001_4	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		3.00											7.00		21.00				1.00		3.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	4	1	04	01	H9572_001_4	6	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		30.00											18.00		54.00				10.00		30.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	4	1	04	01	H9572_001_4	6	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	4	1	04	01	H9572_001_4	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											46.00	48		48				46.00	48		48										48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	4	1	04	01	H9572_001_4	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	30						1.00	30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	6	1	04	01	H9572_001_6	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		3.00											7.00		21.00				1.00		3.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	6	1	04	01	H9572_001_6	6	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		30.00											18.00		54.00				10.00		30.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	6	1	04	01	H9572_001_6	6	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	6	1	04	01	H9572_001_6	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											46.00	48		48				46.00	48		48										48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	001	6	1	04	01	H9572_001_6	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	30						1.00	30												30						30					30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	1	1	04	01	H9572_002_1	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	1	1	04	01	H9572_002_1	7	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	1	1	04	01	H9572_002_1	7	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	1	1	04	01	H9572_002_1	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											54.00	50		50				54.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	1	1	04	01	H9572_002_1	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	2	1	04	01	H9572_002_2	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	2	1	04	01	H9572_002_2	7	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	2	1	04	01	H9572_002_2	7	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	2	1	04	01	H9572_002_2	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											54.00	50		50				54.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	2	1	04	01	H9572_002_2	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	3	1	04	01	H9572_002_3	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	3	1	04	01	H9572_002_3	7	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	3	1	04	01	H9572_002_3	7	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	3	1	04	01	H9572_002_3	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											54.00	50		50				54.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	3	1	04	01	H9572_002_3	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	4	1	04	01	H9572_002_4	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	4	1	04	01	H9572_002_4	7	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	4	1	04	01	H9572_002_4	7	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	4	1	04	01	H9572_002_4	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											54.00	50		50				54.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	4	1	04	01	H9572_002_4	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	6	1	04	01	H9572_002_6	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	6	1	04	01	H9572_002_6	7	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	6	1	04	01	H9572_002_6	7	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	6	1	04	01	H9572_002_6	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											54.00	50		50				54.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	002	6	1	04	01	H9572_002_6	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	1	1	04	01	H9572_003_1	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	1	1	04	01	H9572_003_1	6	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								16.00		48.00					9.00		27.00											16.00		48.00				9.00		27.00				16.00				16.00			0.52	0.29		0.52	0.29	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	1	1	04	01	H9572_003_1	6	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	1	1	04	01	H9572_003_1	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											41.00	45		45				41.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	1	1	04	01	H9572_003_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	2	1	04	01	H9572_003_2	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	2	1	04	01	H9572_003_2	6	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								16.00		48.00					9.00		27.00											16.00		48.00				9.00		27.00				16.00				16.00			0.52	0.29		0.52	0.29	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	2	1	04	01	H9572_003_2	6	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	2	1	04	01	H9572_003_2	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											41.00	45		45				41.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	2	1	04	01	H9572_003_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	3	1	04	01	H9572_003_3	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	3	1	04	01	H9572_003_3	6	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								16.00		48.00					9.00		27.00											16.00		48.00				9.00		27.00				16.00				16.00			0.52	0.29		0.52	0.29	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	3	1	04	01	H9572_003_3	6	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	3	1	04	01	H9572_003_3	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											41.00	45		45				41.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	3	1	04	01	H9572_003_3	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	4	1	04	01	H9572_003_4	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	4	1	04	01	H9572_003_4	6	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								16.00		48.00					9.00		27.00											16.00		48.00				9.00		27.00				16.00				16.00			0.52	0.29		0.52	0.29	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	4	1	04	01	H9572_003_4	6	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	4	1	04	01	H9572_003_4	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											41.00	45		45				41.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	4	1	04	01	H9572_003_4	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	6	1	04	01	H9572_003_6	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	6	1	04	01	H9572_003_6	6	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								16.00		48.00					9.00		27.00											16.00		48.00				9.00		27.00				16.00				16.00			0.52	0.29		0.52	0.29	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	6	1	04	01	H9572_003_6	6	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	6	1	04	01	H9572_003_6	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											41.00	45		45				41.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	003	6	1	04	01	H9572_003_6	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	1	1	04	01	H9572_004_1	6	Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	1	1	04	01	H9572_004_1	6	Generic	3	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	1	1	04	01	H9572_004_1	6	Preferred Brand	3	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	1	1	04	01	H9572_004_1	6	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											60.00	50		50				56.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	1	1	04	01	H9572_004_1	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	2	1	04	01	H9572_004_2	6	Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	2	1	04	01	H9572_004_2	6	Generic	3	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	2	1	04	01	H9572_004_2	6	Preferred Brand	3	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	2	1	04	01	H9572_004_2	6	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											60.00	50		50				56.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	2	1	04	01	H9572_004_2	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	3	1	04	01	H9572_004_3	6	Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	3	1	04	01	H9572_004_3	6	Generic	3	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	3	1	04	01	H9572_004_3	6	Preferred Brand	3	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	3	1	04	01	H9572_004_3	6	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											60.00	50		50				56.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	3	1	04	01	H9572_004_3	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	4	1	04	01	H9572_004_4	6	Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	4	1	04	01	H9572_004_4	6	Generic	3	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	4	1	04	01	H9572_004_4	6	Preferred Brand	3	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	4	1	04	01	H9572_004_4	6	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											60.00	50		50				56.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	4	1	04	01	H9572_004_4	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	6	1	04	01	H9572_004_6	6	Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	6	1	04	01	H9572_004_6	6	Generic	3	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	6	1	04	01	H9572_004_6	6	Preferred Brand	3	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	6	1	04	01	H9572_004_6	6	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											60.00	50		50				56.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9572	004	6	1	04	01	H9572_004_6	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9576	001	0	1	48	05	H9576_001_0	6	Generic Drugs	4	01			1	1	111		01	100		1	30	60	90				2	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9576	001	0	1	48	05	H9576_001_0	6	Brand Drugs	4	10			2	1	111		01	100		1	30	60	90				2	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9576	001	0	1	48	05	H9576_001_0	6	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	100		1	30	60	90				2	2			90				30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9589	001	0	1	04	01	H9589_001_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9589	001	0	1	04	01	H9589_001_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9589	001	0	1	04	01	H9589_001_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9589	001	0	1	04	01	H9589_001_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9589	001	0	1	04	01	H9589_001_0	9	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				721.27	28	28	28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9589	001	0	1	04	01	H9589_001_0	9	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	11.00	22.00	33.00																					22.00																11.00				11.00		0.37						0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9589	003	0	1	04	01	H9589_003_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9589	003	0	1	04	01	H9589_003_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9589	003	0	1	04	01	H9589_003_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9589	003	0	1	04	01	H9589_003_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9589	003	0	1	04	01	H9589_003_0	9	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				748.11	28	28	28																				28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	002	0	1	01	01	H9595_002_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.06			0.06			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	002	0	1	01	01	H9595_002_0	5	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	002	0	1	01	01	H9595_002_0	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	002	0	1	01	01	H9595_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	002	0	1	01	01	H9595_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	003	0	1	01	01	H9595_003_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.06			0.06			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	003	0	1	01	01	H9595_003_0	5	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	003	0	1	01	01	H9595_003_0	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	003	0	1	01	01	H9595_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	003	0	1	01	01	H9595_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					29																				29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	004	0	1	01	01	H9595_004_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.06			0.06			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	004	0	1	01	01	H9595_004_0	5	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	004	0	1	01	01	H9595_004_0	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	004	0	1	01	01	H9595_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9595	004	0	1	01	01	H9595_004_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	007	0	1	04	01	H9615_007_0	9	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	007	0	1	04	01	H9615_007_0	9	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H9615	007	0	1	04	01	H9615_007_0	9	Generic	4	01	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	007	0	1	04	01	H9615_007_0	9	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	007	0	1	04	01	H9615_007_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				80.60	36		36																								36		36				36		36			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	007	0	1	04	01	H9615_007_0	9	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1398.75	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	008	0	1	04	01	H9615_008_0	6	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	008	0	1	04	01	H9615_008_0	6	Generic	4	01	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		22.00				11.00				11.00		0.37				0.37	0.37	0.35	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	008	0	1	04	01	H9615_008_0	6	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	008	0	1	04	01	H9615_008_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				83.64	36		36																								36		36				36		36			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	008	0	1	04	01	H9615_008_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1299.99	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	009	0	1	04	01	H9615_009_0	7	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	009	0	1	04	01	H9615_009_0	7	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H9615	009	0	1	04	01	H9615_009_0	7	Generic	4	01	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	009	0	1	04	01	H9615_009_0	7	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	009	0	1	04	01	H9615_009_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				96.61	36		36																								36		36				36		36			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	009	0	1	04	01	H9615_009_0	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				967.86	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	010	0	1	04	01	H9615_010_0	7	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	010	0	1	04	01	H9615_010_0	7	Generic	4	01	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	11.00		33.00																									33.00		33.00				33.00		22.00				11.00				11.00		0.37				1.10	1.10	0.35	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	010	0	1	04	01	H9615_010_0	7	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	010	0	1	04	01	H9615_010_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				99.48	36		36																								36		36				36		36			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	010	0	1	04	01	H9615_010_0	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				551.37	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	012	0	1	04	01	H9615_012_0	6	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		2.00				1.00				1.00		0.03				0.03	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	012	0	1	04	01	H9615_012_0	6	Generic	4	01	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		24.00				12.00				12.00		0.40				0.40	0.40	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	012	0	1	04	01	H9615_012_0	6	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	012	0	1	04	01	H9615_012_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				88.64	36		36																								36		36				36		36			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9615	012	0	1	04	01	H9615_012_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				804.71	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9630	001	0	1	01	01	H9630_001_0	2	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	001	0	1	01	01	H9630_001_0	2	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	001	0	1	01	01	H9630_001_0	2	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	001	0	1	01	01	H9630_001_0	2	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	001	0	1	01	01	H9630_001_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	001	0	1	01	01	H9630_001_0	2	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	002	0	1	01	01	H9630_002_0	2	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	002	0	1	01	01	H9630_002_0	2	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	002	0	1	01	01	H9630_002_0	2	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	002	0	1	01	01	H9630_002_0	2	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	002	0	1	01	01	H9630_002_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	002	0	1	01	01	H9630_002_0	2	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	003	0	1	01	01	H9630_003_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	003	0	1	01	01	H9630_003_0	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	003	0	1	01	01	H9630_003_0	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	003	0	1	01	01	H9630_003_0	3	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	003	0	1	01	01	H9630_003_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9630	003	0	1	01	01	H9630_003_0	3	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9699	004	1	1	01	01	H9699_004_1	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	1	1	01	01	H9699_004_1	7	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H9699	004	1	1	01	01	H9699_004_1	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		40.00					13.00		26.00					13.00		26.00																20.00				13.00			0.67	0.43	0.43			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	1	1	01	01	H9699_004_1	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		94.00					40.00		80.00					40.00		80.00																47.00				40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	1	1	01	01	H9699_004_1	7	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		200.00					93.00		186.00					93.00		186.00																100.00				93.00			3.33	3.10	3.10			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	1	1	01	01	H9699_004_1	7	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	2	1	01	01	H9699_004_2	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	2	1	01	01	H9699_004_2	7	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H9699	004	2	1	01	01	H9699_004_2	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		40.00					13.00		26.00					13.00		26.00																20.00				13.00			0.67	0.43	0.43			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	2	1	01	01	H9699_004_2	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		94.00					40.00		80.00					40.00		80.00																47.00				40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	2	1	01	01	H9699_004_2	7	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		200.00					93.00		186.00					93.00		186.00																100.00				93.00			3.33	3.10	3.10			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	2	1	01	01	H9699_004_2	7	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	3	1	01	01	H9699_004_3	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	3	1	01	01	H9699_004_3	7	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
H9699	004	3	1	01	01	H9699_004_3	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		40.00					13.00		26.00					13.00		26.00																20.00				13.00			0.67	0.43	0.43			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	3	1	01	01	H9699_004_3	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		94.00					40.00		80.00					40.00		80.00																47.00				40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	3	1	01	01	H9699_004_3	7	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		200.00					93.00		186.00					93.00		186.00																100.00				93.00			3.33	3.10	3.10			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9699	004	3	1	01	01	H9699_004_3	7	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
H9712	001	0	1	48	05	H9712_001_0	7	Generic Drugs	4	11			1	1	010		01			1	30														30		31																																																						Generic Drugs, Brand Drugs	3		0.00	0.00	0.00	0.00			0.00	0.00			
H9712	001	0	1	48	05	H9712_001_0	7	Brand Drugs	4	11			2	1	010		01			1	30														30		31																																																						Generic Drugs, Brand Drugs	3		0.00	0.00	0.00	0.00			0.00	0.00			
H9725	001	0	1	01	01	H9725_001_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	3.00					10.00	20.00	20.00																10.00				10.00			0.33	0.10	0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9725	001	0	1	01	01	H9725_001_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					13.00	26.00	26.00					20.00	40.00	40.00																20.00				20.00			0.67	0.43	0.67			0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9725	001	0	1	01	01	H9725_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																47.00				47.00			1.57	1.40	1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9725	001	0	1	01	01	H9725_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											69.40	50	50	50				62.27	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9725	001	0	1	01	01	H9725_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											351.99	27						327.66	27						27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	002	0	1	01	01	H9730_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	002	0	1	01	01	H9730_002_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	002	0	1	01	01	H9730_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	002	0	1	01	01	H9730_002_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				71.48	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	002	0	1	01	01	H9730_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				691.58	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	003	0	1	01	01	H9730_003_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	003	0	1	01	01	H9730_003_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		5.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	003	0	1	01	01	H9730_003_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		105.00				42.00				42.00		1.40				1.40	1.40	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	003	0	1	01	01	H9730_003_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.23	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	003	0	1	01	01	H9730_003_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				470.33	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	004	0	1	01	01	H9730_004_0	2	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	004	0	1	01	01	H9730_004_0	2	Generic	3	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		5.00				2.00				2.00		0.07				0.07	0.07	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	004	0	1	01	01	H9730_004_0	2	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	43.00		129.00																									43.00		129.00				43.00		107.50				43.00				43.00		1.43				1.43	1.43	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	004	0	1	01	01	H9730_004_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				89.09	50		50																								50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	004	0	1	01	01	H9730_004_0	2	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				474.28	25																										25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	005	0	1	02	01	H9730_005_0	3	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	005	0	1	02	01	H9730_005_0	3	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	005	0	1	02	01	H9730_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	005	0	1	02	01	H9730_005_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				72.69	48		48																								48		48				48		48			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9730	005	0	1	02	01	H9730_005_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				681.98	33																										33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9808	004	0	1	04	01	H9808_004_0	6	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5.00	10.00	10.00																			5.00	10.00	10.00																	5.00			5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9808	004	0	1	04	01	H9808_004_0	6	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	4.00	8.00	8.00																			4.00	8.00	8.00																	4.00			4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H9808	004	0	1	04	01	H9808_004_0	6	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15.00	30.00	30.00																			15.00	30.00	30.00																	15.00			15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9808	004	0	1	04	01	H9808_004_0	6	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9808	004	0	1	04	01	H9808_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	85.00	170.00	170.00																			85.00	170.00	170.00																	85.00			85.00		2.83			2.83			2.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9808	004	0	1	04	01	H9808_004_0	6	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				946.71	33	33	33																		33	33	33																33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9808	005	0	1	04	01	H9808_005_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9808	005	0	1	04	01	H9808_005_0	5	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H9808	005	0	1	04	01	H9808_005_0	5	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	12.00	24.00	24.00																			12.00	24.00	24.00																	12.00			12.00		0.40			0.40			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9808	005	0	1	04	01	H9808_005_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9808	005	0	1	04	01	H9808_005_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	75.00	150.00	150.00																			75.00	150.00	150.00																	75.00			75.00		2.50			2.50			2.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9808	005	0	1	04	01	H9808_005_0	5	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1109.21	33	33	33																		33	33	33																33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9811	001	0	1	01	01	H9811_001_0	2	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9811	001	0	1	01	01	H9811_001_0	2	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9811	001	0	1	01	01	H9811_001_0	2	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.40			1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9811	001	0	1	01	01	H9811_001_0	2	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9811	001	0	1	01	01	H9811_001_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9811	001	0	1	01	01	H9811_001_0	2	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9834	001	0	1	01	01	H9834_001_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9834	001	0	1	01	01	H9834_001_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9834	001	0	1	01	01	H9834_001_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9834	001	0	1	01	01	H9834_001_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				35.42	40	40	40																				40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9834	001	0	1	01	01	H9834_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9834	003	0	1	01	01	H9834_003_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9834	003	0	1	01	01	H9834_003_0	5	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9834	003	0	1	01	01	H9834_003_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9834	003	0	1	01	01	H9834_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				23.74	40	40	40																				40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9834	003	0	1	01	01	H9834_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9869	001	0	1	48	05	H9869_001_0	10	Generic Drugs	4	01			1	1	110		01			1	30		90				1	1							30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00			0.00	0.00			
H9869	001	0	1	48	05	H9869_001_0	10	Brand Drugs	4	10			2	1	110		01			1	30		90				1	1							30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1		0.00	0.00	0.00	0.00			0.00	0.00			
H9869	001	0	1	48	05	H9869_001_0	10	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01			1	30		90				1	1							30		31																																																						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2		0.00	0.00	0.00	0.00			0.00	0.00			
H9877	002	0	1	01	01	H9877_002_0	8	Preferred Generic	4	01	1	2	1	1	111		01	110		1	31	60	90				1	2	31		90				31		31	0.00	0.00	0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9877	002	0	1	01	01	H9877_002_0	8	Preferred Generic	4	01	1	2	1	3	111		01	110		1	31	60	90				1	2	31		90				31		31	0.00	0.00	0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H9877	002	0	1	01	01	H9877_002_0	8	Generic	4	01	1	2	2	1	111		01	110		1	31	60	90				1	2	31		90				31		31	15.00	30.00	45.00																			15.00		37.50																15.00				15.00		0.48			0.48			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9877	002	0	1	01	01	H9877_002_0	8	Generic	4	01	1	2	2	3	111		01	110		1	31	60	90				1	2	31		90				31		31	15.00	30.00	45.00																			15.00		37.50																15.00				15.00		0.48			0.48			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H9877	002	0	1	01	01	H9877_002_0	8	Preferred Brand	4	10	1	2	3	1	111		01	110		1	31	60	90				1	2	31		90				31		31	47.00	94.00	141.00																			47.00		117.50																47.00				47.00		1.52			1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9877	002	0	1	01	01	H9877_002_0	8	Non-Preferred Drug	4	10	1	2	4	1	111		01	110		1	31	60	90				1	2	31		90				31		31	100.00	200.00	300.00																			100.00		250.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9877	002	0	1	01	01	H9877_002_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1228.00	28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9877	003	0	1	01	01	H9877_003_0	6	Preferred Generic	4	01	1	2	1	1	111		01	110		1	31	60	90				1	2	31		90				31		31	0.00	0.00	0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9877	003	0	1	01	01	H9877_003_0	6	Preferred Generic	4	01	1	2	1	3	111		01	110		1	31	60	90				1	2	31		90				31		31	0.00	0.00	0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H9877	003	0	1	01	01	H9877_003_0	6	Generic	4	01	1	2	2	1	111		01	110		1	31	60	90				1	2	31		90				31		31	12.00	24.00	36.00																			12.00		30.00																12.00				12.00		0.39			0.39			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9877	003	0	1	01	01	H9877_003_0	6	Generic	4	01	1	2	2	3	111		01	110		1	31	60	90				1	2	31		90				31		31	12.00	24.00	36.00																			12.00		30.00																12.00				12.00		0.39			0.39			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
H9877	003	0	1	01	01	H9877_003_0	6	Preferred Brand	4	10	1	2	3	1	111		01	110		1	31	60	90				1	2	31		90				31		31	47.00	94.00	141.00																			47.00		117.50																47.00				47.00		1.52			1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9877	003	0	1	01	01	H9877_003_0	6	Non-Preferred Drug	4	10	1	2	4	1	111		01	110		1	31	60	90				1	2	31		90				31		31	100.00	200.00	300.00																			100.00		250.00																100.00				100.00		3.23			3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9877	003	0	1	01	01	H9877_003_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1360.00	31																				31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
H9886	003	0	1	01	01	H9886_003_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	003	0	1	01	01	H9886_003_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	003	0	1	01	01	H9886_003_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	003	0	1	01	01	H9886_003_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	003	0	1	01	01	H9886_003_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	003	0	1	01	01	H9886_003_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	003	0	1	01	01	H9886_003_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H9886	004	0	1	01	01	H9886_004_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	004	0	1	01	01	H9886_004_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	004	0	1	01	01	H9886_004_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	004	0	1	01	01	H9886_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	004	0	1	01	01	H9886_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	004	0	1	01	01	H9886_004_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9886	004	0	1	01	01	H9886_004_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H9915	001	0	1	01	01	H9915_001_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	001	0	1	01	01	H9915_001_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	001	0	1	01	01	H9915_001_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	001	0	1	01	01	H9915_001_0	6	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	001	0	1	01	01	H9915_001_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	001	0	1	01	01	H9915_001_0	6	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	007	0	1	01	01	H9915_007_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9915	007	0	1	01	01	H9915_007_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9915	007	0	1	01	01	H9915_007_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9915	007	0	1	01	01	H9915_007_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9915	007	0	1	01	01	H9915_007_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9915	007	0	1	01	01	H9915_007_0	4	Select Diabetic Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9915	008	0	1	01	01	H9915_008_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	008	0	1	01	01	H9915_008_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	008	0	1	01	01	H9915_008_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	008	0	1	01	01	H9915_008_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	008	0	1	01	01	H9915_008_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	008	0	1	01	01	H9915_008_0	4	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
H9915	010	0	1	01	01	H9915_010_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9915	010	0	1	01	01	H9915_010_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9915	010	0	1	01	01	H9915_010_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9915	010	0	1	01	01	H9915_010_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9915	010	0	1	01	01	H9915_010_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9915	010	0	1	01	01	H9915_010_0	4	Select Diabetic Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs													
H9954	002	0	1	01	01	H9954_002_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	002	0	1	01	01	H9954_002_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	002	0	1	01	01	H9954_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	002	0	1	01	01	H9954_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	002	0	1	01	01	H9954_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	002	0	1	01	01	H9954_002_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	002	0	1	01	01	H9954_002_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H9954	004	0	1	01	01	H9954_004_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	004	0	1	01	01	H9954_004_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					13.00	26.00	39.00					13.00	39.00	39.00																13.00				13.00			0.43	0.43	0.43			0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	004	0	1	01	01	H9954_004_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	004	0	1	01	01	H9954_004_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	004	0	1	01	01	H9954_004_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	004	0	1	01	01	H9954_004_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	004	0	1	01	01	H9954_004_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H9954	005	0	1	01	01	H9954_005_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	005	0	1	01	01	H9954_005_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	005	0	1	01	01	H9954_005_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	005	0	1	01	01	H9954_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	005	0	1	01	01	H9954_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	005	0	1	01	01	H9954_005_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	005	0	1	01	01	H9954_005_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
H9954	006	0	1	01	01	H9954_006_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	006	0	1	01	01	H9954_006_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	006	0	1	01	01	H9954_006_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	006	0	1	01	01	H9954_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	006	0	1	01	01	H9954_006_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	006	0	1	01	01	H9954_006_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
H9954	006	0	1	01	01	H9954_006_0	5	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
R0110	002	0	1	31	11	R0110_002_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0110	002	0	1	31	11	R0110_002_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0110	002	0	1	31	11	R0110_002_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0110	002	0	1	31	11	R0110_002_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0110	002	0	1	31	11	R0110_002_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0110	003	0	1	31	11	R0110_003_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0110	003	0	1	31	11	R0110_003_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0110	003	0	1	31	11	R0110_003_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0110	003	0	1	31	11	R0110_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0110	003	0	1	31	11	R0110_003_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0865	003	0	1	31	11	R0865_003_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0865	003	0	1	31	11	R0865_003_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0865	003	0	1	31	11	R0865_003_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0865	003	0	1	31	11	R0865_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0865	003	0	1	31	11	R0865_003_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0923	002	0	1	31	11	R0923_002_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					10.00		30.00											10.00		30.00				10.00		0.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0923	002	0	1	31	11	R0923_002_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0923	002	0	1	31	11	R0923_002_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0923	002	0	1	31	11	R0923_002_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R0923	002	0	1	31	11	R0923_002_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R1390	002	0	1	31	11	R1390_002_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R1390	002	0	1	31	11	R1390_002_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R1390	002	0	1	31	11	R1390_002_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R1390	002	0	1	31	11	R1390_002_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R1390	002	0	1	31	11	R1390_002_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R1532	002	0	1	31	11	R1532_002_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R1532	002	0	1	31	11	R1532_002_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R1532	002	0	1	31	11	R1532_002_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R1532	002	0	1	31	11	R1532_002_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R1532	002	0	1	31	11	R1532_002_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3332	001	0	1	31	11	R3332_001_0	13	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
R3332	001	0	1	31	11	R3332_001_0	13	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
R3332	001	0	1	31	11	R3332_001_0	13	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					10.00		30.00					10.00		30.00																20.00				10.00			0.65	0.32	0.32			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
R3332	001	0	1	31	11	R3332_001_0	13	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		141.00					47.00		141.00																47.00				47.00			1.52	1.52	1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
R3332	001	0	1	31	11	R3332_001_0	13	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					100.00		300.00					100.00		300.00																100.00				100.00			3.23	3.23	3.23			3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
R3332	001	0	1	31	11	R3332_001_0	13	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											537.88	28						537.88	28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
R3332	001	0	1	31	11	R3332_001_0	13	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
R3332	001	0	1	31	11	R3332_001_0	13	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs											1		
R3392	002	0	1	31	11	R3392_002_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3392	002	0	1	31	11	R3392_002_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3392	002	0	1	31	11	R3392_002_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3392	002	0	1	31	11	R3392_002_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3392	002	0	1	31	11	R3392_002_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	008	0	1	31	11	R3444_008_0	3	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	008	0	1	31	11	R3444_008_0	3	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	008	0	1	31	11	R3444_008_0	3	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	008	0	1	31	11	R3444_008_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	008	0	1	31	11	R3444_008_0	3	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	009	0	1	31	11	R3444_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	009	0	1	31	11	R3444_009_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	009	0	1	31	11	R3444_009_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	009	0	1	31	11	R3444_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	009	0	1	31	11	R3444_009_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				894.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	012	0	1	31	11	R3444_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	012	0	1	31	11	R3444_012_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	012	0	1	31	11	R3444_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	012	0	1	31	11	R3444_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3444	012	0	1	31	11	R3444_012_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				716.00	30		30																										30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3887	002	0	1	31	11	R3887_002_0	3	Preferred Generic	3	11	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											2.00	25		25				1.00	19		19										25		25				19		19			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3887	002	0	1	31	11	R3887_002_0	3	Generic	3	11	1	1	2	1		110	01		110	1				30		90	2	2				30		90	30		31											3.00	25		25				3.00	25		25										25		25				25		25			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3887	002	0	1	31	11	R3887_002_0	3	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				28.00	25		25										25		25				25		25			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3887	002	0	1	31	11	R3887_002_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	25		25				35.00	25		25										25		25				25		25			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R3887	002	0	1	31	11	R3887_002_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4182	003	0	1	31	11	R4182_003_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4182	003	0	1	31	11	R4182_003_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4182	003	0	1	31	11	R4182_003_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4182	003	0	1	31	11	R4182_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4182	003	0	1	31	11	R4182_003_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4182	004	0	1	31	11	R4182_004_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4182	004	0	1	31	11	R4182_004_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4182	004	0	1	31	11	R4182_004_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4182	004	0	1	31	11	R4182_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4182	004	0	1	31	11	R4182_004_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4845	002	0	1	31	11	R4845_002_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4845	002	0	1	31	11	R4845_002_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4845	002	0	1	31	11	R4845_002_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4845	002	0	1	31	11	R4845_002_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R4845	002	0	1	31	11	R4845_002_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5329	001	0	1	31	11	R5329_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5329	001	0	1	31	11	R5329_001_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5329	001	0	1	31	11	R5329_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5329	001	0	1	31	11	R5329_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5329	001	0	1	31	11	R5329_001_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				691.00	33		33																										33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	001	0	1	31	11	R5342_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	001	0	1	31	11	R5342_001_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	001	0	1	31	11	R5342_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	001	0	1	31	11	R5342_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	001	0	1	31	11	R5342_001_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				664.00	26		26																										26						26			26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	005	0	1	31	11	R5342_005_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	005	0	1	31	11	R5342_005_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	005	0	1	31	11	R5342_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	005	0	1	31	11	R5342_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	005	0	1	31	11	R5342_005_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				650.00	28		28																										28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	006	0	1	31	11	R5342_006_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	006	0	1	31	11	R5342_006_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	006	0	1	31	11	R5342_006_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	006	0	1	31	11	R5342_006_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5342	006	0	1	31	11	R5342_006_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				800.00	31		31																										31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5361	002	0	1	31	11	R5361_002_0	3	Preferred Generic	3	11	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											2.00	25		25				1.00	19		19										25		25				19		19			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5361	002	0	1	31	11	R5361_002_0	3	Generic	3	11	1	1	2	1		110	01		110	1				30		90	2	2				30		90	30		31											3.00	25		25				3.00	25		25										25		25				25		25			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5361	002	0	1	31	11	R5361_002_0	3	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				30.00	25		25										25		25				25		25			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5361	002	0	1	31	11	R5361_002_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	25		25				40.00	25		25										25		25				25		25			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5361	002	0	1	31	11	R5361_002_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5495	002	0	1	31	11	R5495_002_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5495	002	0	1	31	11	R5495_002_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5495	002	0	1	31	11	R5495_002_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5495	002	0	1	31	11	R5495_002_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5495	002	0	1	31	11	R5495_002_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5826	005	0	1	31	11	R5826_005_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5826	005	0	1	31	11	R5826_005_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5826	005	0	1	31	11	R5826_005_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5826	005	0	1	31	11	R5826_005_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5826	005	0	1	31	11	R5826_005_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5826	074	0	1	31	11	R5826_074_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5826	074	0	1	31	11	R5826_074_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5826	074	0	1	31	11	R5826_074_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5826	074	0	1	31	11	R5826_074_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5826	074	0	1	31	11	R5826_074_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R5941	014	0	1	31	11	R5941_014_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					6.00	12.00	18.00					6.00	18.00	18.00																11.00				11.00			0.37	0.20	0.20			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	014	0	1	31	11	R5941_014_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	014	0	1	31	11	R5941_014_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	014	0	1	31	11	R5941_014_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											91.85	42	42	42				89.66	41	41	41				41	41	41															42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	014	0	1	31	11	R5941_014_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	014	0	1	31	11	R5941_014_0	3	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	014	0	1	31	11	R5941_014_0	3	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
R5941	015	0	1	31	11	R5941_015_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					6.00	12.00	18.00					6.00	18.00	18.00																11.00				11.00			0.37	0.20	0.20			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	015	0	1	31	11	R5941_015_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	015	0	1	31	11	R5941_015_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	015	0	1	31	11	R5941_015_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											97.10	47	47	47				95.03	46	46	46				46	46	46															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	015	0	1	31	11	R5941_015_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	015	0	1	31	11	R5941_015_0	3	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
R5941	015	0	1	31	11	R5941_015_0	3	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
R6694	003	0	1	31	11	R6694_003_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	003	0	1	31	11	R6694_003_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
R6694	003	0	1	31	11	R6694_003_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	003	0	1	31	11	R6694_003_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
R6694	003	0	1	31	11	R6694_003_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	003	0	1	31	11	R6694_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	003	0	1	31	11	R6694_003_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	005	0	1	31	11	R6694_005_0	3	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	005	0	1	31	11	R6694_005_0	3	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	005	0	1	31	11	R6694_005_0	3	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	005	0	1	31	11	R6694_005_0	3	Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	005	0	1	31	11	R6694_005_0	3	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	006	0	1	31	11	R6694_006_0	4	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	006	0	1	31	11	R6694_006_0	4	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	10.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	006	0	1	31	11	R6694_006_0	4	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	121.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	006	0	1	31	11	R6694_006_0	4	Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6694	006	0	1	31	11	R6694_006_0	4	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	008	0	1	31	11	R6801_008_0	4	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	008	0	1	31	11	R6801_008_0	4	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	008	0	1	31	11	R6801_008_0	4	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	008	0	1	31	11	R6801_008_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	008	0	1	31	11	R6801_008_0	4	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	009	0	1	31	11	R6801_009_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	009	0	1	31	11	R6801_009_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	009	0	1	31	11	R6801_009_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	009	0	1	31	11	R6801_009_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	009	0	1	31	11	R6801_009_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				976.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	012	0	1	31	11	R6801_012_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	012	0	1	31	11	R6801_012_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	012	0	1	31	11	R6801_012_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	012	0	1	31	11	R6801_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R6801	012	0	1	31	11	R6801_012_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				726.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7220	002	0	1	31	11	R7220_002_0	2	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7220	002	0	1	31	11	R7220_002_0	2	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7220	002	0	1	31	11	R7220_002_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7220	002	0	1	31	11	R7220_002_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7220	002	0	1	31	11	R7220_002_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7315	002	0	1	31	11	R7315_002_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7315	002	0	1	31	11	R7315_002_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7315	002	0	1	31	11	R7315_002_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7315	002	0	1	31	11	R7315_002_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7315	002	0	1	31	11	R7315_002_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	001	0	1	31	11	R7444_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	001	0	1	31	11	R7444_001_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	001	0	1	31	11	R7444_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	001	0	1	31	11	R7444_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	001	0	1	31	11	R7444_001_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				579.00	27		27																										27						27			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	003	0	1	31	11	R7444_003_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						6.00				3.00				3.00		0.10						0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	003	0	1	31	11	R7444_003_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						28.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	003	0	1	31	11	R7444_003_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	003	0	1	31	11	R7444_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	003	0	1	31	11	R7444_003_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				704.00	25		25																										25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	008	0	1	31	11	R7444_008_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	008	0	1	31	11	R7444_008_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	008	0	1	31	11	R7444_008_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	008	0	1	31	11	R7444_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	008	0	1	31	11	R7444_008_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				774.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	009	0	1	31	11	R7444_009_0	3	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	009	0	1	31	11	R7444_009_0	3	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	009	0	1	31	11	R7444_009_0	3	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	009	0	1	31	11	R7444_009_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	009	0	1	31	11	R7444_009_0	3	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	010	0	1	31	11	R7444_010_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	010	0	1	31	11	R7444_010_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	010	0	1	31	11	R7444_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	010	0	1	31	11	R7444_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
R7444	010	0	1	31	11	R7444_010_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1091.00	29		29																										29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	001	0		29	10	S0522_001_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	001	0		29	10	S0522_001_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					3.00		9.00													27.00						9.00				9.00				9.00			0.30	0.10				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	001	0		29	10	S0522_001_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					35.00		105.00													141.00						105.00				47.00				47.00			1.56	1.16				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	001	0		29	10	S0522_001_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											86.00	35		35				59.00	25		25												35						25			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	001	0		29	10	S0522_001_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											496.00	25		25				496.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	002	0		29	10	S0522_002_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	002	0		29	10	S0522_002_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	002	0		29	10	S0522_002_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								36.00		108.00					26.00		78.00													108.00						78.00				36.00				36.00			1.20	0.86				1.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	002	0		29	10	S0522_002_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											88.00	39		39				62.00	29		29												39						29			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	002	0		29	10	S0522_002_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											418.00	25		25				418.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	004	0		29	10	S0522_004_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	004	0		29	10	S0522_004_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					3.00		9.00													21.00						9.00				7.00				7.00			0.23	0.10				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	004	0		29	10	S0522_004_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					35.00		105.00													141.00						105.00				47.00				47.00			1.56	1.16				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	004	0		29	10	S0522_004_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											92.00	33		33				66.00	25		25												33						25			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	004	0		29	10	S0522_004_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											498.00	25		25				498.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	006	0		29	10	S0522_006_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	006	0		29	10	S0522_006_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													24.00						9.00				8.00				8.00			0.26	0.10				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	006	0		29	10	S0522_006_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					35.00		105.00													141.00						105.00				47.00				47.00			1.56	1.16				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	006	0		29	10	S0522_006_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											91.00	32		32				67.00	25		25												32						25			32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	006	0		29	10	S0522_006_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											501.00	25		25				501.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	008	0		29	10	S0522_008_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	008	0		29	10	S0522_008_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	008	0		29	10	S0522_008_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						96.00				42.00				42.00			1.40	1.06				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	008	0		29	10	S0522_008_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											92.00	40		40				65.00	30		30												40						30			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	008	0		29	10	S0522_008_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											501.00	25		25				501.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	010	0		29	10	S0522_010_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	010	0		29	10	S0522_010_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					3.00		9.00													21.00						9.00				7.00				7.00			0.23	0.10				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	010	0		29	10	S0522_010_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								44.00		132.00					34.00		102.00													132.00						102.00				44.00				44.00			1.46	1.13				1.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	010	0		29	10	S0522_010_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	36		36				64.00	26		26												36						26			36			36									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	010	0		29	10	S0522_010_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											487.00	25		25				487.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	012	0		29	10	S0522_012_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	012	0		29	10	S0522_012_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	012	0		29	10	S0522_012_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						96.00				42.00				42.00			1.40	1.06				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	012	0		29	10	S0522_012_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											95.00	39		39				66.00	29		29												39						29			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	012	0		29	10	S0522_012_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											527.00	25		25				527.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	014	0		29	10	S0522_014_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	014	0		29	10	S0522_014_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	014	0		29	10	S0522_014_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					28.00		84.00													114.00						84.00				38.00				38.00			1.26	0.93				1.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	014	0		29	10	S0522_014_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											96.00	44		44				69.00	34		34												44						34			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	014	0		29	10	S0522_014_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											499.00	25		25				499.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	016	0		29	10	S0522_016_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	016	0		29	10	S0522_016_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	016	0		29	10	S0522_016_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					28.00		84.00													114.00						84.00				38.00				38.00			1.26	0.93				1.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	016	0		29	10	S0522_016_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											90.00	40		40				63.00	30		30												40						30			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	016	0		29	10	S0522_016_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											504.00	25		25				504.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	018	0		29	10	S0522_018_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	018	0		29	10	S0522_018_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	018	0		29	10	S0522_018_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								40.00		120.00					30.00		90.00													120.00						90.00				40.00				40.00			1.33	1.00				1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	018	0		29	10	S0522_018_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											90.00	38		38				62.00	28		28												38						28			38			38									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	018	0		29	10	S0522_018_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											488.00	25		25				488.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	020	0		29	10	S0522_020_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	020	0		29	10	S0522_020_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					3.00		9.00													21.00						9.00				7.00				7.00			0.23	0.10				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	020	0		29	10	S0522_020_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								40.00		120.00					30.00		90.00													120.00						90.00				40.00				40.00			1.33	1.00				1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	020	0		29	10	S0522_020_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											90.00	35		35				90.00	35		35												35						35			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	020	0		29	10	S0522_020_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											454.00	25		25				454.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	022	0		29	10	S0522_022_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	022	0		29	10	S0522_022_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	022	0		29	10	S0522_022_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													129.00						99.00				43.00				43.00			1.43	1.10				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	022	0		29	10	S0522_022_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											89.00	36		36				60.00	26		26												36						26			36			36									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	022	0		29	10	S0522_022_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											466.00	25		25				466.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	024	0		29	10	S0522_024_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	024	0		29	10	S0522_024_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	024	0		29	10	S0522_024_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					28.00		84.00													114.00						84.00				38.00				38.00			1.26	0.93				1.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	024	0		29	10	S0522_024_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											91.00	44		44				65.00	34		34												44						34			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	024	0		29	10	S0522_024_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											509.00	25		25				509.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	026	0		29	10	S0522_026_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	026	0		29	10	S0522_026_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	026	0		29	10	S0522_026_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													129.00						99.00				43.00				43.00			1.43	1.10				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	026	0		29	10	S0522_026_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											92.00	36		36				62.00	26		26												36						26			36			36									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	026	0		29	10	S0522_026_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											507.00	25		25				507.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	028	0		29	10	S0522_028_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	028	0		29	10	S0522_028_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													30.00						9.00				10.00				10.00			0.33	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	028	0		29	10	S0522_028_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								37.00		111.00					27.00		81.00													111.00						81.00				37.00				37.00			1.23	0.90				1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	028	0		29	10	S0522_028_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											95.00	34		34				66.00	25		25												34						25			34			34									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	028	0		29	10	S0522_028_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											442.00	25		25				442.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	030	0		29	10	S0522_030_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	030	0		29	10	S0522_030_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					3.00		9.00													21.00						9.00				7.00				7.00			0.23	0.10				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	030	0		29	10	S0522_030_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								39.00		117.00					29.00		87.00													117.00						87.00				39.00				39.00			1.30	0.96				1.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	030	0		29	10	S0522_030_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											97.00	40		40				68.00	30		30												40						30			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	030	0		29	10	S0522_030_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											527.00	25		25				527.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	032	0		29	10	S0522_032_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	032	0		29	10	S0522_032_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	032	0		29	10	S0522_032_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								36.00		108.00					26.00		78.00													108.00						78.00				36.00				36.00			1.20	0.86				1.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	032	0		29	10	S0522_032_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											97.00	41		41				69.00	31		31												41						31			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	032	0		29	10	S0522_032_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											428.00	25		25				428.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	034	0		29	10	S0522_034_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	034	0		29	10	S0522_034_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					3.00		9.00													21.00						9.00				7.00				7.00			0.23	0.10				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	034	0		29	10	S0522_034_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					35.00		105.00													141.00						105.00				47.00				47.00			1.56	1.16				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	034	0		29	10	S0522_034_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	32		32				68.00	25		25												32						25			32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	034	0		29	10	S0522_034_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											536.00	25		25				536.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	036	0		29	10	S0522_036_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	036	0		29	10	S0522_036_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					3.00		9.00													21.00						9.00				7.00				7.00			0.23	0.10				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	036	0		29	10	S0522_036_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													129.00						99.00				43.00				43.00			1.43	1.10				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	036	0		29	10	S0522_036_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	37		37				63.00	27		27												37						27			37			37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	036	0		29	10	S0522_036_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											503.00	25		25				503.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	037	0		29	10	S0522_037_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	037	0		29	10	S0522_037_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	037	0		29	10	S0522_037_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								41.00		123.00					31.00		93.00													123.00						93.00				41.00				41.00			1.36	1.03				1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	037	0		29	10	S0522_037_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											98.00	43		43				70.00	33		33												43						33			43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	037	0		29	10	S0522_037_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											519.00	25		25				519.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	038	0		29	10	S0522_038_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	038	0		29	10	S0522_038_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	038	0		29	10	S0522_038_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								30.00		90.00					20.00		60.00													90.00						60.00				30.00				30.00			1.00	0.66				.96		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	038	0		29	10	S0522_038_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											90.00	48		48				66.00	38		38												48						38			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	038	0		29	10	S0522_038_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											478.00	25		25				478.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	039	0		29	10	S0522_039_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	039	0		29	10	S0522_039_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													30.00						9.00				10.00				10.00			0.33	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	039	0		29	10	S0522_039_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					35.00		105.00													141.00						105.00				47.00				47.00			1.56	1.16				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	039	0		29	10	S0522_039_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											87.00	33		33				61.00	25		25												33						25			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	039	0		29	10	S0522_039_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											593.00	25		25				593.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	040	0		29	10	S0522_040_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	040	0		29	10	S0522_040_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	040	0		29	10	S0522_040_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								37.00		111.00					27.00		81.00													111.00						81.00				37.00				37.00			1.23	0.90				1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	040	0		29	10	S0522_040_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											92.00	41		41				65.00	31		31												41						31			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	040	0		29	10	S0522_040_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											508.00	25		25				508.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	041	0		29	10	S0522_041_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	041	0		29	10	S0522_041_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	041	0		29	10	S0522_041_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								33.00		99.00					23.00		69.00													99.00						69.00				33.00				33.00			1.10	0.76				1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	041	0		29	10	S0522_041_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											95.00	42		42				68.00	32		32												42						32			42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	041	0		29	10	S0522_041_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											481.00	25		25				481.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	042	0		29	10	S0522_042_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	042	0		29	10	S0522_042_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						9.00				6.00				6.00			0.20	0.10				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	042	0		29	10	S0522_042_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								44.00		132.00					34.00		102.00													132.00						102.00				44.00				44.00			1.46	1.13				1.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	042	0		29	10	S0522_042_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											91.00	40		40				68.00	30		30												40						30			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	042	0		29	10	S0522_042_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											413.00	25		25				413.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	043	0		29	10	S0522_043_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	043	0		29	10	S0522_043_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													36.00						9.00				12.00				12.00			0.40	0.10				0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	043	0		29	10	S0522_043_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													129.00						99.00				43.00				43.00			1.43	1.10				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	043	0		29	10	S0522_043_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											69.00	29		29				56.00	25		25												29						25			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	043	0		29	10	S0522_043_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											482.00	25		25				482.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	044	0		29	10	S0522_044_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	044	0		29	10	S0522_044_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													24.00						9.00				8.00				8.00			0.26	0.10				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	044	0		29	10	S0522_044_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					28.00		84.00													114.00						84.00				38.00				38.00			1.26	0.93				1.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	044	0		29	10	S0522_044_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											99.00	39		39				69.00	29		29												39						29			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	044	0		29	10	S0522_044_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											530.00	25		25				530.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	045	0		29	10	S0522_045_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	045	0		29	10	S0522_045_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													24.00						9.00				8.00				8.00			0.26	0.10				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	045	0		29	10	S0522_045_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						96.00				42.00				42.00			1.40	1.06				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	045	0		29	10	S0522_045_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											82.00	34		34				57.00	25		25												34						25			34			34									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	045	0		29	10	S0522_045_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											475.00	25		25				475.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	046	0		29	10	S0522_046_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						6.00				4.00				4.00			0.13	0.06				0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	046	0		29	10	S0522_046_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	046	0		29	10	S0522_046_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				47.00			1.56	1.23				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	046	0		29	10	S0522_046_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											99.00	33		33				71.00	25		25												33						25			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	046	0		29	10	S0522_046_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											585.00	25		25				585.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	047	0		29	10	S0522_047_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	047	0		29	10	S0522_047_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					4.00		12.00													27.00						12.00				9.00				9.00			0.30	0.13				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	047	0		29	10	S0522_047_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						96.00				42.00				42.00			1.40	1.06				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	047	0		29	10	S0522_047_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											99.00	40		40				70.00	30		30												40						30			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	047	0		29	10	S0522_047_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											558.00	25		25				558.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	078	0		29	10	S0522_078_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	078	0		29	10	S0522_078_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					3.00		9.00													21.00						9.00				7.00				7.00			0.23	0.10				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	078	0		29	10	S0522_078_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													129.00						99.00				43.00				43.00			1.43	1.10				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	078	0		29	10	S0522_078_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											86.00	37		37				59.00	27		27												37						27			37			37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	078	0		29	10	S0522_078_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											476.00	25		25				476.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	079	0		29	10	S0522_079_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	079	0		29	10	S0522_079_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													24.00						9.00				8.00				8.00			0.26	0.10				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	079	0		29	10	S0522_079_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								44.00		132.00					34.00		102.00													132.00						102.00				44.00				44.00			1.46	1.13				1.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	079	0		29	10	S0522_079_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											87.00	36		36				59.00	26		26												36						26			36			36									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S0522	079	0		29	10	S0522_079_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											468.00	25		25				468.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S1030	001	0		29	10	S1030_001_0	2	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								12.00		36.00					2.00		4.00					2.00		4.00																12.00				12.00			0.40	0.06	0.06			0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S1030	001	0		29	10	S1030_001_0	2	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								18.00		54.00					8.00		16.00					8.00		16.00																18.00				18.00			0.60	0.26	0.26			0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S1030	001	0		29	10	S1030_001_0	2	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					37.00		74.00					37.00		74.00																47.00				47.00			1.56	1.23	1.23			1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S1030	001	0		29	10	S1030_001_0	2	Non-Preferred Brand	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											66.00	50		50				51.00	40		40				40		40															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S1030	001	0		29	10	S1030_001_0	2	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S1030	006	0		29	10	S1030_006_0	2	Preferred Generic	2	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								11.00		33.00					1.00		2.00					1.00		2.00																11.00				11.00			0.36	0.03	0.03			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S1030	006	0		29	10	S1030_006_0	2	Generic	2	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		42.00					4.00		8.00					4.00		8.00																14.00				14.00			0.46	0.13	0.13			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S1030	006	0		29	10	S1030_006_0	2	Preferred Brand	2	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					37.00		74.00					37.00		74.00																47.00				47.00			1.56	1.23	1.23			1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S1030	006	0		29	10	S1030_006_0	2	Non-Preferred Brand	2	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											81.00	50		50				62.00	40		40				40		40															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S1030	006	0		29	10	S1030_006_0	2	Specialty Tier	2	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S2468	003	0		29	10	S2468_003_0	2	Preferred Generic	3	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					2.00	4.00	4.00							4.00																8.00				8.00			0.27	0.07				0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2468	003	0		29	10	S2468_003_0	2	Generic	3	11	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								14.00	28.00	42.00					6.00	12.00	12.00							12.00																14.00				14.00			0.47	0.20				0.45	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2468	003	0		29	10	S2468_003_0	2	Preferred Brand	3	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								38.00	76.00	114.00					31.00	62.00	62.00							62.00																38.00				38.00			1.27	1.03				1.23	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2468	003	0		29	10	S2468_003_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	01	100		1				30	60	90	2	2			90				30		31											52.05	27	27	27				48.20	25	25	25						25															27			27								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2468	003	0		29	10	S2468_003_0	2	Injectable Drugs	3	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											99.31	25	25	25				99.31	25	25	25						25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2468	003	0		29	10	S2468_003_0	2	Specialty Tier	3	11	1	1	6	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2468	004	0		29	10	S2468_004_0	2	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								13.00	26.00	39.00					4.00	8.00	8.00							8.00																13.00				13.00			0.43	0.13				0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2468	004	0		29	10	S2468_004_0	2	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								17.00	34.00	51.00					10.00	20.00	20.00							20.00																17.00				17.00			0.57	0.33				0.55	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2468	004	0		29	10	S2468_004_0	2	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2468	004	0		29	10	S2468_004_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	90	2	2			90				30		31											61.60	29	29	29				57.36	27	27	27						27															29			29								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2468	004	0		29	10	S2468_004_0	2	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											107.87	25	25	25				107.87	25	25	25						25															25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2468	004	0		29	10	S2468_004_0	2	Specialty Tier	4	11	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier													
S2668	005	0		29	10	S2668_005_0	2	Preferred Generic	2	01	1	2	1	1	111		01	110		1	30	60	90				1	2	30		90				30		31	1.00	2.00	3.00																			1.00		3.00																1.00				1.00		0.03			0.03			0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2668	005	0		29	10	S2668_005_0	2	Generic	2	01	1	2	2	1	111		01	110		1	30	60	90				1	2	30		90				30		31	5.00	10.00	15.00																			5.00		15.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2668	005	0		29	10	S2668_005_0	2	Preferred Brand	2	10	1	2	3	1	111		01	110		1	30	60	90				1	2	30		90				30		31	40.00	80.00	120.00																			40.00		120.00																40.00				40.00		1.33			1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2668	005	0		29	10	S2668_005_0	2	Non-Preferred Drug	2	11	1	1	4	1	111		01	110		1	30	60	90				1	2	30		90				30		31				36.64	40	40	40																		40		40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2668	005	0		29	10	S2668_005_0	2	Specialty Tier	2	11	1	1	5	1	111		01	110		1	30	60	90				1	2	30		90				30		31				137.35	25	25	25																		25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2668	006	0		29	10	S2668_006_0	3	Preferred Generic	4	01	1	2	1	1	111		01	110		1	30	60	90				1	2	30		90				30		31	1.00	2.00	3.00																			1.00		3.00																1.00				1.00		0.03			0.03			0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2668	006	0		29	10	S2668_006_0	3	Generic	4	01	1	2	2	1	111		01	110		1	30	60	90				1	2	30		90				30		31	4.00	8.00	12.00																			4.00		12.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2668	006	0		29	10	S2668_006_0	3	Preferred Brand	4	10	1	2	3	1	111		01	110		1	30	60	90				1	2	30		90				30		31	35.00	70.00	105.00																			35.00		105.00																35.00				35.00		1.17			1.17			1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2668	006	0		29	10	S2668_006_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	110		1	30	60	90				1	2	30		90				30		31				29.68	35	35	35																		35		35															35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2668	006	0		29	10	S2668_006_0	3	Specialty Tier	4	11	1	1	5	1	111		01	110		1	30	60	90				1	2	30		90				30		31				194.50	33	33	33																		33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2874	001	0		29	10	S2874_001_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2874	001	0		29	10	S2874_001_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2874	001	0		29	10	S2874_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2874	001	0		29	10	S2874_001_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S2874	001	0		29	10	S2874_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											59.00	50		50				50.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2874	001	0		29	10	S2874_001_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S2874	001	0		29	10	S2874_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2874	004	0		29	10	S2874_004_0	2	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2874	004	0		29	10	S2874_004_0	2	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2874	004	0		29	10	S2874_004_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											19.00	25		25				15.00	20		20										25		25				20		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2874	004	0		29	10	S2874_004_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	42		42				49.00	35		35										42		42				35		30			42			42								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2874	004	0		29	10	S2874_004_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2893	001	0		29	10	S2893_001_0	5	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	2.00	2.00																7.00				7.00			0.23	0.07	0.07			0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2893	001	0		29	10	S2893_001_0	5	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					7.00	14.00	21.00					7.00	14.00	14.00																19.00				19.00			0.63	0.23	0.23			0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2893	001	0		29	10	S2893_001_0	5	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					35.00	70.00	70.00																45.00				45.00			1.50	1.17	1.17			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2893	001	0		29	10	S2893_001_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											70.56	50	50	50				55.87	40	40	40				40	40	40															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2893	001	0		29	10	S2893_001_0	5	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2893	003	0		29	10	S2893_003_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2893	003	0		29	10	S2893_003_0	5	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S2893	003	0		29	10	S2893_003_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2893	003	0		29	10	S2893_003_0	5	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S2893	003	0		29	10	S2893_003_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								40.00	80.00	120.00					30.00	60.00	90.00					30.00	60.00	60.00																40.00				40.00			1.33	1.00	1.00			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2893	003	0		29	10	S2893_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								80.00	160.00	240.00					70.00	140.00	210.00					70.00	140.00	140.00																80.00				80.00			2.67	2.33	2.33			2.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S2893	003	0		29	10	S2893_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4054	001	0		29	10	S4054_001_0	9	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
S4054	001	0		29	10	S4054_001_0	9	Generic	2	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	11.00		27.50																					22.00																11.00				11.00		0.37						0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
S4054	001	0		29	10	S4054_001_0	9	Preferred Brand	2	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
S4054	001	0		29	10	S4054_001_0	9	Non-Preferred Brand	2	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					200.00																100.00				100.00		3.33						3.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
S4054	001	0		29	10	S4054_001_0	9	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				200.00	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
S4054	001	0		29	10	S4054_001_0	9	Select Care Drugs	2	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs													
S4607	001	0		29	10	S4607_001_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	001	0		29	10	S4607_001_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	001	0		29	10	S4607_001_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											45.22	16	16	16				45.58	16	16	16				16	16	16															16			16									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	001	0		29	10	S4607_001_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											41.56	50	50	50				38.34	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	001	0		29	10	S4607_001_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	002	0		29	10	S4607_002_0	3	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	002	0		29	10	S4607_002_0	3	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	002	0		29	10	S4607_002_0	3	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											28.85	11	11	11				28.66	11	11	11				11	11	11															11			11									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	002	0		29	10	S4607_002_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											49.81	45	45	45				49.23	45	45	45				45	45	45															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	002	0		29	10	S4607_002_0	3	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	003	0		29	10	S4607_003_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	003	0		29	10	S4607_003_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	003	0		29	10	S4607_003_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											30.80	11	11	11				31.11	11	11	11				11	11	11															11			11									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	003	0		29	10	S4607_003_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											57.63	50	50	50				57.60	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	003	0		29	10	S4607_003_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	008	0		29	10	S4607_008_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	008	0		29	10	S4607_008_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	008	0		29	10	S4607_008_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											44.99	15	15	15				45.56	15	15	15				15	15	15															15			15									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	008	0		29	10	S4607_008_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											42.81	50	50	50				39.03	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	008	0		29	10	S4607_008_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	009	0		29	10	S4607_009_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	009	0		29	10	S4607_009_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	009	0		29	10	S4607_009_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											26.73	10	10	10				26.52	10	10	10				10	10	10															10			10									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	009	0		29	10	S4607_009_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											52.19	50	50	50				51.71	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	009	0		29	10	S4607_009_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	010	0		29	10	S4607_010_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	010	0		29	10	S4607_010_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	33.00					4.00	8.00	12.00					4.00	8.00	12.00																11.00				11.00			0.37	0.13	0.13			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	010	0		29	10	S4607_010_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											44.13	15	15	15				44.36	15	15	15				15	15	15															15			15									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	010	0		29	10	S4607_010_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											54.27	50	50	50				50.61	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	010	0		29	10	S4607_010_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	011	0		29	10	S4607_011_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	011	0		29	10	S4607_011_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	011	0		29	10	S4607_011_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											41.53	14	14	14				41.43	14	14	14				14	14	14															14			14									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	011	0		29	10	S4607_011_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											48.69	50	50	50				43.63	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	011	0		29	10	S4607_011_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	012	0		29	10	S4607_012_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	012	0		29	10	S4607_012_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	33.00					4.00	8.00	12.00					4.00	8.00	12.00																11.00				11.00			0.37	0.13	0.13			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	012	0		29	10	S4607_012_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											45.65	15	15	15				45.85	15	15	15				15	15	15															15			15									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	012	0		29	10	S4607_012_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											45.65	50	50	50				42.08	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	012	0		29	10	S4607_012_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	013	0		29	10	S4607_013_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	013	0		29	10	S4607_013_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	013	0		29	10	S4607_013_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											45.77	16	16	16				45.94	16	16	16				16	16	16															16			16									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	013	0		29	10	S4607_013_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											53.25	50	50	50				50.43	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	013	0		29	10	S4607_013_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	014	0		29	10	S4607_014_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	6.00																9.00				9.00			0.30	0.07	0.07			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	014	0		29	10	S4607_014_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	33.00					4.00	8.00	12.00					4.00	8.00	12.00																11.00				11.00			0.37	0.13	0.13			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	014	0		29	10	S4607_014_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											42.72	14	14	14				42.39	14	14	14				14	14	14															14			14									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	014	0		29	10	S4607_014_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											51.41	50	50	50				45.52	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	014	0		29	10	S4607_014_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	015	0		29	10	S4607_015_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	015	0		29	10	S4607_015_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	33.00					4.00	8.00	12.00					4.00	8.00	12.00																11.00				11.00			0.37	0.13	0.13			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	015	0		29	10	S4607_015_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											44.53	15	15	15				44.15	15	15	15				15	15	15															15			15									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	015	0		29	10	S4607_015_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											45.48	50	50	50				40.38	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	015	0		29	10	S4607_015_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	016	0		29	10	S4607_016_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					2.00	4.00	6.00																9.00				9.00			0.30	0.07	0.07			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	016	0		29	10	S4607_016_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	016	0		29	10	S4607_016_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											46.35	15	15	15				45.90	15	15	15				15	15	15															15			15									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	016	0		29	10	S4607_016_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											43.65	50	50	50				40.65	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	016	0		29	10	S4607_016_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	017	0		29	10	S4607_017_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	017	0		29	10	S4607_017_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	017	0		29	10	S4607_017_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											42.94	14	14	14				44.50	14	14	14				14	14	14															14			14									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	017	0		29	10	S4607_017_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											43.80	50	50	50				37.85	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	017	0		29	10	S4607_017_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	018	0		29	10	S4607_018_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	018	0		29	10	S4607_018_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	018	0		29	10	S4607_018_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											44.49	15	15	15				44.54	15	15	15				15	15	15															15			15									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	018	0		29	10	S4607_018_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											49.45	50	50	50				45.24	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	018	0		29	10	S4607_018_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	019	0		29	10	S4607_019_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	019	0		29	10	S4607_019_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	33.00					4.00	8.00	12.00					4.00	8.00	12.00																11.00				11.00			0.37	0.13	0.13			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	019	0		29	10	S4607_019_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											39.19	13	13	13				39.79	13	13	13				13	13	13															13			13									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	019	0		29	10	S4607_019_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											49.41	50	50	50				44.34	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	019	0		29	10	S4607_019_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	020	0		29	10	S4607_020_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	020	0		29	10	S4607_020_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	33.00					4.00	8.00	12.00					4.00	8.00	12.00																11.00				11.00			0.37	0.13	0.13			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	020	0		29	10	S4607_020_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											45.70	16	16	16				46.06	16	16	16				16	16	16															16			16									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	020	0		29	10	S4607_020_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											45.92	50	50	50				42.46	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	020	0		29	10	S4607_020_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	021	0		29	10	S4607_021_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	021	0		29	10	S4607_021_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	021	0		29	10	S4607_021_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											38.27	13	13	13				37.89	13	13	13				13	13	13															13			13									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	021	0		29	10	S4607_021_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											48.51	50	50	50				46.15	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	021	0		29	10	S4607_021_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	022	0		29	10	S4607_022_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	022	0		29	10	S4607_022_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	022	0		29	10	S4607_022_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											40.29	13	13	13				41.05	13	13	13				13	13	13															13			13									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	022	0		29	10	S4607_022_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											52.19	50	50	50				48.52	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	022	0		29	10	S4607_022_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	023	0		29	10	S4607_023_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	023	0		29	10	S4607_023_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	023	0		29	10	S4607_023_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											39.78	14	14	14				39.05	14	14	14				14	14	14															14			14									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	023	0		29	10	S4607_023_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											56.48	50	50	50				49.10	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	023	0		29	10	S4607_023_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	024	0		29	10	S4607_024_0	2	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	024	0		29	10	S4607_024_0	2	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	33.00					4.00	8.00	12.00					4.00	8.00	12.00																11.00				11.00			0.37	0.13	0.13			0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	024	0		29	10	S4607_024_0	2	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											46.25	15	15	15				46.54	15	15	15				15	15	15															15			15									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	024	0		29	10	S4607_024_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											52.92	50	50	50				46.35	50	50	50				50	50	50															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4607	024	0		29	10	S4607_024_0	2	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	012	0		29	10	S4802_012_0	4	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	012	0		29	10	S4802_012_0	4	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		2.50				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	012	0		29	10	S4802_012_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					33.00		99.00											45.00		135.00				33.00		82.50				45.00				45.00			1.50	1.10		1.50	1.10	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	012	0		29	10	S4802_012_0	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.46	50		50				74.31	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	012	0		29	10	S4802_012_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											480.35	25						480.35	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	013	0		29	10	S4802_013_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	013	0		29	10	S4802_013_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	013	0		29	10	S4802_013_0	2	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								41.00		123.00					30.00		90.00											41.00		123.00				30.00		75.00				41.00				41.00			1.37	1.00		1.37	1.00	1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	013	0		29	10	S4802_013_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											95.59	50		50				80.30	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	013	0		29	10	S4802_013_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											502.93	25						502.93	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	014	0		29	10	S4802_014_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					8.00		24.00											19.00		57.00				8.00		0.00				19.00				19.00			0.63	0.27		0.63	0.27	0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	014	0		29	10	S4802_014_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		37.50				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	014	0		29	10	S4802_014_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	014	0		29	10	S4802_014_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											81.97	50		50				81.97	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	014	0		29	10	S4802_014_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											727.42	33						727.42	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	020	0		29	10	S4802_020_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	020	0		29	10	S4802_020_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		2.50				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	020	0		29	10	S4802_020_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								41.00		123.00					29.00		87.00											41.00		123.00				29.00		72.50				41.00				41.00			1.37	0.97		1.37	0.97	1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	020	0		29	10	S4802_020_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											84.61	50		50				57.53	34		34										50		50				34		34			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	020	0		29	10	S4802_020_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											524.22	25						524.22	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	021	0		29	10	S4802_021_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	021	0		29	10	S4802_021_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		2.50				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	021	0		29	10	S4802_021_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					33.00		99.00											45.00		135.00				33.00		82.50				45.00				45.00			1.50	1.10		1.50	1.10	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	021	0		29	10	S4802_021_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											90.48	50		50				76.00	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	021	0		29	10	S4802_021_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											523.84	25						523.84	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	069	0		29	10	S4802_069_0	3	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	069	0		29	10	S4802_069_0	3	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	069	0		29	10	S4802_069_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	069	0		29	10	S4802_069_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											89.12	50		50				83.77	47		47										50		50				47		47			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	069	0		29	10	S4802_069_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											500.83	25						500.83	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	070	0		29	10	S4802_070_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	070	0		29	10	S4802_070_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	070	0		29	10	S4802_070_0	2	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					33.00		99.00											47.00		141.00				33.00		82.50				47.00				47.00			1.57	1.10		1.57	1.10	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	070	0		29	10	S4802_070_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											76.97	50		50				67.73	44		44										50		50				44		44			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	070	0		29	10	S4802_070_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											536.17	25						536.17	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	071	0		29	10	S4802_071_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	071	0		29	10	S4802_071_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		2.50				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	071	0		29	10	S4802_071_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	071	0		29	10	S4802_071_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.41	50		50				74.27	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	071	0		29	10	S4802_071_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											521.65	25						521.65	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	072	0		29	10	S4802_072_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					5.00		15.00											19.00		57.00				5.00		0.00				19.00				19.00			0.63	0.17		0.63	0.17	0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	072	0		29	10	S4802_072_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		37.50				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	072	0		29	10	S4802_072_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	072	0		29	10	S4802_072_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											81.35	50		50				78.10	48		48										50		50				48		48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	072	0		29	10	S4802_072_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											691.81	33						691.81	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	073	0		29	10	S4802_073_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	073	0		29	10	S4802_073_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	073	0		29	10	S4802_073_0	2	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								43.00		129.00					29.00		87.00											43.00		129.00				29.00		72.50				43.00				43.00			1.43	0.97		1.43	0.97	1.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	073	0		29	10	S4802_073_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											81.78	50		50				50.70	31		31										50		50				31		31			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	073	0		29	10	S4802_073_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											517.69	25						517.69	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	074	0		29	10	S4802_074_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	074	0		29	10	S4802_074_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	074	0		29	10	S4802_074_0	2	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								44.00		132.00					29.00		87.00											44.00		132.00				29.00		72.50				44.00				44.00			1.47	0.97		1.47	0.97	1.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	074	0		29	10	S4802_074_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											83.94	50		50				70.51	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	074	0		29	10	S4802_074_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											521.29	25						521.29	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	075	0		29	10	S4802_075_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	075	0		29	10	S4802_075_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	075	0		29	10	S4802_075_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	075	0		29	10	S4802_075_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											89.03	50		50				85.47	48		48										50		50				48		48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	075	0		29	10	S4802_075_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											467.48	25						467.48	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	076	0		29	10	S4802_076_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	076	0		29	10	S4802_076_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					1.00		3.00											8.00		24.00				1.00		2.50				8.00				8.00			0.27	0.03		0.27	0.03	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	076	0		29	10	S4802_076_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	076	0		29	10	S4802_076_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											94.04	50		50				78.99	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	076	0		29	10	S4802_076_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											495.47	25						495.47	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	077	0		29	10	S4802_077_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	077	0		29	10	S4802_077_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		2.50				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	077	0		29	10	S4802_077_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	077	0		29	10	S4802_077_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.44	50		50				97.18	48		48										50		50				48		48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	077	0		29	10	S4802_077_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											479.06	25						479.06	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	078	0		29	10	S4802_078_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	078	0		29	10	S4802_078_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					1.00		3.00											20.00		60.00				1.00		2.50				20.00				20.00			0.67	0.03		0.67	0.03	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	078	0		29	10	S4802_078_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	078	0		29	10	S4802_078_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											95.44	50		50				91.62	48		48										50		50				48		48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	078	0		29	10	S4802_078_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											484.95	25						484.95	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	079	0		29	10	S4802_079_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	079	0		29	10	S4802_079_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	079	0		29	10	S4802_079_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	079	0		29	10	S4802_079_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											86.00	50		50				82.56	48		48										50		50				48		48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	079	0		29	10	S4802_079_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											543.03	25						543.03	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	080	0		29	10	S4802_080_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	080	0		29	10	S4802_080_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		2.50				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	080	0		29	10	S4802_080_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	080	0		29	10	S4802_080_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.78	50		50				88.11	48		48										50		50				48		48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	080	0		29	10	S4802_080_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											476.44	25						476.44	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	081	0		29	10	S4802_081_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	081	0		29	10	S4802_081_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		5.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	081	0		29	10	S4802_081_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	081	0		29	10	S4802_081_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											83.73	50		50				80.38	48		48										50		50				48		48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	081	0		29	10	S4802_081_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											519.89	25						519.89	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	082	0		29	10	S4802_082_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	082	0		29	10	S4802_082_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	082	0		29	10	S4802_082_0	2	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								44.00		132.00					31.00		93.00											44.00		132.00				31.00		77.50				44.00				44.00			1.47	1.03		1.47	1.03	1.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	082	0		29	10	S4802_082_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											76.68	50		50				64.41	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	082	0		29	10	S4802_082_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											567.85	25						567.85	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	083	0		29	10	S4802_083_0	3	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	083	0		29	10	S4802_083_0	3	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	083	0		29	10	S4802_083_0	3	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								44.00		132.00					29.00		87.00											44.00		132.00				29.00		72.50				44.00				44.00			1.47	0.97		1.47	0.97	1.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	083	0		29	10	S4802_083_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											86.65	50		50				65.86	38		38										50		50				38		38			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	083	0		29	10	S4802_083_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											539.53	25						539.53	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	084	0		29	10	S4802_084_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	084	0		29	10	S4802_084_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		2.50				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	084	0		29	10	S4802_084_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	084	0		29	10	S4802_084_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.30	50		50				83.41	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	084	0		29	10	S4802_084_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											524.79	25						524.79	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	085	0		29	10	S4802_085_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	085	0		29	10	S4802_085_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		2.50				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	085	0		29	10	S4802_085_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	085	0		29	10	S4802_085_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.40	50		50				81.82	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	085	0		29	10	S4802_085_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											508.15	25						508.15	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	086	0		29	10	S4802_086_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	086	0		29	10	S4802_086_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	086	0		29	10	S4802_086_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	086	0		29	10	S4802_086_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.08	50		50				76.51	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	086	0		29	10	S4802_086_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											538.42	25						538.42	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	087	0		29	10	S4802_087_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	087	0		29	10	S4802_087_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	087	0		29	10	S4802_087_0	2	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								42.00		126.00					29.00		87.00											42.00		126.00				29.00		72.50				42.00				42.00			1.40	0.97		1.40	0.97	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	087	0		29	10	S4802_087_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											85.49	47		47				69.12	38		38										47		47				38		38			47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	087	0		29	10	S4802_087_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											542.17	25						542.17	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	088	0		29	10	S4802_088_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	088	0		29	10	S4802_088_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	088	0		29	10	S4802_088_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	088	0		29	10	S4802_088_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.97	50		50				79.65	48		48										50		50				48		48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	088	0		29	10	S4802_088_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											567.75	25						567.75	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	089	0		29	10	S4802_089_0	3	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	089	0		29	10	S4802_089_0	3	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		5.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	089	0		29	10	S4802_089_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	089	0		29	10	S4802_089_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											84.26	50		50				80.89	48		48										50		50				48		48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	089	0		29	10	S4802_089_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											497.18	25						497.18	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	090	0		29	10	S4802_090_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	090	0		29	10	S4802_090_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		2.50				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	090	0		29	10	S4802_090_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	090	0		29	10	S4802_090_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											80.41	50		50				67.54	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	090	0		29	10	S4802_090_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											549.11	25						549.11	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	091	0		29	10	S4802_091_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	091	0		29	10	S4802_091_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					1.00		3.00											9.00		27.00				1.00		2.50				9.00				9.00			0.30	0.03		0.30	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	091	0		29	10	S4802_091_0	2	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								39.00		117.00					25.00		75.00											39.00		117.00				25.00		62.50				39.00				39.00			1.30	0.83		1.30	0.83	1.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	091	0		29	10	S4802_091_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											78.05	44		44				60.31	34		34										44		44				34		34			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	091	0		29	10	S4802_091_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											486.07	25						486.07	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	092	0		29	10	S4802_092_0	3	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	092	0		29	10	S4802_092_0	3	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					1.00		3.00											7.00		21.00				1.00		2.50				7.00				7.00			0.23	0.03		0.23	0.03	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	092	0		29	10	S4802_092_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	092	0		29	10	S4802_092_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											80.14	50		50				67.32	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	092	0		29	10	S4802_092_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											510.68	25						510.68	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	093	0		29	10	S4802_093_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	093	0		29	10	S4802_093_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	093	0		29	10	S4802_093_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	093	0		29	10	S4802_093_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											81.32	50		50				78.07	48		48										50		50				48		48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	093	0		29	10	S4802_093_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											525.59	25						525.59	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	094	0		29	10	S4802_094_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	094	0		29	10	S4802_094_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					1.00		3.00											11.00		33.00				1.00		2.50				11.00				11.00			0.37	0.03		0.37	0.03	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	094	0		29	10	S4802_094_0	2	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					32.00		96.00											47.00		141.00				32.00		80.00				47.00				47.00			1.57	1.07		1.57	1.07	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	094	0		29	10	S4802_094_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.21	50		50				87.31	44		44										50		50				44		44			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	094	0		29	10	S4802_094_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											514.55	25						514.55	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	095	0		29	10	S4802_095_0	3	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	095	0		29	10	S4802_095_0	3	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					1.00		3.00											12.00		36.00				1.00		2.50				12.00				12.00			0.40	0.03		0.40	0.03	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	095	0		29	10	S4802_095_0	3	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					34.00		102.00											47.00		141.00				34.00		85.00				47.00				47.00			1.57	1.13		1.57	1.13	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	095	0		29	10	S4802_095_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.07	50		50				91.15	46		46										50		50				46		46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	095	0		29	10	S4802_095_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											485.12	25						485.12	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	096	0		29	10	S4802_096_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	096	0		29	10	S4802_096_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					1.00		3.00											9.00		27.00				1.00		2.50				9.00				9.00			0.30	0.03		0.30	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	096	0		29	10	S4802_096_0	2	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					33.00		99.00											45.00		135.00				33.00		82.50				45.00				45.00			1.50	1.10		1.50	1.10	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	096	0		29	10	S4802_096_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											83.06	50		50				66.45	40		40										50		50				40		40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	096	0		29	10	S4802_096_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											580.28	25						580.28	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	097	0		29	10	S4802_097_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	097	0		29	10	S4802_097_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					2.00		6.00											19.00		57.00				2.00		5.00				19.00				19.00			0.63	0.07		0.63	0.07	0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	097	0		29	10	S4802_097_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	097	0		29	10	S4802_097_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.88	50		50				94.64	47		47										50		50				47		47			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	097	0		29	10	S4802_097_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											550.33	25						550.33	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	098	0		29	10	S4802_098_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	098	0		29	10	S4802_098_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	098	0		29	10	S4802_098_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					24.00		72.00											47.00		141.00				24.00		60.00				47.00				47.00			1.57	0.80		1.57	0.80	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	098	0		29	10	S4802_098_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											54.92	50		50				32.95	30		30										50		50				30		30			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	098	0		29	10	S4802_098_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											558.17	33						558.17	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	099	0		29	10	S4802_099_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	099	0		29	10	S4802_099_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	099	0		29	10	S4802_099_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					34.00		102.00											47.00		141.00				34.00		85.00				47.00				47.00			1.57	1.13		1.57	1.13	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	099	0		29	10	S4802_099_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											60.31	50		50				42.22	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	099	0		29	10	S4802_099_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											600.83	33						600.83	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	100	0		29	10	S4802_100_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	100	0		29	10	S4802_100_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	100	0		29	10	S4802_100_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	100	0		29	10	S4802_100_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.54	50		50				41.68	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	100	0		29	10	S4802_100_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											748.06	33						748.06	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	101	0		29	10	S4802_101_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	101	0		29	10	S4802_101_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	101	0		29	10	S4802_101_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	101	0		29	10	S4802_101_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.34	50		50				43.64	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	101	0		29	10	S4802_101_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											609.07	33						609.07	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	102	0		29	10	S4802_102_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	102	0		29	10	S4802_102_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	102	0		29	10	S4802_102_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	102	0		29	10	S4802_102_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											49.39	50		50				34.57	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	102	0		29	10	S4802_102_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											674.80	33						674.80	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	103	0		29	10	S4802_103_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	103	0		29	10	S4802_103_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	103	0		29	10	S4802_103_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	103	0		29	10	S4802_103_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											52.46	50		50				36.72	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	103	0		29	10	S4802_103_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											764.26	33						764.26	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	104	0		29	10	S4802_104_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	104	0		29	10	S4802_104_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	104	0		29	10	S4802_104_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					33.00		99.00											47.00		141.00				33.00		82.50				47.00				47.00			1.57	1.10		1.57	1.10	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	104	0		29	10	S4802_104_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											47.70	50		50				38.16	40		40										50		50				40		40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	104	0		29	10	S4802_104_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											519.96	33						519.96	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	105	0		29	10	S4802_105_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	105	0		29	10	S4802_105_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	105	0		29	10	S4802_105_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	105	0		29	10	S4802_105_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											49.66	50		50				39.73	40		40										50		50				40		40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	105	0		29	10	S4802_105_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											674.45	33						674.45	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	106	0		29	10	S4802_106_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	106	0		29	10	S4802_106_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	106	0		29	10	S4802_106_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	106	0		29	10	S4802_106_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											45.85	50		50				36.68	40		40										50		50				40		40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	106	0		29	10	S4802_106_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											590.08	33						590.08	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	107	0		29	10	S4802_107_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	107	0		29	10	S4802_107_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	107	0		29	10	S4802_107_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	107	0		29	10	S4802_107_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											44.36	50		50				31.05	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	107	0		29	10	S4802_107_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											656.51	33						656.51	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	108	0		29	10	S4802_108_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	108	0		29	10	S4802_108_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	108	0		29	10	S4802_108_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		75.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	108	0		29	10	S4802_108_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											53.64	50		50				37.54	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	108	0		29	10	S4802_108_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											703.67	33						703.67	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	109	0		29	10	S4802_109_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	109	0		29	10	S4802_109_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	109	0		29	10	S4802_109_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					34.00		102.00											47.00		141.00				34.00		85.00				47.00				47.00			1.57	1.13		1.57	1.13	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	109	0		29	10	S4802_109_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											46.58	50		50				27.95	30		30										50		50				30		30			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	109	0		29	10	S4802_109_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											713.84	33						713.84	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	110	0		29	10	S4802_110_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	110	0		29	10	S4802_110_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	110	0		29	10	S4802_110_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		72.50				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	110	0		29	10	S4802_110_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											49.21	50		50				34.45	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	110	0		29	10	S4802_110_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											704.91	33						704.91	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	111	0		29	10	S4802_111_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	111	0		29	10	S4802_111_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	111	0		29	10	S4802_111_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		75.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	111	0		29	10	S4802_111_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											48.92	50		50				34.24	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	111	0		29	10	S4802_111_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											586.21	33						586.21	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	112	0		29	10	S4802_112_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	112	0		29	10	S4802_112_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	112	0		29	10	S4802_112_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					34.00		102.00											47.00		141.00				34.00		85.00				47.00				47.00			1.57	1.13		1.57	1.13	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	112	0		29	10	S4802_112_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											51.43	50		50				36.00	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	112	0		29	10	S4802_112_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											766.09	33						766.09	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	113	0		29	10	S4802_113_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	113	0		29	10	S4802_113_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	113	0		29	10	S4802_113_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		75.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	113	0		29	10	S4802_113_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											56.85	50		50				39.79	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	113	0		29	10	S4802_113_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											648.78	33						648.78	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	114	0		29	10	S4802_114_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	114	0		29	10	S4802_114_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		5.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	114	0		29	10	S4802_114_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	114	0		29	10	S4802_114_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											52.04	50		50				46.83	45		45										50		50				45		45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	114	0		29	10	S4802_114_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											776.42	33						776.42	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	115	0		29	10	S4802_115_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	115	0		29	10	S4802_115_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	115	0		29	10	S4802_115_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					28.00		84.00											47.00		141.00				28.00		70.00				47.00				47.00			1.57	0.93		1.57	0.93	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	115	0		29	10	S4802_115_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											43.28	50		50				25.97	30		30										50		50				30		30			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	115	0		29	10	S4802_115_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											735.67	33						735.67	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	116	0		29	10	S4802_116_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	116	0		29	10	S4802_116_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	116	0		29	10	S4802_116_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					33.00		99.00											47.00		141.00				33.00		82.50				47.00				47.00			1.57	1.10		1.57	1.10	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	116	0		29	10	S4802_116_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											47.64	50		50				33.35	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	116	0		29	10	S4802_116_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											666.99	33						666.99	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	118	0		29	10	S4802_118_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	118	0		29	10	S4802_118_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	118	0		29	10	S4802_118_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					32.00		96.00											47.00		141.00				32.00		80.00				47.00				47.00			1.57	1.07		1.57	1.07	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	118	0		29	10	S4802_118_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											50.47	50		50				40.38	40		40										50		50				40		40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	118	0		29	10	S4802_118_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											693.37	33						693.37	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	119	0		29	10	S4802_119_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	119	0		29	10	S4802_119_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.10		0.67	0.10	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	119	0		29	10	S4802_119_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	119	0		29	10	S4802_119_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											53.14	50		50				47.82	45		45										50		50				45		45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	119	0		29	10	S4802_119_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											643.09	33						643.09	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	120	0		29	10	S4802_120_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	120	0		29	10	S4802_120_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	120	0		29	10	S4802_120_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	120	0		29	10	S4802_120_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											60.74	50		50				42.52	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	120	0		29	10	S4802_120_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											701.57	33						701.57	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	121	0		29	10	S4802_121_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	121	0		29	10	S4802_121_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	121	0		29	10	S4802_121_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	121	0		29	10	S4802_121_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											56.30	50		50				45.04	40		40										50		50				40		40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	121	0		29	10	S4802_121_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											639.98	33						639.98	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	122	0		29	10	S4802_122_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	122	0		29	10	S4802_122_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	122	0		29	10	S4802_122_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		72.50				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	122	0		29	10	S4802_122_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											63.83	50		50				44.68	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	122	0		29	10	S4802_122_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											623.88	33						623.88	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	123	0		29	10	S4802_123_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	123	0		29	10	S4802_123_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	123	0		29	10	S4802_123_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					28.00		84.00											47.00		141.00				28.00		70.00				47.00				47.00			1.57	0.93		1.57	0.93	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	123	0		29	10	S4802_123_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											55.03	50		50				33.02	30		30										50		50				30		30			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	123	0		29	10	S4802_123_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											781.08	33						781.08	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	125	0		29	10	S4802_125_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	125	0		29	10	S4802_125_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	125	0		29	10	S4802_125_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					24.00		72.00											47.00		141.00				24.00		60.00				47.00				47.00			1.57	0.80		1.57	0.80	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	125	0		29	10	S4802_125_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											64.77	50		50				38.86	30		30										50		50				30		30			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	125	0		29	10	S4802_125_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											559.63	33						559.63	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	127	0		29	10	S4802_127_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	127	0		29	10	S4802_127_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	127	0		29	10	S4802_127_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	127	0		29	10	S4802_127_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											53.83	50		50				32.30	30		30										50		50				30		30			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	127	0		29	10	S4802_127_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											737.25	33						737.25	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	128	0		29	10	S4802_128_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	128	0		29	10	S4802_128_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	128	0		29	10	S4802_128_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					32.00		96.00											47.00		141.00				32.00		80.00				47.00				47.00			1.57	1.07		1.57	1.07	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	128	0		29	10	S4802_128_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											54.78	50		50				43.82	40		40										50		50				40		40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	128	0		29	10	S4802_128_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											737.02	33						737.02	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	129	0		29	10	S4802_129_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	129	0		29	10	S4802_129_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	129	0		29	10	S4802_129_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	129	0		29	10	S4802_129_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											63.02	50		50				50.41	40		40										50		50				40		40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	129	0		29	10	S4802_129_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											685.56	33						685.56	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	130	0		29	10	S4802_130_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	130	0		29	10	S4802_130_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	130	0		29	10	S4802_130_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	130	0		29	10	S4802_130_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											67.62	50		50				47.33	35		35										50		50				35		35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	130	0		29	10	S4802_130_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											687.71	33						687.71	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	132	0		29	10	S4802_132_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	132	0		29	10	S4802_132_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	132	0		29	10	S4802_132_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		75.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	132	0		29	10	S4802_132_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.26	50		50				49.81	40		40										50		50				40		40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	132	0		29	10	S4802_132_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											540.24	25						540.24	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	133	0		29	10	S4802_133_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	133	0		29	10	S4802_133_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	133	0		29	10	S4802_133_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		75.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	133	0		29	10	S4802_133_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.72	50		50				37.63	30		30										50		50				30		30			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	133	0		29	10	S4802_133_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											538.65	25						538.65	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	134	0		29	10	S4802_134_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	134	0		29	10	S4802_134_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	134	0		29	10	S4802_134_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		72.50				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	134	0		29	10	S4802_134_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.44	50		50				37.46	30		30										50		50				30		30			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	134	0		29	10	S4802_134_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											539.89	25						539.89	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	135	0		29	10	S4802_135_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	135	0		29	10	S4802_135_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	135	0		29	10	S4802_135_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					25.00		75.00											47.00		141.00				25.00		62.50				47.00				47.00			1.57	0.83		1.57	0.83	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	135	0		29	10	S4802_135_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.69	50		50				31.34	25		25										50		50				25		25			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S4802	135	0		29	10	S4802_135_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											538.64	25						538.64	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5540	002	0		29	10	S5540_002_0	5	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5540	002	0		29	10	S5540_002_0	5	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	24.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5540	002	0		29	10	S5540_002_0	5	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5540	002	0		29	10	S5540_002_0	5	Non-Preferred Brand	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											84.79	50	50	50				84.79	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5540	002	0		29	10	S5540_002_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											799.24	25						799.24	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5540	004	0		29	10	S5540_004_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5540	004	0		29	10	S5540_004_0	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5540	004	0		29	10	S5540_004_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5540	004	0		29	10	S5540_004_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					30.00	60.00	90.00											45.00	90.00	135.00				30.00	60.00	90.00				45.00				45.00			1.50	1.00		1.50	1.00	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5540	004	0		29	10	S5540_004_0	5	Non-Preferred Brand	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											66.42	50	50	50				66.42	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5540	004	0		29	10	S5540_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1015.32	33						1015.32	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5552	003	0		29	10	S5552_003_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	003	0		29	10	S5552_003_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	003	0		29	10	S5552_003_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	003	0		29	10	S5552_003_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5552	003	0		29	10	S5552_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	50		50				63.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	003	0		29	10	S5552_003_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5552	003	0		29	10	S5552_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	004	0		29	10	S5552_004_0	2	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	004	0		29	10	S5552_004_0	2	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	004	0		29	10	S5552_004_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	20		20				26.00	20		20										20		20				20		15			20			20								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	004	0		29	10	S5552_004_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	35		35				59.00	35		35										35		35				35		30			35			35								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	004	0		29	10	S5552_004_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	005	0		29	10	S5552_005_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	005	0		29	10	S5552_005_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					4.00		12.00											15.00		45.00				4.00		8.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	005	0		29	10	S5552_005_0	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	25		25				33.00	25		25										25		25				25		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	005	0		29	10	S5552_005_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	44		44				48.00	35		35										44		44				35		30			44			44								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5552	005	0		29	10	S5552_005_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5584	001	0		29	10	S5584_001_0	5	Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5584	001	0		29	10	S5584_001_0	5	Generic	3	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		33.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5584	001	0		29	10	S5584_001_0	5	Preferred Brand	3	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5584	001	0		29	10	S5584_001_0	5	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											55.00	50		50				53.00	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5584	001	0		29	10	S5584_001_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5584	002	0		29	10	S5584_002_0	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5584	002	0		29	10	S5584_002_0	5	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		15.00				10.00				10.00			0.32	0.16		0.32	0.16	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5584	002	0		29	10	S5584_002_0	5	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		120.00				45.00				45.00			1.45	1.29		1.45	1.29	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5584	002	0		29	10	S5584_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											42.00	45		45				41.00	45		45										45		45				45		45			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5584	002	0		29	10	S5584_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5593	002	0		29	10	S5593_002_0	7	Preferred Generic	2	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													12.50						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5593	002	0		29	10	S5593_002_0	7	Generic	2	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					5.00		15.00													25.00						12.50				10.00				10.00			0.32	0.16				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5593	002	0		29	10	S5593_002_0	7	Preferred Brand	2	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											45.53	25		25				45.53	20		20												25						20			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5593	002	0		29	10	S5593_002_0	7	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											58.54	50		50				58.54	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5593	002	0		29	10	S5593_002_0	7	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31											1171.99	25						1171.99	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5593	003	0		29	10	S5593_003_0	6	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													12.50						0.00				5.00				5.00			0.16	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5593	003	0		29	10	S5593_003_0	6	Preferred Generic	4	01	1	1	1	3		110	01		100	1				31		90	1	2						90	31		31											2.81	24		24				2.81	19		19												24						19			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5593	003	0		29	10	S5593_003_0	6	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					5.00		15.00													25.00						12.50				10.00				10.00			0.32	0.16				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5593	003	0		29	10	S5593_003_0	6	Generic	4	01	1	1	2	3		110	01		100	1				31		90	1	2						90	31		31											11.02	24		24				11.02	19		19												24						19			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5593	003	0		29	10	S5593_003_0	6	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								45.00		135.00					40.00		120.00													112.50						100.00				45.00				45.00			1.45	1.29				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5593	003	0		29	10	S5593_003_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											62.63	50		50				62.63	35		35												50						35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5593	003	0		29	10	S5593_003_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1531.28	33						1531.28	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5596	001	0		29	10	S5596_001_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	001	0		29	10	S5596_001_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	001	0		29	10	S5596_001_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	001	0		29	10	S5596_001_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	001	0		29	10	S5596_001_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											90.82	47	47	47				75.37	39	39	39				39	39	39															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	001	0		29	10	S5596_001_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	001	0		29	10	S5596_001_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	001	0		29	10	S5596_001_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	003	0		29	10	S5596_003_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	003	0		29	10	S5596_003_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	003	0		29	10	S5596_003_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	003	0		29	10	S5596_003_0	1	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	003	0		29	10	S5596_003_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					28.00	56.00	84.00					28.00	84.00	84.00																47.00				47.00			1.57	0.93	0.93			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	003	0		29	10	S5596_003_0	1	Preferred Brand	4	11	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											127.98	28	28	28				125.65	27	27	27				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	1	
S5596	003	0		29	10	S5596_003_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											93.54	40	40	40				81.84	35	35	35				35	35	35															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	003	0		29	10	S5596_003_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	003	0		29	10	S5596_003_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	003	0		29	10	S5596_003_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	005	0		29	10	S5596_005_0	2	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	3.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	005	0		29	10	S5596_005_0	2	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					6.00	12.00	18.00					6.00	18.00	18.00																20.00				20.00			0.67	0.20	0.20			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	005	0		29	10	S5596_005_0	2	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					38.00	76.00	114.00					38.00	114.00	114.00																47.00				47.00			1.57	1.27	1.27			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	005	0		29	10	S5596_005_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											69.73	50	50	50				55.78	40	40	40				40	40	40															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	005	0		29	10	S5596_005_0	2	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	005	0		29	10	S5596_005_0	2	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	006	0		29	10	S5596_006_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	006	0		29	10	S5596_006_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	006	0		29	10	S5596_006_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	006	0		29	10	S5596_006_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	006	0		29	10	S5596_006_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											91.28	47	47	47				75.74	39	39	39				39	39	39															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	006	0		29	10	S5596_006_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	006	0		29	10	S5596_006_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	006	0		29	10	S5596_006_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	007	0		29	10	S5596_007_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	007	0		29	10	S5596_007_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	007	0		29	10	S5596_007_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	007	0		29	10	S5596_007_0	1	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	007	0		29	10	S5596_007_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					28.00	56.00	84.00					28.00	84.00	84.00																47.00				47.00			1.57	0.93	0.93			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	007	0		29	10	S5596_007_0	1	Preferred Brand	4	11	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											126.08	28	28	28				123.79	27	27	27				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	1	
S5596	007	0		29	10	S5596_007_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											95.31	40	40	40				83.39	35	35	35				35	35	35															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	007	0		29	10	S5596_007_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	007	0		29	10	S5596_007_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	007	0		29	10	S5596_007_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	009	0		29	10	S5596_009_0	1	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					1.00	2.00	3.00					1.00	3.00	3.00																8.00				8.00			0.27	0.03	0.03			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	009	0		29	10	S5596_009_0	1	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					5.00	10.00	15.00					5.00	15.00	15.00																15.00				15.00			0.50	0.17	0.17			0.44		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	009	0		29	10	S5596_009_0	1	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								39.00	78.00	117.00					32.00	64.00	96.00					32.00	96.00	96.00																39.00				39.00			1.30	1.07	1.07			1.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	009	0		29	10	S5596_009_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											73.39	50	50	50				58.71	40	40	40				40	40	40															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	009	0		29	10	S5596_009_0	1	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	009	0		29	10	S5596_009_0	1	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	010	0		29	10	S5596_010_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	010	0		29	10	S5596_010_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	010	0		29	10	S5596_010_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	010	0		29	10	S5596_010_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	010	0		29	10	S5596_010_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											94.71	47	47	47				78.59	39	39	39				39	39	39															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	010	0		29	10	S5596_010_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	010	0		29	10	S5596_010_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	010	0		29	10	S5596_010_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	011	0		29	10	S5596_011_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	011	0		29	10	S5596_011_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	011	0		29	10	S5596_011_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	011	0		29	10	S5596_011_0	1	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	011	0		29	10	S5596_011_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					28.00	56.00	84.00					28.00	84.00	84.00																47.00				47.00			1.57	0.93	0.93			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	011	0		29	10	S5596_011_0	1	Preferred Brand	4	11	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											121.44	28	28	28				119.23	27	27	27				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	1	
S5596	011	0		29	10	S5596_011_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											97.95	40	40	40				85.70	35	35	35				35	35	35															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	011	0		29	10	S5596_011_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	011	0		29	10	S5596_011_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	011	0		29	10	S5596_011_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	013	0		29	10	S5596_013_0	1	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					1.00	2.00	3.00					1.00	3.00	3.00																17.00				17.00			0.57	0.03	0.03			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	013	0		29	10	S5596_013_0	1	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					6.00	12.00	18.00					6.00	18.00	18.00																19.00				19.00			0.63	0.20	0.20			0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	013	0		29	10	S5596_013_0	1	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					35.00	70.00	105.00					35.00	105.00	105.00																47.00				47.00			1.57	1.17	1.17			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	013	0		29	10	S5596_013_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											77.85	50	50	50				62.28	40	40	40				40	40	40															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	013	0		29	10	S5596_013_0	1	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	013	0		29	10	S5596_013_0	1	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	014	0		29	10	S5596_014_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	014	0		29	10	S5596_014_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	014	0		29	10	S5596_014_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	014	0		29	10	S5596_014_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	014	0		29	10	S5596_014_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											98.03	47	47	47				81.34	39	39	39				39	39	39															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	014	0		29	10	S5596_014_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	014	0		29	10	S5596_014_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	014	0		29	10	S5596_014_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	015	0		29	10	S5596_015_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	015	0		29	10	S5596_015_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	015	0		29	10	S5596_015_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	015	0		29	10	S5596_015_0	1	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	015	0		29	10	S5596_015_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					28.00	56.00	84.00					28.00	84.00	84.00																47.00				47.00			1.57	0.93	0.93			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	015	0		29	10	S5596_015_0	1	Preferred Brand	4	11	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											129.23	28	28	28				126.88	27	27	27				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	1	
S5596	015	0		29	10	S5596_015_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											98.21	40	40	40				85.93	35	35	35				35	35	35															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	015	0		29	10	S5596_015_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	015	0		29	10	S5596_015_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	015	0		29	10	S5596_015_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	017	0		29	10	S5596_017_0	1	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					1.00	2.00	3.00					1.00	3.00	3.00																8.00				8.00			0.27	0.03	0.03			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	017	0		29	10	S5596_017_0	1	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					5.00	10.00	15.00					5.00	15.00	15.00																17.00				17.00			0.57	0.17	0.17			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	017	0		29	10	S5596_017_0	1	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								38.00	76.00	114.00					30.00	60.00	90.00					30.00	90.00	90.00																38.00				38.00			1.27	1.00	1.00			1.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	017	0		29	10	S5596_017_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											74.94	50	50	50				59.95	40	40	40				40	40	40															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	017	0		29	10	S5596_017_0	1	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	017	0		29	10	S5596_017_0	1	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	018	0		29	10	S5596_018_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	018	0		29	10	S5596_018_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	018	0		29	10	S5596_018_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	018	0		29	10	S5596_018_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	018	0		29	10	S5596_018_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											86.32	47	47	47				71.62	39	39	39				39	39	39															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	018	0		29	10	S5596_018_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	018	0		29	10	S5596_018_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	018	0		29	10	S5596_018_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	019	0		29	10	S5596_019_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	019	0		29	10	S5596_019_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	019	0		29	10	S5596_019_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	019	0		29	10	S5596_019_0	1	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	019	0		29	10	S5596_019_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					28.00	56.00	84.00					28.00	84.00	84.00																47.00				47.00			1.57	0.93	0.93			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	019	0		29	10	S5596_019_0	1	Preferred Brand	4	11	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											122.51	28	28	28				120.28	27	27	27				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	1	
S5596	019	0		29	10	S5596_019_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											88.43	40	40	40				77.38	35	35	35				35	35	35															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	019	0		29	10	S5596_019_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	019	0		29	10	S5596_019_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	019	0		29	10	S5596_019_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	033	0		29	10	S5596_033_0	1	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					1.00	2.00	3.00					1.00	3.00	3.00																11.00				11.00			0.37	0.03	0.03			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	033	0		29	10	S5596_033_0	1	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								16.00	32.00	48.00					5.00	10.00	15.00					5.00	15.00	15.00																16.00				16.00			0.53	0.17	0.17			0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	033	0		29	10	S5596_033_0	1	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								39.00	78.00	117.00					30.00	60.00	90.00					30.00	90.00	90.00																39.00				39.00			1.30	1.00	1.00			1.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	033	0		29	10	S5596_033_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											85.10	48	48	48				70.91	40	40	40				40	40	40															48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	033	0		29	10	S5596_033_0	1	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	033	0		29	10	S5596_033_0	1	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	034	0		29	10	S5596_034_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	034	0		29	10	S5596_034_0	2	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	034	0		29	10	S5596_034_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	034	0		29	10	S5596_034_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	034	0		29	10	S5596_034_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											99.64	43	43	43				90.37	39	39	39				39	39	39															43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	034	0		29	10	S5596_034_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	034	0		29	10	S5596_034_0	2	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	034	0		29	10	S5596_034_0	2	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	035	0		29	10	S5596_035_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	035	0		29	10	S5596_035_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	035	0		29	10	S5596_035_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	035	0		29	10	S5596_035_0	1	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	035	0		29	10	S5596_035_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					28.00	56.00	84.00					28.00	84.00	84.00																47.00				47.00			1.57	0.93	0.93			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	035	0		29	10	S5596_035_0	1	Preferred Brand	4	11	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											124.21	28	28	28				121.95	27	27	27				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	1	
S5596	035	0		29	10	S5596_035_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											98.99	36	36	36				96.24	35	35	35				35	35	35															36			36									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	035	0		29	10	S5596_035_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	035	0		29	10	S5596_035_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	035	0		29	10	S5596_035_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	043	0		29	10	S5596_043_0	1	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					1.00	2.00	3.00					1.00	3.00	3.00																8.00				8.00			0.27	0.03	0.03			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	043	0		29	10	S5596_043_0	1	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								14.00	28.00	42.00					5.00	10.00	15.00					5.00	15.00	15.00																14.00				14.00			0.47	0.17	0.17			0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	043	0		29	10	S5596_043_0	1	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								38.00	76.00	114.00					31.00	62.00	93.00					31.00	93.00	93.00																38.00				38.00			1.27	1.03	1.03			1.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	043	0		29	10	S5596_043_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											64.86	47	47	47				55.20	40	40	40				40	40	40															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	043	0		29	10	S5596_043_0	1	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	043	0		29	10	S5596_043_0	1	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	044	0		29	10	S5596_044_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	044	0		29	10	S5596_044_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	044	0		29	10	S5596_044_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	044	0		29	10	S5596_044_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	044	0		29	10	S5596_044_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											85.84	47	47	47				71.23	39	39	39				39	39	39															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	044	0		29	10	S5596_044_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	044	0		29	10	S5596_044_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	044	0		29	10	S5596_044_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	045	0		29	10	S5596_045_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	045	0		29	10	S5596_045_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	045	0		29	10	S5596_045_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	045	0		29	10	S5596_045_0	1	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	045	0		29	10	S5596_045_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					28.00	56.00	84.00					28.00	84.00	84.00																47.00				47.00			1.57	0.93	0.93			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	045	0		29	10	S5596_045_0	1	Preferred Brand	4	11	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											122.24	28	28	28				120.02	27	27	27				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	1	
S5596	045	0		29	10	S5596_045_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											86.08	40	40	40				75.32	35	35	35				35	35	35															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	045	0		29	10	S5596_045_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	045	0		29	10	S5596_045_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	045	0		29	10	S5596_045_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	046	0		29	10	S5596_046_0	1	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					1.00	2.00	3.00					1.00	3.00	3.00																18.00				18.00			0.60	0.03	0.03			0.53		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	046	0		29	10	S5596_046_0	1	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					6.00	12.00	18.00					6.00	18.00	18.00																19.00				19.00			0.63	0.20	0.20			0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	046	0		29	10	S5596_046_0	1	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					35.00	70.00	105.00					35.00	105.00	105.00																47.00				47.00			1.57	1.17	1.17			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	046	0		29	10	S5596_046_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											86.63	50	50	50				69.30	40	40	40				40	40	40															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	046	0		29	10	S5596_046_0	1	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	046	0		29	10	S5596_046_0	1	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					0.00	0.00	0.00					0.00	0.00	0.00																8.00				8.00			0.27	0.00	0.00			0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	056	0		29	10	S5596_056_0	1	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	3.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	056	0		29	10	S5596_056_0	1	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					6.00	12.00	18.00					6.00	18.00	18.00																20.00				20.00			0.67	0.20	0.20			0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	056	0		29	10	S5596_056_0	1	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								39.00	78.00	117.00					32.00	64.00	96.00					32.00	96.00	96.00																39.00				39.00			1.30	1.07	1.07			1.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	056	0		29	10	S5596_056_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											68.31	43	43	43				63.55	40	40	40				40	40	40															43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	056	0		29	10	S5596_056_0	1	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	056	0		29	10	S5596_056_0	1	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	057	0		29	10	S5596_057_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	057	0		29	10	S5596_057_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	057	0		29	10	S5596_057_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	057	0		29	10	S5596_057_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	057	0		29	10	S5596_057_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											88.49	47	47	47				73.43	39	39	39				39	39	39															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	057	0		29	10	S5596_057_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	057	0		29	10	S5596_057_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	057	0		29	10	S5596_057_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	058	0		29	10	S5596_058_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	058	0		29	10	S5596_058_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	058	0		29	10	S5596_058_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	058	0		29	10	S5596_058_0	1	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	058	0		29	10	S5596_058_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					28.00	56.00	84.00					28.00	84.00	84.00																47.00				47.00			1.57	0.93	0.93			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	058	0		29	10	S5596_058_0	1	Preferred Brand	4	11	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											130.11	28	28	28				127.75	27	27	27				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	1	
S5596	058	0		29	10	S5596_058_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											93.88	40	40	40				82.14	35	35	35				35	35	35															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	058	0		29	10	S5596_058_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	058	0		29	10	S5596_058_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	058	0		29	10	S5596_058_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	059	0		29	10	S5596_059_0	1	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					1.00	2.00	3.00					1.00	3.00	3.00																18.00				18.00			0.60	0.03	0.03			0.53		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	059	0		29	10	S5596_059_0	1	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					5.00	10.00	15.00					5.00	15.00	15.00																19.00				19.00			0.63	0.17	0.17			0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	059	0		29	10	S5596_059_0	1	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					31.00	62.00	93.00					31.00	93.00	93.00																45.00				45.00			1.50	1.03	1.03			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	059	0		29	10	S5596_059_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											77.07	50	50	50				61.65	40	40	40				40	40	40															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	059	0		29	10	S5596_059_0	1	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	059	0		29	10	S5596_059_0	1	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	060	0		29	10	S5596_060_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	060	0		29	10	S5596_060_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	060	0		29	10	S5596_060_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	060	0		29	10	S5596_060_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	060	0		29	10	S5596_060_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											99.31	43	43	43				90.07	39	39	39				39	39	39															43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	060	0		29	10	S5596_060_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	060	0		29	10	S5596_060_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	060	0		29	10	S5596_060_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	061	0		29	10	S5596_061_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	061	0		29	10	S5596_061_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	061	0		29	10	S5596_061_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	061	0		29	10	S5596_061_0	1	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	061	0		29	10	S5596_061_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					28.00	56.00	84.00					28.00	84.00	84.00																47.00				47.00			1.57	0.93	0.93			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	061	0		29	10	S5596_061_0	1	Preferred Brand	4	11	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											131.92	28	28	28				129.52	27	27	27				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	1	
S5596	061	0		29	10	S5596_061_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											97.68	38	38	38				89.96	35	35	35				35	35	35															38			38									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	061	0		29	10	S5596_061_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	061	0		29	10	S5596_061_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	061	0		29	10	S5596_061_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	062	0		29	10	S5596_062_0	1	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								16.00	32.00	48.00					1.00	2.00	3.00					1.00	3.00	3.00																16.00				16.00			0.53	0.03	0.03			0.47		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	062	0		29	10	S5596_062_0	1	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					5.00	10.00	15.00					5.00	15.00	15.00																17.00				17.00			0.57	0.17	0.17			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	062	0		29	10	S5596_062_0	1	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								38.00	76.00	114.00					32.00	64.00	96.00					32.00	96.00	96.00																38.00				38.00			1.27	1.07	1.07			1.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	062	0		29	10	S5596_062_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											88.06	50	50	50				81.02	46	46	46				46	46	46															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	062	0		29	10	S5596_062_0	1	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	062	0		29	10	S5596_062_0	1	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					0.00	0.00	0.00					0.00	0.00	0.00																11.00				11.00			0.37	0.00	0.00			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	063	0		29	10	S5596_063_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	063	0		29	10	S5596_063_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	063	0		29	10	S5596_063_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	063	0		29	10	S5596_063_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	063	0		29	10	S5596_063_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											94.30	47	47	47				78.25	39	39	39				39	39	39															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	063	0		29	10	S5596_063_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	063	0		29	10	S5596_063_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	063	0		29	10	S5596_063_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	064	0		29	10	S5596_064_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	064	0		29	10	S5596_064_0	1	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	064	0		29	10	S5596_064_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	064	0		29	10	S5596_064_0	1	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5596	064	0		29	10	S5596_064_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					28.00	56.00	84.00					28.00	84.00	84.00																47.00				47.00			1.57	0.93	0.93			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	064	0		29	10	S5596_064_0	1	Preferred Brand	4	11	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											135.09	28	28	28				132.63	27	27	27				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	1	
S5596	064	0		29	10	S5596_064_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											98.88	37	37	37				93.53	35	35	35				35	35	35															37			37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	064	0		29	10	S5596_064_0	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	064	0		29	10	S5596_064_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5596	064	0		29	10	S5596_064_0	1	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5601	002	0		29	10	S5601_002_0	2	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	002	0		29	10	S5601_002_0	2	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					14.00	28.00	35.00											20.00	40.00	60.00				14.00	28.00	35.00				20.00				20.00			0.67	0.47		0.67	0.47	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	002	0		29	10	S5601_002_0	2	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					43.00	86.00	107.50											47.00	94.00	141.00				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	002	0		29	10	S5601_002_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											85.04	50	50	50				73.13	43	43	43										50	50	50				43	43	43			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	002	0		29	10	S5601_002_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											815.80	33						815.80	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	003	0		29	10	S5601_003_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	003	0		29	10	S5601_003_0	3	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	003	0		29	10	S5601_003_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	003	0		29	10	S5601_003_0	3	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	003	0		29	10	S5601_003_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	003	0		29	10	S5601_003_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											85.30	50	50	50				68.24	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	003	0		29	10	S5601_003_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											526.17	33						526.17	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	004	0		29	10	S5601_004_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	004	0		29	10	S5601_004_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					12.00	24.00	30.00											20.00	40.00	60.00				12.00	24.00	30.00				20.00				20.00			0.67	0.40		0.67	0.40	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	004	0		29	10	S5601_004_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					38.00	76.00	95.00											47.00	94.00	141.00				38.00	76.00	95.00				47.00				47.00			1.57	1.27		1.57	1.27	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	004	0		29	10	S5601_004_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											86.66	50	50	50				65.87	38	38	38										50	50	50				38	38	38			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	004	0		29	10	S5601_004_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											645.50	33						645.50	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	005	0		29	10	S5601_005_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	005	0		29	10	S5601_005_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	005	0		29	10	S5601_005_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	005	0		29	10	S5601_005_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	005	0		29	10	S5601_005_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	005	0		29	10	S5601_005_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											93.23	50	50	50				74.59	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	005	0		29	10	S5601_005_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											687.01	33						687.01	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	006	0		29	10	S5601_006_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	006	0		29	10	S5601_006_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					14.00	28.00	35.00											20.00	40.00	60.00				14.00	28.00	35.00				20.00				20.00			0.67	0.47		0.67	0.47	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	006	0		29	10	S5601_006_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					40.00	80.00	100.00											47.00	94.00	141.00				40.00	80.00	100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	006	0		29	10	S5601_006_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											96.17	50	50	50				84.63	44	44	44										50	50	50				44	44	44			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	006	0		29	10	S5601_006_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											597.84	33						597.84	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	007	0		29	10	S5601_007_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	007	0		29	10	S5601_007_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	007	0		29	10	S5601_007_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	007	0		29	10	S5601_007_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	007	0		29	10	S5601_007_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	007	0		29	10	S5601_007_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											95.48	50	50	50				76.38	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	007	0		29	10	S5601_007_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											690.22	33						690.22	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	008	0		29	10	S5601_008_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	008	0		29	10	S5601_008_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					14.00	28.00	35.00											20.00	40.00	60.00				14.00	28.00	35.00				20.00				20.00			0.67	0.47		0.67	0.47	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	008	0		29	10	S5601_008_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					43.00	86.00	107.50											47.00	94.00	141.00				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	008	0		29	10	S5601_008_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											89.29	50	50	50				82.15	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	008	0		29	10	S5601_008_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											615.15	33						615.15	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	009	0		29	10	S5601_009_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	009	0		29	10	S5601_009_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	009	0		29	10	S5601_009_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	009	0		29	10	S5601_009_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	009	0		29	10	S5601_009_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	009	0		29	10	S5601_009_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											94.81	50	50	50				75.85	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	009	0		29	10	S5601_009_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											676.04	33						676.04	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	010	0		29	10	S5601_010_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					9.00	18.00	22.50											10.00	20.00	30.00				9.00	18.00	0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	010	0		29	10	S5601_010_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					19.00	38.00	47.50											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	010	0		29	10	S5601_010_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					46.00	92.00	115.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	010	0		29	10	S5601_010_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											79.07	50	50	50				77.49	49	49	49										50	50	50				49	49	49			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	010	0		29	10	S5601_010_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											611.54	33						611.54	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	011	0		29	10	S5601_011_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	011	0		29	10	S5601_011_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	011	0		29	10	S5601_011_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	011	0		29	10	S5601_011_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	011	0		29	10	S5601_011_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	011	0		29	10	S5601_011_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											84.18	50	50	50				67.34	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	011	0		29	10	S5601_011_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											610.61	33						610.61	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	012	0		29	10	S5601_012_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	012	0		29	10	S5601_012_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					14.00	28.00	35.00											20.00	40.00	60.00				14.00	28.00	35.00				20.00				20.00			0.67	0.47		0.67	0.47	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	012	0		29	10	S5601_012_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					42.00	84.00	105.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	012	0		29	10	S5601_012_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											87.39	50	50	50				78.66	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	012	0		29	10	S5601_012_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											672.18	33						672.18	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	013	0		29	10	S5601_013_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	013	0		29	10	S5601_013_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	013	0		29	10	S5601_013_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	013	0		29	10	S5601_013_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	013	0		29	10	S5601_013_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	013	0		29	10	S5601_013_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											87.24	50	50	50				69.79	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	013	0		29	10	S5601_013_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											708.41	33						708.41	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	014	0		29	10	S5601_014_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					5.00	10.00	12.50											7.00	14.00	21.00				5.00	10.00	0.00				7.00				7.00			0.23	0.17		0.23	0.17	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	014	0		29	10	S5601_014_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					18.00	36.00	45.00											20.00	40.00	60.00				18.00	36.00	45.00				20.00				20.00			0.67	0.60		0.67	0.60	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	014	0		29	10	S5601_014_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					44.00	88.00	110.00											47.00	94.00	141.00				44.00	88.00	110.00				47.00				47.00			1.57	1.47		1.57	1.47	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	014	0		29	10	S5601_014_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											80.68	50	50	50				77.45	48	48	48										50	50	50				48	48	48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	014	0		29	10	S5601_014_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											619.08	33						619.08	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	015	0		29	10	S5601_015_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	015	0		29	10	S5601_015_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	015	0		29	10	S5601_015_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	015	0		29	10	S5601_015_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	015	0		29	10	S5601_015_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					40.00	80.00	100.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.57	1.33		1.57	1.33	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	015	0		29	10	S5601_015_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											80.88	50	50	50				74.41	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	015	0		29	10	S5601_015_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											551.09	33						551.09	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	016	0		29	10	S5601_016_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	016	0		29	10	S5601_016_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					17.00	34.00	42.50											20.00	40.00	60.00				17.00	34.00	42.50				20.00				20.00			0.67	0.57		0.67	0.57	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	016	0		29	10	S5601_016_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					44.00	88.00	110.00											47.00	94.00	141.00				44.00	88.00	110.00				47.00				47.00			1.57	1.47		1.57	1.47	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	016	0		29	10	S5601_016_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											82.98	50	50	50				78.00	47	47	47										50	50	50				47	47	47			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	016	0		29	10	S5601_016_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											650.76	33						650.76	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	017	0		29	10	S5601_017_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	017	0		29	10	S5601_017_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	017	0		29	10	S5601_017_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	017	0		29	10	S5601_017_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	017	0		29	10	S5601_017_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	017	0		29	10	S5601_017_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											82.70	50	50	50				66.16	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	017	0		29	10	S5601_017_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											579.19	33						579.19	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	018	0		29	10	S5601_018_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					6.00	12.00	15.00											7.00	14.00	21.00				6.00	12.00	0.00				7.00				7.00			0.23	0.20		0.23	0.20	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	018	0		29	10	S5601_018_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					19.00	38.00	47.50											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	018	0		29	10	S5601_018_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					46.00	92.00	115.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	018	0		29	10	S5601_018_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											78.83	50	50	50				77.25	49	49	49										50	50	50				49	49	49			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	018	0		29	10	S5601_018_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											639.74	33						639.74	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	019	0		29	10	S5601_019_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	019	0		29	10	S5601_019_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	019	0		29	10	S5601_019_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	019	0		29	10	S5601_019_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	019	0		29	10	S5601_019_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					40.00	80.00	100.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.57	1.33		1.57	1.33	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	019	0		29	10	S5601_019_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											80.49	50	50	50				74.05	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	019	0		29	10	S5601_019_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											674.33	33						674.33	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	020	0		29	10	S5601_020_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	020	0		29	10	S5601_020_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					14.00	28.00	35.00											20.00	40.00	60.00				14.00	28.00	35.00				20.00				20.00			0.67	0.47		0.67	0.47	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	020	0		29	10	S5601_020_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					43.00	86.00	107.50											47.00	94.00	141.00				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	020	0		29	10	S5601_020_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											77.24	50	50	50				72.61	47	47	47										50	50	50				47	47	47			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	020	0		29	10	S5601_020_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											602.56	33						602.56	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	021	0		29	10	S5601_021_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	021	0		29	10	S5601_021_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	021	0		29	10	S5601_021_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	021	0		29	10	S5601_021_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	021	0		29	10	S5601_021_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					40.00	80.00	100.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.57	1.33		1.57	1.33	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	021	0		29	10	S5601_021_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											79.24	50	50	50				72.90	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	021	0		29	10	S5601_021_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											616.36	33						616.36	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	022	0		29	10	S5601_022_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					6.00	12.00	15.00											7.00	14.00	21.00				6.00	12.00	0.00				7.00				7.00			0.23	0.20		0.23	0.20	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	022	0		29	10	S5601_022_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					19.00	38.00	47.50											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	022	0		29	10	S5601_022_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					46.00	92.00	115.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	022	0		29	10	S5601_022_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											85.54	50	50	50				83.83	49	49	49										50	50	50				49	49	49			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	022	0		29	10	S5601_022_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											642.03	33						642.03	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	023	0		29	10	S5601_023_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	023	0		29	10	S5601_023_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	023	0		29	10	S5601_023_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	023	0		29	10	S5601_023_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	023	0		29	10	S5601_023_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	023	0		29	10	S5601_023_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											88.18	50	50	50				70.54	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	023	0		29	10	S5601_023_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											709.47	33						709.47	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	024	0		29	10	S5601_024_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	024	0		29	10	S5601_024_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					13.00	26.00	32.50											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	024	0		29	10	S5601_024_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					42.00	84.00	105.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	024	0		29	10	S5601_024_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											78.38	50	50	50				72.11	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	024	0		29	10	S5601_024_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											676.40	33						676.40	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	025	0		29	10	S5601_025_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	025	0		29	10	S5601_025_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	025	0		29	10	S5601_025_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	025	0		29	10	S5601_025_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	025	0		29	10	S5601_025_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					40.00	80.00	100.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.57	1.33		1.57	1.33	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	025	0		29	10	S5601_025_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											84.74	50	50	50				77.97	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	025	0		29	10	S5601_025_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											628.09	33						628.09	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	026	0		29	10	S5601_026_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	026	0		29	10	S5601_026_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					13.00	26.00	32.50											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	026	0		29	10	S5601_026_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					41.00	82.00	102.50											47.00	94.00	141.00				41.00	82.00	102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	026	0		29	10	S5601_026_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											96.63	50	50	50				79.23	41	41	41										50	50	50				41	41	41			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	026	0		29	10	S5601_026_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											707.37	33						707.37	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	027	0		29	10	S5601_027_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	027	0		29	10	S5601_027_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	027	0		29	10	S5601_027_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	027	0		29	10	S5601_027_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	027	0		29	10	S5601_027_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	027	0		29	10	S5601_027_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											92.91	50	50	50				74.33	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	027	0		29	10	S5601_027_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											652.86	33						652.86	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	028	0		29	10	S5601_028_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	028	0		29	10	S5601_028_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					17.00	34.00	42.50											20.00	40.00	60.00				17.00	34.00	42.50				20.00				20.00			0.67	0.57		0.67	0.57	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	028	0		29	10	S5601_028_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					43.00	86.00	107.50											47.00	94.00	141.00				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	028	0		29	10	S5601_028_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											86.17	50	50	50				81.00	47	47	47										50	50	50				47	47	47			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	028	0		29	10	S5601_028_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											647.33	33						647.33	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	029	0		29	10	S5601_029_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	029	0		29	10	S5601_029_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	029	0		29	10	S5601_029_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	029	0		29	10	S5601_029_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	029	0		29	10	S5601_029_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					40.00	80.00	100.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.57	1.33		1.57	1.33	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	029	0		29	10	S5601_029_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											85.28	50	50	50				78.46	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	029	0		29	10	S5601_029_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											628.07	33						628.07	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	030	0		29	10	S5601_030_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	030	0		29	10	S5601_030_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					13.00	26.00	32.50											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	030	0		29	10	S5601_030_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					41.00	82.00	102.50											47.00	94.00	141.00				41.00	82.00	102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	030	0		29	10	S5601_030_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											87.85	50	50	50				72.04	41	41	41										50	50	50				41	41	41			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	030	0		29	10	S5601_030_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											653.70	33						653.70	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	031	0		29	10	S5601_031_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	031	0		29	10	S5601_031_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	031	0		29	10	S5601_031_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	031	0		29	10	S5601_031_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	031	0		29	10	S5601_031_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					40.00	80.00	100.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.57	1.33		1.57	1.33	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	031	0		29	10	S5601_031_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											85.63	50	50	50				78.78	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	031	0		29	10	S5601_031_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											599.61	33						599.61	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	032	0		29	10	S5601_032_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								6.00	12.00	18.00					3.00	6.00	7.50											6.00	12.00	18.00				3.00	6.00	0.00				6.00				6.00			0.20	0.10		0.20	0.10	0.18		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	032	0		29	10	S5601_032_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								19.00	38.00	57.00					10.00	20.00	25.00											19.00	38.00	57.00				10.00	20.00	25.00				19.00				19.00			0.63	0.33		0.63	0.33	0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	032	0		29	10	S5601_032_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								46.00	92.00	138.00					34.00	68.00	85.00											46.00	92.00	138.00				34.00	68.00	85.00				46.00				46.00			1.53	1.13		1.53	1.13	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	032	0		29	10	S5601_032_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											87.50	48	48	48				61.98	34	34	34										48	48	48				34	34	34			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	032	0		29	10	S5601_032_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											662.22	33						662.22	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	033	0		29	10	S5601_033_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	033	0		29	10	S5601_033_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	033	0		29	10	S5601_033_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	033	0		29	10	S5601_033_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	033	0		29	10	S5601_033_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	033	0		29	10	S5601_033_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											91.60	50	50	50				73.28	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	033	0		29	10	S5601_033_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											637.00	33						637.00	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	034	0		29	10	S5601_034_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	034	0		29	10	S5601_034_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					17.00	34.00	42.50											20.00	40.00	60.00				17.00	34.00	42.50				20.00				20.00			0.67	0.57		0.67	0.57	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	034	0		29	10	S5601_034_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					44.00	88.00	110.00											47.00	94.00	141.00				44.00	88.00	110.00				47.00				47.00			1.57	1.47		1.57	1.47	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	034	0		29	10	S5601_034_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											92.05	50	50	50				88.37	48	48	48										50	50	50				48	48	48			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	034	0		29	10	S5601_034_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											665.53	33						665.53	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	035	0		29	10	S5601_035_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	035	0		29	10	S5601_035_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	035	0		29	10	S5601_035_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	035	0		29	10	S5601_035_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	035	0		29	10	S5601_035_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	035	0		29	10	S5601_035_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											98.76	50	50	50				79.01	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	035	0		29	10	S5601_035_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											704.16	33						704.16	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	036	0		29	10	S5601_036_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	036	0		29	10	S5601_036_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					11.00	22.00	27.50											20.00	40.00	60.00				11.00	22.00	27.50				20.00				20.00			0.67	0.37		0.67	0.37	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	036	0		29	10	S5601_036_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	036	0		29	10	S5601_036_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											90.87	50	50	50				63.61	35	35	35										50	50	50				35	35	35			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	036	0		29	10	S5601_036_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											676.90	33						676.90	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	037	0		29	10	S5601_037_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	037	0		29	10	S5601_037_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	037	0		29	10	S5601_037_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	037	0		29	10	S5601_037_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	037	0		29	10	S5601_037_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					40.00	80.00	100.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.57	1.33		1.57	1.33	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	037	0		29	10	S5601_037_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											87.95	50	50	50				80.92	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	037	0		29	10	S5601_037_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											688.01	33						688.01	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	038	0		29	10	S5601_038_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	038	0		29	10	S5601_038_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00				20.00				20.00			0.67	0.33		0.67	0.33	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	038	0		29	10	S5601_038_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					34.00	68.00	85.00											47.00	94.00	141.00				34.00	68.00	85.00				47.00				47.00			1.57	1.13		1.57	1.13	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	038	0		29	10	S5601_038_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											81.17	50	50	50				55.20	34	34	34										50	50	50				34	34	34			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	038	0		29	10	S5601_038_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											743.44	33						743.44	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	040	0		29	10	S5601_040_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	040	0		29	10	S5601_040_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					12.00	24.00	30.00											20.00	40.00	60.00				12.00	24.00	30.00				20.00				20.00			0.67	0.40		0.67	0.40	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	040	0		29	10	S5601_040_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					41.00	82.00	102.50											47.00	94.00	141.00				41.00	82.00	102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	040	0		29	10	S5601_040_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											80.39	50	50	50				72.35	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	040	0		29	10	S5601_040_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											651.86	33						651.86	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	041	0		29	10	S5601_041_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	041	0		29	10	S5601_041_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	041	0		29	10	S5601_041_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	041	0		29	10	S5601_041_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	041	0		29	10	S5601_041_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					40.00	80.00	100.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.57	1.33		1.57	1.33	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	041	0		29	10	S5601_041_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											77.65	50	50	50				71.44	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	041	0		29	10	S5601_041_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											639.81	33						639.81	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	042	0		29	10	S5601_042_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	042	0		29	10	S5601_042_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00				20.00				20.00			0.67	0.33		0.67	0.33	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	042	0		29	10	S5601_042_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								46.00	92.00	138.00					34.00	68.00	85.00											46.00	92.00	138.00				34.00	68.00	85.00				46.00				46.00			1.53	1.13		1.53	1.13	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	042	0		29	10	S5601_042_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											77.94	46	46	46				57.61	34	34	34										46	46	46				34	34	34			46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	042	0		29	10	S5601_042_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											588.87	33						588.87	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	044	0		29	10	S5601_044_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					9.00	18.00	22.50											10.00	20.00	30.00				9.00	18.00	0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	044	0		29	10	S5601_044_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					19.00	38.00	47.50											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	044	0		29	10	S5601_044_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					46.00	92.00	115.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	044	0		29	10	S5601_044_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											89.27	50	50	50				87.49	49	49	49										50	50	50				49	49	49			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	044	0		29	10	S5601_044_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											626.05	33						626.05	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	045	0		29	10	S5601_045_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	045	0		29	10	S5601_045_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					2.00	4.00	5.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	045	0		29	10	S5601_045_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	045	0		29	10	S5601_045_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					8.00	16.00	20.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	045	0		29	10	S5601_045_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					40.00	80.00	100.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.57	1.33		1.57	1.33	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	045	0		29	10	S5601_045_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											90.37	50	50	50				83.14	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	045	0		29	10	S5601_045_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											615.14	33						615.14	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	046	0		29	10	S5601_046_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								6.00	12.00	18.00					3.00	6.00	7.50											6.00	12.00	18.00				3.00	6.00	0.00				6.00				6.00			0.20	0.10		0.20	0.10	0.18		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	046	0		29	10	S5601_046_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								19.00	38.00	57.00					10.00	20.00	25.00											19.00	38.00	57.00				10.00	20.00	25.00				19.00				19.00			0.63	0.33		0.63	0.33	0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	046	0		29	10	S5601_046_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								44.00	88.00	132.00					34.00	68.00	85.00											44.00	88.00	132.00				34.00	68.00	85.00				44.00				44.00			1.47	1.13		1.47	1.13	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	046	0		29	10	S5601_046_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											73.41	44	44	44				56.72	34	34	34										44	44	44				34	34	34			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	046	0		29	10	S5601_046_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											699.05	33						699.05	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	048	0		29	10	S5601_048_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	048	0		29	10	S5601_048_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					13.00	26.00	32.50											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	048	0		29	10	S5601_048_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					42.00	84.00	105.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	048	0		29	10	S5601_048_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											83.95	50	50	50				70.52	42	42	42										50	50	50				42	42	42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	048	0		29	10	S5601_048_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											748.59	33						748.59	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	049	0		29	10	S5601_049_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	049	0		29	10	S5601_049_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	049	0		29	10	S5601_049_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	049	0		29	10	S5601_049_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	049	0		29	10	S5601_049_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	049	0		29	10	S5601_049_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											83.26	50	50	50				66.61	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	049	0		29	10	S5601_049_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											661.08	33						661.08	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	050	0		29	10	S5601_050_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	050	0		29	10	S5601_050_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					12.00	24.00	30.00											20.00	40.00	60.00				12.00	24.00	30.00				20.00				20.00			0.67	0.40		0.67	0.40	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	050	0		29	10	S5601_050_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					39.00	78.00	97.50											47.00	94.00	141.00				39.00	78.00	97.50				47.00				47.00			1.57	1.30		1.57	1.30	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	050	0		29	10	S5601_050_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											86.86	50	50	50				67.75	39	39	39										50	50	50				39	39	39			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	050	0		29	10	S5601_050_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											670.68	33						670.68	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	051	0		29	10	S5601_051_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	051	0		29	10	S5601_051_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	051	0		29	10	S5601_051_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	051	0		29	10	S5601_051_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	051	0		29	10	S5601_051_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	051	0		29	10	S5601_051_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											88.81	50	50	50				71.04	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	051	0		29	10	S5601_051_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											611.32	33						611.32	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	052	0		29	10	S5601_052_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	052	0		29	10	S5601_052_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					12.00	24.00	30.00											20.00	40.00	60.00				12.00	24.00	30.00				20.00				20.00			0.67	0.40		0.67	0.40	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	052	0		29	10	S5601_052_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					42.00	84.00	105.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	052	0		29	10	S5601_052_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											75.75	50	50	50				68.17	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	052	0		29	10	S5601_052_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											754.14	33						754.14	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	053	0		29	10	S5601_053_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	053	0		29	10	S5601_053_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	053	0		29	10	S5601_053_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	053	0		29	10	S5601_053_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	053	0		29	10	S5601_053_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	053	0		29	10	S5601_053_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											77.85	50	50	50				62.28	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	053	0		29	10	S5601_053_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											593.47	33						593.47	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	054	0		29	10	S5601_054_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					9.00	18.00	22.50											10.00	20.00	30.00				9.00	18.00	0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	054	0		29	10	S5601_054_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					19.00	38.00	47.50											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	054	0		29	10	S5601_054_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					46.00	92.00	115.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	054	0		29	10	S5601_054_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											78.99	50	50	50				77.41	49	49	49										50	50	50				49	49	49			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	054	0		29	10	S5601_054_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											733.98	33						733.98	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	055	0		29	10	S5601_055_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	055	0		29	10	S5601_055_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	055	0		29	10	S5601_055_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	055	0		29	10	S5601_055_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	055	0		29	10	S5601_055_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	055	0		29	10	S5601_055_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											86.59	50	50	50				69.27	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	055	0		29	10	S5601_055_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											562.27	33						562.27	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	056	0		29	10	S5601_056_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	056	0		29	10	S5601_056_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					16.00	32.00	40.00											20.00	40.00	60.00				16.00	32.00	40.00				20.00				20.00			0.67	0.53		0.67	0.53	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	056	0		29	10	S5601_056_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					41.00	82.00	102.50											47.00	94.00	141.00				41.00	82.00	102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	056	0		29	10	S5601_056_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											79.79	50	50	50				71.81	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	056	0		29	10	S5601_056_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											651.65	31						651.65	31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	057	0		29	10	S5601_057_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	057	0		29	10	S5601_057_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	057	0		29	10	S5601_057_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	057	0		29	10	S5601_057_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	057	0		29	10	S5601_057_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	057	0		29	10	S5601_057_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											87.31	50	50	50				69.85	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	057	0		29	10	S5601_057_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											674.59	33						674.59	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	058	0		29	10	S5601_058_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								8.00	16.00	24.00					7.00	14.00	17.50											8.00	16.00	24.00				7.00	14.00	0.00				8.00				8.00			0.27	0.23		0.27	0.23	0.24		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	058	0		29	10	S5601_058_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					19.00	38.00	47.50											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	058	0		29	10	S5601_058_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					46.00	92.00	115.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	058	0		29	10	S5601_058_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											87.91	50	50	50				86.16	49	49	49										50	50	50				49	49	49			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	058	0		29	10	S5601_058_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											630.25	33						630.25	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	059	0		29	10	S5601_059_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	059	0		29	10	S5601_059_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	059	0		29	10	S5601_059_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	059	0		29	10	S5601_059_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	059	0		29	10	S5601_059_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	059	0		29	10	S5601_059_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											85.14	50	50	50				68.11	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	059	0		29	10	S5601_059_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											733.12	33						733.12	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	060	0		29	10	S5601_060_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	060	0		29	10	S5601_060_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00				20.00				20.00			0.67	0.33		0.67	0.33	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	060	0		29	10	S5601_060_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					34.00	68.00	85.00											47.00	94.00	141.00				34.00	68.00	85.00				47.00				47.00			1.57	1.13		1.57	1.13	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	060	0		29	10	S5601_060_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											76.24	48	48	48				54.00	34	34	34										48	48	48				34	34	34			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	060	0		29	10	S5601_060_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											684.40	33						684.40	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	061	0		29	10	S5601_061_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	061	0		29	10	S5601_061_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	061	0		29	10	S5601_061_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	061	0		29	10	S5601_061_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	061	0		29	10	S5601_061_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	061	0		29	10	S5601_061_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											82.75	50	50	50				66.20	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	061	0		29	10	S5601_061_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											615.26	33						615.26	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	062	0		29	10	S5601_062_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	062	0		29	10	S5601_062_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					14.00	28.00	35.00											20.00	40.00	60.00				14.00	28.00	35.00				20.00				20.00			0.67	0.47		0.67	0.47	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	062	0		29	10	S5601_062_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					41.00	82.00	102.50											47.00	94.00	141.00				41.00	82.00	102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	062	0		29	10	S5601_062_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											87.88	50	50	50				79.09	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	062	0		29	10	S5601_062_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											692.49	33						692.49	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	063	0		29	10	S5601_063_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	063	0		29	10	S5601_063_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	063	0		29	10	S5601_063_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	063	0		29	10	S5601_063_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	063	0		29	10	S5601_063_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	063	0		29	10	S5601_063_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											83.39	50	50	50				66.71	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	063	0		29	10	S5601_063_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											584.43	33						584.43	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	064	0		29	10	S5601_064_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	064	0		29	10	S5601_064_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					13.00	26.00	32.50											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	064	0		29	10	S5601_064_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					42.00	84.00	105.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	064	0		29	10	S5601_064_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											100.36	50	50	50				92.33	46	46	46										50	50	50				46	46	46			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	064	0		29	10	S5601_064_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											632.67	33						632.67	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	065	0		29	10	S5601_065_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	065	0		29	10	S5601_065_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	065	0		29	10	S5601_065_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	065	0		29	10	S5601_065_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	065	0		29	10	S5601_065_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	065	0		29	10	S5601_065_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											93.59	50	50	50				74.87	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	065	0		29	10	S5601_065_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											568.50	33						568.50	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	066	0		29	10	S5601_066_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								7.00	14.00	21.00					3.00	6.00	7.50											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.21		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	066	0		29	10	S5601_066_0	1	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					13.00	26.00	32.50											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	066	0		29	10	S5601_066_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					41.00	82.00	102.50											47.00	94.00	141.00				41.00	82.00	102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	066	0		29	10	S5601_066_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											99.96	50	50	50				89.96	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	066	0		29	10	S5601_066_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		34											534.78	31						534.78	31												31						31					31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	067	0		29	10	S5601_067_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	067	0		29	10	S5601_067_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	067	0		29	10	S5601_067_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	067	0		29	10	S5601_067_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	067	0		29	10	S5601_067_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	067	0		29	10	S5601_067_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											85.56	50	50	50				68.45	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	067	0		29	10	S5601_067_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											578.96	33						578.96	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	068	0		29	10	S5601_068_0	1	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	1.00	2.00	2.50																			1.00	2.00	0.00																1.00				1.00		0.03			0.03			0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	068	0		29	10	S5601_068_0	1	Generic	2	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	4.00	8.00	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	068	0		29	10	S5601_068_0	1	Preferred Brand	2	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34				10.98	17	17	17																		17	17	17															17			17									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	068	0		29	10	S5601_068_0	1	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34				56.20	36	36	36																		36	36	36															36			36									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	068	0		29	10	S5601_068_0	1	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		34				375.38	25																				25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	107	0		29	10	S5601_107_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	107	0		29	10	S5601_107_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	107	0		29	10	S5601_107_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	107	0		29	10	S5601_107_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	107	0		29	10	S5601_107_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	107	0		29	10	S5601_107_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											79.11	50	50	50				63.29	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	107	0		29	10	S5601_107_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											853.52	33						853.52	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	108	0		29	10	S5601_108_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	108	0		29	10	S5601_108_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	108	0		29	10	S5601_108_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	108	0		29	10	S5601_108_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	108	0		29	10	S5601_108_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	108	0		29	10	S5601_108_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											82.87	50	50	50				66.30	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	108	0		29	10	S5601_108_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											574.95	33						574.95	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	109	0		29	10	S5601_109_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	109	0		29	10	S5601_109_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					1.00	2.00	2.50											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	109	0		29	10	S5601_109_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	109	0		29	10	S5601_109_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.59		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5601	109	0		29	10	S5601_109_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					35.00	70.00	87.50											47.00	94.00	141.00				35.00	70.00	70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	109	0		29	10	S5601_109_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											83.06	50	50	50				66.45	40	40	40										50	50	50				40	40	40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5601	109	0		29	10	S5601_109_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		34											675.63	33						675.63	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5609	001	0		29	10	S5609_001_0	7	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	001	0		29	10	S5609_001_0	7	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	001	0		29	10	S5609_001_0	7	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	001	0		29	10	S5609_001_0	7	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				101.70	45	45	45																		45	45	45															45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	001	0		29	10	S5609_001_0	7	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				1284.08	28																				28																	28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	001	0		29	10	S5609_001_0	7	Select Care Drugs	3	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	002	0		29	10	S5609_002_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	002	0		29	10	S5609_002_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5609	002	0		29	10	S5609_002_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	002	0		29	10	S5609_002_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	105.00																			42.00	84.00	105.00																42.00				42.00		1.40			1.40			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	002	0		29	10	S5609_002_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				90.40	40	40	40																		40	40	40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	002	0		29	10	S5609_002_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1513.38	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	002	0		29	10	S5609_002_0	7	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5609	002	0		29	10	S5609_002_0	7	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5617	003	0		29	10	S5617_003_0	5	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	003	0		29	10	S5617_003_0	5	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	003	0		29	10	S5617_003_0	5	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	003	0		29	10	S5617_003_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											64.19	41	41	41				55.13	40	40	40										41	41	41				40	40	40			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	003	0		29	10	S5617_003_0	5	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	008	0		29	10	S5617_008_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	008	0		29	10	S5617_008_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	008	0		29	10	S5617_008_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	90.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	008	0		29	10	S5617_008_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.86	34	34	34				57.68	34	34	34										34	34	34				34	34	34			34			34									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	008	0		29	10	S5617_008_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	013	0		29	10	S5617_013_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	013	0		29	10	S5617_013_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	013	0		29	10	S5617_013_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	013	0		29	10	S5617_013_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.43	41	41	41				50.31	41	41	41										41	41	41				41	41	41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	013	0		29	10	S5617_013_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	018	0		29	10	S5617_018_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	018	0		29	10	S5617_018_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	018	0		29	10	S5617_018_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	90.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	018	0		29	10	S5617_018_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											56.42	37	37	37				54.22	37	37	37										37	37	37				37	37	37			37			37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	018	0		29	10	S5617_018_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	053	0		29	10	S5617_053_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	053	0		29	10	S5617_053_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	053	0		29	10	S5617_053_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								38.00	76.00	114.00					33.00	66.00	99.00											38.00	76.00	114.00				33.00	66.00	99.00				38.00				38.00			1.27	1.10		1.27	1.10	1.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	053	0		29	10	S5617_053_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.71	40	40	40				43.82	39	39	39										40	40	40				39	39	39			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	053	0		29	10	S5617_053_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	068	0		29	10	S5617_068_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	068	0		29	10	S5617_068_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	068	0		29	10	S5617_068_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	068	0		29	10	S5617_068_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											59.74	40	40	40				48.26	38	38	38										40	40	40				38	38	38			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	068	0		29	10	S5617_068_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	088	0		29	10	S5617_088_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	088	0		29	10	S5617_088_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	088	0		29	10	S5617_088_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	90.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	088	0		29	10	S5617_088_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											48.21	40	40	40				44.02	38	38	38										40	40	40				38	38	38			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	088	0		29	10	S5617_088_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	103	0		29	10	S5617_103_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	103	0		29	10	S5617_103_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	103	0		29	10	S5617_103_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	90.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	103	0		29	10	S5617_103_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.22	42	42	42				44.12	39	39	39										42	42	42				39	39	39			42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	103	0		29	10	S5617_103_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	108	0		29	10	S5617_108_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	108	0		29	10	S5617_108_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	108	0		29	10	S5617_108_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	108	0		29	10	S5617_108_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											48.44	41	41	41				43.20	41	41	41										41	41	41				41	41	41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	108	0		29	10	S5617_108_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	113	0		29	10	S5617_113_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	113	0		29	10	S5617_113_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	113	0		29	10	S5617_113_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	90.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	113	0		29	10	S5617_113_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.30	39	39	39				46.06	38	38	38										39	39	39				38	38	38			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	113	0		29	10	S5617_113_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	118	0		29	10	S5617_118_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	118	0		29	10	S5617_118_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	118	0		29	10	S5617_118_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								39.00	78.00	117.00					34.00	68.00	102.00											39.00	78.00	117.00				34.00	68.00	102.00				39.00				39.00			1.30	1.13		1.30	1.13	1.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	118	0		29	10	S5617_118_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											41.51	41	41	41				33.14	39	39	39										41	41	41				39	39	39			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	118	0		29	10	S5617_118_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	123	0		29	10	S5617_123_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	123	0		29	10	S5617_123_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	123	0		29	10	S5617_123_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								38.00	76.00	114.00					33.00	66.00	99.00											38.00	76.00	114.00				33.00	66.00	99.00				38.00				38.00			1.27	1.10		1.27	1.10	1.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	123	0		29	10	S5617_123_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											56.30	38	38	38				50.72	38	38	38										38	38	38				38	38	38			38			38									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	123	0		29	10	S5617_123_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	128	0		29	10	S5617_128_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	128	0		29	10	S5617_128_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	128	0		29	10	S5617_128_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	128	0		29	10	S5617_128_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.61	47	47	47				48.98	44	44	44										47	47	47				44	44	44			47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	128	0		29	10	S5617_128_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	133	0		29	10	S5617_133_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	133	0		29	10	S5617_133_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	133	0		29	10	S5617_133_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								38.00	76.00	114.00					33.00	66.00	99.00											38.00	76.00	114.00				33.00	66.00	99.00				38.00				38.00			1.27	1.10		1.27	1.10	1.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	133	0		29	10	S5617_133_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											59.56	40	40	40				44.46	38	38	38										40	40	40				38	38	38			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	133	0		29	10	S5617_133_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	138	0		29	10	S5617_138_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	138	0		29	10	S5617_138_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	138	0		29	10	S5617_138_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								39.00	78.00	117.00					34.00	68.00	102.00											39.00	78.00	117.00				34.00	68.00	102.00				39.00				39.00			1.30	1.13		1.30	1.13	1.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	138	0		29	10	S5617_138_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.28	40	40	40				48.12	40	40	40										40	40	40				40	40	40			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	138	0		29	10	S5617_138_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	143	0		29	10	S5617_143_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	143	0		29	10	S5617_143_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	143	0		29	10	S5617_143_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	90.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	143	0		29	10	S5617_143_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.73	39	39	39				45.97	39	39	39										39	39	39				39	39	39			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	143	0		29	10	S5617_143_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	148	0		29	10	S5617_148_0	4	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	148	0		29	10	S5617_148_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	148	0		29	10	S5617_148_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	148	0		29	10	S5617_148_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.55	42	42	42				54.82	40	40	40										42	42	42				40	40	40			42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	148	0		29	10	S5617_148_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	153	0		29	10	S5617_153_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	153	0		29	10	S5617_153_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	153	0		29	10	S5617_153_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	90.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	153	0		29	10	S5617_153_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											59.48	42	42	42				50.15	40	40	40										42	42	42				40	40	40			42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	153	0		29	10	S5617_153_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	158	0		29	10	S5617_158_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	158	0		29	10	S5617_158_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	158	0		29	10	S5617_158_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								39.00	78.00	117.00					34.00	68.00	102.00											39.00	78.00	117.00				34.00	68.00	102.00				39.00				39.00			1.30	1.13		1.30	1.13	1.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	158	0		29	10	S5617_158_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.42	39	39	39				51.88	39	39	39										39	39	39				39	39	39			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	158	0		29	10	S5617_158_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	163	0		29	10	S5617_163_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	163	0		29	10	S5617_163_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	163	0		29	10	S5617_163_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	163	0		29	10	S5617_163_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.09	46	46	46				69.46	46	46	46										46	46	46				46	46	46			46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	163	0		29	10	S5617_163_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	214	0		29	10	S5617_214_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	214	0		29	10	S5617_214_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	214	0		29	10	S5617_214_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	214	0		29	10	S5617_214_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											59.20	41	41	41				52.82	40	40	40										41	41	41				40	40	40			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	214	0		29	10	S5617_214_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	215	0		29	10	S5617_215_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	215	0		29	10	S5617_215_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	215	0		29	10	S5617_215_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	215	0		29	10	S5617_215_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.46	40	40	40				46.58	39	39	39										40	40	40				39	39	39			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	215	0		29	10	S5617_215_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	216	0		29	10	S5617_216_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	216	0		29	10	S5617_216_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	216	0		29	10	S5617_216_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	216	0		29	10	S5617_216_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.65	39	39	39				46.35	38	38	38										39	39	39				38	38	38			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	216	0		29	10	S5617_216_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	217	0		29	10	S5617_217_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	217	0		29	10	S5617_217_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	217	0		29	10	S5617_217_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	90.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	217	0		29	10	S5617_217_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											67.25	44	44	44				55.57	42	42	42										44	44	44				42	42	42			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	217	0		29	10	S5617_217_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	218	0		29	10	S5617_218_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	218	0		29	10	S5617_218_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	218	0		29	10	S5617_218_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	90.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	218	0		29	10	S5617_218_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.23	42	42	42				55.31	42	42	42										42	42	42				42	42	42			42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	218	0		29	10	S5617_218_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	219	0		29	10	S5617_219_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	219	0		29	10	S5617_219_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	219	0		29	10	S5617_219_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				37.00				37.00			1.23	1.07		1.23	1.07	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	219	0		29	10	S5617_219_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											44.18	40	40	40				38.87	39	39	39										40	40	40				39	39	39			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	219	0		29	10	S5617_219_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	220	0		29	10	S5617_220_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	220	0		29	10	S5617_220_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	220	0		29	10	S5617_220_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	90.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	220	0		29	10	S5617_220_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.06	39	39	39				45.21	39	39	39										39	39	39				39	39	39			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	220	0		29	10	S5617_220_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	221	0		29	10	S5617_221_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	221	0		29	10	S5617_221_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	221	0		29	10	S5617_221_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	221	0		29	10	S5617_221_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.29	40	40	40				48.40	39	39	39										40	40	40				39	39	39			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	221	0		29	10	S5617_221_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	222	0		29	10	S5617_222_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	222	0		29	10	S5617_222_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	222	0		29	10	S5617_222_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	222	0		29	10	S5617_222_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.18	40	40	40				45.93	39	39	39										40	40	40				39	39	39			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	222	0		29	10	S5617_222_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	223	0		29	10	S5617_223_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	223	0		29	10	S5617_223_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	223	0		29	10	S5617_223_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								39.00	78.00	117.00					34.00	68.00	102.00											39.00	78.00	117.00				34.00	68.00	102.00				39.00				39.00			1.30	1.13		1.30	1.13	1.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	223	0		29	10	S5617_223_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.26	40	40	40				51.35	39	39	39										40	40	40				39	39	39			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	223	0		29	10	S5617_223_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	224	0		29	10	S5617_224_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	224	0		29	10	S5617_224_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	224	0		29	10	S5617_224_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	224	0		29	10	S5617_224_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.40	40	40	40				40.70	39	39	39										40	40	40				39	39	39			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	224	0		29	10	S5617_224_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	225	0		29	10	S5617_225_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	225	0		29	10	S5617_225_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	225	0		29	10	S5617_225_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								39.00	78.00	117.00					34.00	68.00	102.00											39.00	78.00	117.00				34.00	68.00	102.00				39.00				39.00			1.30	1.13		1.30	1.13	1.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	225	0		29	10	S5617_225_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											48.64	41	41	41				40.31	38	38	38										41	41	41				38	38	38			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	225	0		29	10	S5617_225_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	226	0		29	10	S5617_226_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	226	0		29	10	S5617_226_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	226	0		29	10	S5617_226_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	226	0		29	10	S5617_226_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.07	42	42	42				40.57	41	41	41										42	42	42				41	41	41			42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	226	0		29	10	S5617_226_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	227	0		29	10	S5617_227_0	3	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	227	0		29	10	S5617_227_0	3	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	227	0		29	10	S5617_227_0	3	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	227	0		29	10	S5617_227_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.22	40	40	40				58.12	39	39	39										40	40	40				39	39	39			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	227	0		29	10	S5617_227_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	246	0		29	10	S5617_246_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	246	0		29	10	S5617_246_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	246	0		29	10	S5617_246_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	246	0		29	10	S5617_246_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	246	0		29	10	S5617_246_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	246	0		29	10	S5617_246_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.80	50	50	50				37.85	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	246	0		29	10	S5617_246_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	247	0		29	10	S5617_247_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	247	0		29	10	S5617_247_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	247	0		29	10	S5617_247_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	247	0		29	10	S5617_247_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	247	0		29	10	S5617_247_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	247	0		29	10	S5617_247_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											48.85	50	50	50				43.44	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	247	0		29	10	S5617_247_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	248	0		29	10	S5617_248_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	248	0		29	10	S5617_248_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	248	0		29	10	S5617_248_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	248	0		29	10	S5617_248_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	248	0		29	10	S5617_248_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	248	0		29	10	S5617_248_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.89	50	50	50				40.20	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	248	0		29	10	S5617_248_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	249	0		29	10	S5617_249_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	249	0		29	10	S5617_249_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	249	0		29	10	S5617_249_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	249	0		29	10	S5617_249_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	249	0		29	10	S5617_249_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	249	0		29	10	S5617_249_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											44.28	50	50	50				39.90	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	249	0		29	10	S5617_249_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	250	0		29	10	S5617_250_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	250	0		29	10	S5617_250_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	250	0		29	10	S5617_250_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	250	0		29	10	S5617_250_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	250	0		29	10	S5617_250_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	250	0		29	10	S5617_250_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											40.14	50	50	50				35.81	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	250	0		29	10	S5617_250_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	251	0		29	10	S5617_251_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	251	0		29	10	S5617_251_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	251	0		29	10	S5617_251_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	251	0		29	10	S5617_251_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	251	0		29	10	S5617_251_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	251	0		29	10	S5617_251_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											41.55	50	50	50				36.59	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	251	0		29	10	S5617_251_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	252	0		29	10	S5617_252_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	252	0		29	10	S5617_252_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	252	0		29	10	S5617_252_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	252	0		29	10	S5617_252_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	252	0		29	10	S5617_252_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	252	0		29	10	S5617_252_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											42.83	50	50	50				40.51	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	252	0		29	10	S5617_252_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	253	0		29	10	S5617_253_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	253	0		29	10	S5617_253_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	253	0		29	10	S5617_253_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	253	0		29	10	S5617_253_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	253	0		29	10	S5617_253_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	253	0		29	10	S5617_253_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.23	50	50	50				39.21	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	253	0		29	10	S5617_253_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	254	0		29	10	S5617_254_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	254	0		29	10	S5617_254_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	254	0		29	10	S5617_254_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	254	0		29	10	S5617_254_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	254	0		29	10	S5617_254_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	254	0		29	10	S5617_254_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.63	50	50	50				42.04	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	254	0		29	10	S5617_254_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	255	0		29	10	S5617_255_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	255	0		29	10	S5617_255_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	255	0		29	10	S5617_255_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	255	0		29	10	S5617_255_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	255	0		29	10	S5617_255_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	255	0		29	10	S5617_255_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.48	50	50	50				37.48	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	255	0		29	10	S5617_255_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	256	0		29	10	S5617_256_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	256	0		29	10	S5617_256_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	256	0		29	10	S5617_256_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	256	0		29	10	S5617_256_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	256	0		29	10	S5617_256_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	256	0		29	10	S5617_256_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											41.23	50	50	50				39.56	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	256	0		29	10	S5617_256_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	257	0		29	10	S5617_257_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	257	0		29	10	S5617_257_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	257	0		29	10	S5617_257_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	257	0		29	10	S5617_257_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	257	0		29	10	S5617_257_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	257	0		29	10	S5617_257_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.29	50	50	50				35.34	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	257	0		29	10	S5617_257_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	258	0		29	10	S5617_258_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	258	0		29	10	S5617_258_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	258	0		29	10	S5617_258_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	258	0		29	10	S5617_258_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	258	0		29	10	S5617_258_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	258	0		29	10	S5617_258_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											42.92	50	50	50				34.88	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	258	0		29	10	S5617_258_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	259	0		29	10	S5617_259_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	259	0		29	10	S5617_259_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	259	0		29	10	S5617_259_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	259	0		29	10	S5617_259_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	259	0		29	10	S5617_259_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	259	0		29	10	S5617_259_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											48.86	50	50	50				37.84	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	259	0		29	10	S5617_259_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	260	0		29	10	S5617_260_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	260	0		29	10	S5617_260_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	260	0		29	10	S5617_260_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	260	0		29	10	S5617_260_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	260	0		29	10	S5617_260_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	260	0		29	10	S5617_260_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											39.99	50	50	50				32.13	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	260	0		29	10	S5617_260_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	261	0		29	10	S5617_261_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	261	0		29	10	S5617_261_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	261	0		29	10	S5617_261_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	261	0		29	10	S5617_261_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	261	0		29	10	S5617_261_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	261	0		29	10	S5617_261_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											39.72	50	50	50				32.77	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	261	0		29	10	S5617_261_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	262	0		29	10	S5617_262_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	262	0		29	10	S5617_262_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	262	0		29	10	S5617_262_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	262	0		29	10	S5617_262_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	262	0		29	10	S5617_262_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	262	0		29	10	S5617_262_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											40.95	50	50	50				34.81	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	262	0		29	10	S5617_262_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	263	0		29	10	S5617_263_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	263	0		29	10	S5617_263_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	263	0		29	10	S5617_263_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	263	0		29	10	S5617_263_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	263	0		29	10	S5617_263_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	263	0		29	10	S5617_263_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											40.98	50	50	50				35.60	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	263	0		29	10	S5617_263_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	264	0		29	10	S5617_264_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	264	0		29	10	S5617_264_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	264	0		29	10	S5617_264_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	264	0		29	10	S5617_264_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	264	0		29	10	S5617_264_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	264	0		29	10	S5617_264_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.05	50	50	50				40.60	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	264	0		29	10	S5617_264_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	265	0		29	10	S5617_265_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	265	0		29	10	S5617_265_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	265	0		29	10	S5617_265_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	265	0		29	10	S5617_265_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	265	0		29	10	S5617_265_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	265	0		29	10	S5617_265_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.26	50	50	50				34.90	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	265	0		29	10	S5617_265_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	266	0		29	10	S5617_266_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	266	0		29	10	S5617_266_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	266	0		29	10	S5617_266_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	266	0		29	10	S5617_266_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	266	0		29	10	S5617_266_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	266	0		29	10	S5617_266_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.55	50	50	50				35.61	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	266	0		29	10	S5617_266_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	267	0		29	10	S5617_267_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	267	0		29	10	S5617_267_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	267	0		29	10	S5617_267_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	267	0		29	10	S5617_267_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	267	0		29	10	S5617_267_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	267	0		29	10	S5617_267_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.11	50	50	50				39.23	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	267	0		29	10	S5617_267_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	268	0		29	10	S5617_268_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	268	0		29	10	S5617_268_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	268	0		29	10	S5617_268_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	268	0		29	10	S5617_268_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	268	0		29	10	S5617_268_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	268	0		29	10	S5617_268_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											41.39	50	50	50				40.07	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	268	0		29	10	S5617_268_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	269	0		29	10	S5617_269_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	269	0		29	10	S5617_269_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	269	0		29	10	S5617_269_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	269	0		29	10	S5617_269_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	269	0		29	10	S5617_269_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	269	0		29	10	S5617_269_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											41.76	50	50	50				37.42	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	269	0		29	10	S5617_269_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	270	0		29	10	S5617_270_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	270	0		29	10	S5617_270_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	270	0		29	10	S5617_270_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	270	0		29	10	S5617_270_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	270	0		29	10	S5617_270_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	270	0		29	10	S5617_270_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											39.74	50	50	50				36.31	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	270	0		29	10	S5617_270_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	271	0		29	10	S5617_271_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	271	0		29	10	S5617_271_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	271	0		29	10	S5617_271_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	271	0		29	10	S5617_271_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	271	0		29	10	S5617_271_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	271	0		29	10	S5617_271_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.87	50	50	50				43.07	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	271	0		29	10	S5617_271_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	272	0		29	10	S5617_272_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	272	0		29	10	S5617_272_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	272	0		29	10	S5617_272_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	272	0		29	10	S5617_272_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	272	0		29	10	S5617_272_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	272	0		29	10	S5617_272_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											49.27	50	50	50				43.10	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	272	0		29	10	S5617_272_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	273	0		29	10	S5617_273_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	273	0		29	10	S5617_273_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	273	0		29	10	S5617_273_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	273	0		29	10	S5617_273_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	273	0		29	10	S5617_273_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	273	0		29	10	S5617_273_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											42.04	50	50	50				37.41	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	273	0		29	10	S5617_273_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	274	0		29	10	S5617_274_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	274	0		29	10	S5617_274_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	274	0		29	10	S5617_274_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	274	0		29	10	S5617_274_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	274	0		29	10	S5617_274_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	274	0		29	10	S5617_274_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.02	50	50	50				41.91	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	274	0		29	10	S5617_274_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	275	0		29	10	S5617_275_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	275	0		29	10	S5617_275_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	275	0		29	10	S5617_275_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	275	0		29	10	S5617_275_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	275	0		29	10	S5617_275_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	275	0		29	10	S5617_275_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											41.53	50	50	50				40.25	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	275	0		29	10	S5617_275_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	276	0		29	10	S5617_276_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	276	0		29	10	S5617_276_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	276	0		29	10	S5617_276_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	276	0		29	10	S5617_276_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	276	0		29	10	S5617_276_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	276	0		29	10	S5617_276_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.45	50	50	50				48.87	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	276	0		29	10	S5617_276_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	277	0		29	10	S5617_277_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	277	0		29	10	S5617_277_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	277	0		29	10	S5617_277_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	277	0		29	10	S5617_277_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	277	0		29	10	S5617_277_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	277	0		29	10	S5617_277_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.96	50	50	50				46.87	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	277	0		29	10	S5617_277_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	278	0		29	10	S5617_278_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	278	0		29	10	S5617_278_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	278	0		29	10	S5617_278_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	278	0		29	10	S5617_278_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	278	0		29	10	S5617_278_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	278	0		29	10	S5617_278_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.10	50	50	50				49.80	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	278	0		29	10	S5617_278_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	279	0		29	10	S5617_279_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	279	0		29	10	S5617_279_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	279	0		29	10	S5617_279_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	279	0		29	10	S5617_279_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5617	279	0		29	10	S5617_279_0	2	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	279	0		29	10	S5617_279_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											44.97	50	50	50				42.03	50	50	50										50	50	50				50	50	50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5617	279	0		29	10	S5617_279_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	104	0		29	10	S5660_104_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	104	0		29	10	S5660_104_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	104	0		29	10	S5660_104_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	104	0		29	10	S5660_104_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											31.96	43						29.07	41												43						43					43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	104	0		29	10	S5660_104_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	105	0		29	10	S5660_105_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	105	0		29	10	S5660_105_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	105	0		29	10	S5660_105_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	105	0		29	10	S5660_105_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											52.15	42						48.70	40												42						42					42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	105	0		29	10	S5660_105_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	106	0		29	10	S5660_106_0	2	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	106	0		29	10	S5660_106_0	2	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	106	0		29	10	S5660_106_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	106	0		29	10	S5660_106_0	2	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											59.49	48						56.94	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	106	0		29	10	S5660_106_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	107	0		29	10	S5660_107_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	107	0		29	10	S5660_107_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	107	0		29	10	S5660_107_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	107	0		29	10	S5660_107_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											60.51	49						56.57	47												49						49					49			49									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	107	0		29	10	S5660_107_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	108	0		29	10	S5660_108_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	108	0		29	10	S5660_108_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	108	0		29	10	S5660_108_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	108	0		29	10	S5660_108_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											55.99	43						53.59	41												43						43					43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	108	0		29	10	S5660_108_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	109	0		29	10	S5660_109_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	109	0		29	10	S5660_109_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	109	0		29	10	S5660_109_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								25.00		75.00					20.00		60.00													65.00						60.00				25.00				25.00			0.81	0.65				0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	109	0		29	10	S5660_109_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											48.85	50						44.99	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	109	0		29	10	S5660_109_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	110	0		29	10	S5660_110_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	110	0		29	10	S5660_110_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	110	0		29	10	S5660_110_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								25.00		75.00					20.00		60.00													65.00						60.00				25.00				25.00			0.81	0.65				0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	110	0		29	10	S5660_110_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											59.28	50						53.84	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	110	0		29	10	S5660_110_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	111	0		29	10	S5660_111_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	111	0		29	10	S5660_111_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	111	0		29	10	S5660_111_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								25.00		75.00					20.00		60.00													65.00						60.00				25.00				25.00			0.81	0.65				0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	111	0		29	10	S5660_111_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											55.86	50						48.47	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	111	0		29	10	S5660_111_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	112	0		29	10	S5660_112_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	112	0		29	10	S5660_112_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	112	0		29	10	S5660_112_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								28.00		84.00					23.00		69.00													74.00						69.00				28.00				28.00			0.90	0.74				0.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	112	0		29	10	S5660_112_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											49.70	50						44.34	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	112	0		29	10	S5660_112_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	113	0		29	10	S5660_113_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	113	0		29	10	S5660_113_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	113	0		29	10	S5660_113_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	113	0		29	10	S5660_113_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											57.01	48						53.44	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	113	0		29	10	S5660_113_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	114	0		29	10	S5660_114_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	114	0		29	10	S5660_114_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	114	0		29	10	S5660_114_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	114	0		29	10	S5660_114_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											56.96	50						52.46	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	114	0		29	10	S5660_114_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	115	0		29	10	S5660_115_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	115	0		29	10	S5660_115_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	115	0		29	10	S5660_115_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	115	0		29	10	S5660_115_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											58.85	49						55.70	47												49						49					49			49									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	115	0		29	10	S5660_115_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	116	0		29	10	S5660_116_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	116	0		29	10	S5660_116_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	116	0		29	10	S5660_116_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								30.00		90.00					25.00		75.00													80.00						75.00				30.00				30.00			0.97	0.81				0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	116	0		29	10	S5660_116_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											36.20	50						31.05	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	116	0		29	10	S5660_116_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	117	0		29	10	S5660_117_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	117	0		29	10	S5660_117_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	117	0		29	10	S5660_117_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								25.00		75.00					20.00		60.00													65.00						60.00				25.00				25.00			0.81	0.65				0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	117	0		29	10	S5660_117_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											54.97	50						51.81	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	117	0		29	10	S5660_117_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	118	0		29	10	S5660_118_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	118	0		29	10	S5660_118_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	118	0		29	10	S5660_118_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								27.00		81.00					22.00		66.00													71.00						66.00				27.00				27.00			0.87	0.71				0.87		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	118	0		29	10	S5660_118_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											48.68	50						45.09	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	118	0		29	10	S5660_118_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	119	0		29	10	S5660_119_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	119	0		29	10	S5660_119_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	119	0		29	10	S5660_119_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								32.00		96.00					27.00		81.00													86.00						81.00				32.00				32.00			1.03	0.87				1.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	119	0		29	10	S5660_119_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											59.43	50						53.71	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	119	0		29	10	S5660_119_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	120	0		29	10	S5660_120_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	120	0		29	10	S5660_120_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	120	0		29	10	S5660_120_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								26.00		78.00					21.00		63.00													68.00						63.00				26.00				26.00			0.84	0.68				0.84		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	120	0		29	10	S5660_120_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											52.73	50						48.68	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	120	0		29	10	S5660_120_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	121	0		29	10	S5660_121_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	121	0		29	10	S5660_121_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	121	0		29	10	S5660_121_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								28.00		84.00					23.00		69.00													74.00						69.00				28.00				28.00			0.90	0.74				0.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	121	0		29	10	S5660_121_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											51.35	50						44.88	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	121	0		29	10	S5660_121_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	122	0		29	10	S5660_122_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	122	0		29	10	S5660_122_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	122	0		29	10	S5660_122_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								33.00		99.00					28.00		84.00													89.00						84.00				33.00				33.00			1.06	0.90				1.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	122	0		29	10	S5660_122_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											43.59	50						39.35	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	122	0		29	10	S5660_122_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	123	0		29	10	S5660_123_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	123	0		29	10	S5660_123_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	123	0		29	10	S5660_123_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	123	0		29	10	S5660_123_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											56.74	50						52.58	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	123	0		29	10	S5660_123_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	124	0		29	10	S5660_124_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	124	0		29	10	S5660_124_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	124	0		29	10	S5660_124_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								31.00		93.00					26.00		78.00													83.00						78.00				31.00				31.00			1.00	0.84				1.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	124	0		29	10	S5660_124_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											46.95	50						43.34	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	124	0		29	10	S5660_124_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	125	0		29	10	S5660_125_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	125	0		29	10	S5660_125_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	125	0		29	10	S5660_125_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	125	0		29	10	S5660_125_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											58.98	49						55.08	47												49						49					49			49									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	125	0		29	10	S5660_125_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	126	0		29	10	S5660_126_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	126	0		29	10	S5660_126_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	126	0		29	10	S5660_126_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								24.00		72.00					19.00		57.00													62.00						57.00				24.00				24.00			0.77	0.61				0.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	126	0		29	10	S5660_126_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											45.01	50						39.60	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	126	0		29	10	S5660_126_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	127	0		29	10	S5660_127_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	127	0		29	10	S5660_127_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	127	0		29	10	S5660_127_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								25.00		75.00					20.00		60.00													65.00						60.00				25.00				25.00			0.81	0.65				0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	127	0		29	10	S5660_127_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											48.89	50						43.10	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	127	0		29	10	S5660_127_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	128	0		29	10	S5660_128_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	128	0		29	10	S5660_128_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	128	0		29	10	S5660_128_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								27.00		81.00					22.00		66.00													71.00						66.00				27.00				27.00			0.87	0.71				0.87		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	128	0		29	10	S5660_128_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											49.17	50						46.05	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	128	0		29	10	S5660_128_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	129	0		29	10	S5660_129_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	129	0		29	10	S5660_129_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	129	0		29	10	S5660_129_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	129	0		29	10	S5660_129_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											47.41	44						45.21	42												44						44					44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	129	0		29	10	S5660_129_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	130	0		29	10	S5660_130_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	130	0		29	10	S5660_130_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	130	0		29	10	S5660_130_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	130	0		29	10	S5660_130_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											56.65	47						50.34	45												47						47					47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	130	0		29	10	S5660_130_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	131	0		29	10	S5660_131_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	131	0		29	10	S5660_131_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	131	0		29	10	S5660_131_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								24.00		72.00					19.00		57.00													62.00						57.00				24.00				24.00			0.77	0.61				0.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	131	0		29	10	S5660_131_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											52.01	50						46.74	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	131	0		29	10	S5660_131_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	132	0		29	10	S5660_132_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	132	0		29	10	S5660_132_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	132	0		29	10	S5660_132_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	132	0		29	10	S5660_132_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											57.56	49						53.60	47												49						49					49			49									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	132	0		29	10	S5660_132_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	133	0		29	10	S5660_133_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	133	0		29	10	S5660_133_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	133	0		29	10	S5660_133_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	133	0		29	10	S5660_133_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											51.94	44						46.68	42												44						44					44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	133	0		29	10	S5660_133_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	134	0		29	10	S5660_134_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	134	0		29	10	S5660_134_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	134	0		29	10	S5660_134_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								25.00		75.00					20.00		60.00													65.00						60.00				25.00				25.00			0.81	0.65				0.81		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	134	0		29	10	S5660_134_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											50.46	50						51.50	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	134	0		29	10	S5660_134_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	135	0		29	10	S5660_135_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	135	0		29	10	S5660_135_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	135	0		29	10	S5660_135_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								28.00		84.00					23.00		69.00													74.00						69.00				28.00				28.00			0.90	0.74				0.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	135	0		29	10	S5660_135_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											52.38	50						50.09	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	135	0		29	10	S5660_135_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	136	0		29	10	S5660_136_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	136	0		29	10	S5660_136_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	136	0		29	10	S5660_136_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								23.00		69.00					18.00		54.00													59.00						54.00				23.00				23.00			0.74	0.58				0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	136	0		29	10	S5660_136_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											47.98	50						46.28	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	136	0		29	10	S5660_136_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	137	0		29	10	S5660_137_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	137	0		29	10	S5660_137_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	137	0		29	10	S5660_137_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								24.00		72.00					19.00		57.00													62.00						57.00				24.00				24.00			0.77	0.61				0.77		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	137	0		29	10	S5660_137_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											66.28	50						63.60	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	137	0		29	10	S5660_137_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	172	0		29	10	S5660_172_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	172	0		29	10	S5660_172_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	172	0		29	10	S5660_172_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	172	0		29	10	S5660_172_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											159.76	28		28				147.86	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	172	0		29	10	S5660_172_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.76	50						58.61	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	172	0		29	10	S5660_172_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	176	0		29	10	S5660_176_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	176	0		29	10	S5660_176_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	176	0		29	10	S5660_176_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	176	0		29	10	S5660_176_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											163.01	28		28				149.89	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	176	0		29	10	S5660_176_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											51.44	50						48.93	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	176	0		29	10	S5660_176_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	180	0		29	10	S5660_180_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	180	0		29	10	S5660_180_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	180	0		29	10	S5660_180_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	180	0		29	10	S5660_180_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											155.90	28		28				142.87	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	180	0		29	10	S5660_180_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.47	50						58.26	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	180	0		29	10	S5660_180_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	181	0		29	10	S5660_181_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	181	0		29	10	S5660_181_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	181	0		29	10	S5660_181_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	181	0		29	10	S5660_181_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											160.49	28		28				148.57	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	181	0		29	10	S5660_181_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											64.57	50						60.98	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	181	0		29	10	S5660_181_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	182	0		29	10	S5660_182_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	182	0		29	10	S5660_182_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	182	0		29	10	S5660_182_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	182	0		29	10	S5660_182_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											154.88	28		28				143.30	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	182	0		29	10	S5660_182_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											63.54	50						55.80	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	182	0		29	10	S5660_182_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	183	0		29	10	S5660_183_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	183	0		29	10	S5660_183_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	183	0		29	10	S5660_183_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	183	0		29	10	S5660_183_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											156.62	28		28				142.23	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	183	0		29	10	S5660_183_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											97.31	48						93.41	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	183	0		29	10	S5660_183_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	184	0		29	10	S5660_184_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	184	0		29	10	S5660_184_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	184	0		29	10	S5660_184_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	184	0		29	10	S5660_184_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											166.89	28		28				153.75	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	184	0		29	10	S5660_184_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											56.29	50						52.92	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	184	0		29	10	S5660_184_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	185	0		29	10	S5660_185_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	185	0		29	10	S5660_185_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	185	0		29	10	S5660_185_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	185	0		29	10	S5660_185_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											151.35	28		28				138.98	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	185	0		29	10	S5660_185_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											67.98	50						58.32	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	185	0		29	10	S5660_185_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	186	0		29	10	S5660_186_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	186	0		29	10	S5660_186_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	186	0		29	10	S5660_186_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	186	0		29	10	S5660_186_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											164.61	28		28				150.96	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	186	0		29	10	S5660_186_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.11	50						56.39	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	186	0		29	10	S5660_186_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	187	0		29	10	S5660_187_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	187	0		29	10	S5660_187_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	187	0		29	10	S5660_187_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	187	0		29	10	S5660_187_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											167.33	28		28				155.70	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	187	0		29	10	S5660_187_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											40.74	50						37.11	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	187	0		29	10	S5660_187_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	190	0		29	10	S5660_190_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	190	0		29	10	S5660_190_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	190	0		29	10	S5660_190_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	190	0		29	10	S5660_190_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											157.50	28		28				145.35	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	190	0		29	10	S5660_190_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											77.23	50						76.89	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	190	0		29	10	S5660_190_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	192	0		29	10	S5660_192_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	192	0		29	10	S5660_192_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	192	0		29	10	S5660_192_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	192	0		29	10	S5660_192_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											165.34	28		28				150.83	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	192	0		29	10	S5660_192_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											52.70	50						50.25	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	192	0		29	10	S5660_192_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	194	0		29	10	S5660_194_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	194	0		29	10	S5660_194_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	194	0		29	10	S5660_194_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	194	0		29	10	S5660_194_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											160.20	28		28				147.12	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	194	0		29	10	S5660_194_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											60.08	50						51.29	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	194	0		29	10	S5660_194_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	195	0		29	10	S5660_195_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	195	0		29	10	S5660_195_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	195	0		29	10	S5660_195_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	195	0		29	10	S5660_195_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											160.20	28		28				148.81	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	195	0		29	10	S5660_195_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											59.22	50						56.61	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	195	0		29	10	S5660_195_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	196	0		29	10	S5660_196_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	196	0		29	10	S5660_196_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	196	0		29	10	S5660_196_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	196	0		29	10	S5660_196_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											168.25	28		28				151.83	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	196	0		29	10	S5660_196_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											65.56	50						51.60	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	196	0		29	10	S5660_196_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	197	0		29	10	S5660_197_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	197	0		29	10	S5660_197_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	197	0		29	10	S5660_197_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	197	0		29	10	S5660_197_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											155.41	28		28				141.25	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	197	0		29	10	S5660_197_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											97.31	50						93.44	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	197	0		29	10	S5660_197_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	198	0		29	10	S5660_198_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	198	0		29	10	S5660_198_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	198	0		29	10	S5660_198_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	198	0		29	10	S5660_198_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											164.41	28		28				149.17	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	198	0		29	10	S5660_198_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											57.92	50						53.23	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	198	0		29	10	S5660_198_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	199	0		29	10	S5660_199_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	199	0		29	10	S5660_199_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	199	0		29	10	S5660_199_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	199	0		29	10	S5660_199_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											166.92	28		28				151.67	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	199	0		29	10	S5660_199_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											78.61	50						75.66	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	199	0		29	10	S5660_199_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	202	0		29	10	S5660_202_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	202	0		29	10	S5660_202_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	202	0		29	10	S5660_202_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	202	0		29	10	S5660_202_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											163.36	28		28				148.92	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	202	0		29	10	S5660_202_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											66.68	50						63.04	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	202	0		29	10	S5660_202_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	203	0		29	10	S5660_203_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	203	0		29	10	S5660_203_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	203	0		29	10	S5660_203_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	203	0		29	10	S5660_203_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											164.84	28		28				148.66	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	203	0		29	10	S5660_203_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											74.36	50						62.57	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	203	0		29	10	S5660_203_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	204	0		29	10	S5660_204_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	204	0		29	10	S5660_204_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	204	0		29	10	S5660_204_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	204	0		29	10	S5660_204_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											155.73	28		28				138.07	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	204	0		29	10	S5660_204_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											59.03	50						58.65	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	204	0		29	10	S5660_204_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	206	0		29	10	S5660_206_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	206	0		29	10	S5660_206_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	206	0		29	10	S5660_206_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	206	0		29	10	S5660_206_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											178.39	28		28				167.60	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	206	0		29	10	S5660_206_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											49.61	50						44.43	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	206	0		29	10	S5660_206_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	207	0		29	10	S5660_207_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	207	0		29	10	S5660_207_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	207	0		29	10	S5660_207_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	207	0		29	10	S5660_207_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											158.08	28		28				144.49	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	207	0		29	10	S5660_207_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.94	50						59.83	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	207	0		29	10	S5660_207_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	208	0		29	10	S5660_208_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	208	0		29	10	S5660_208_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	208	0		29	10	S5660_208_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	208	0		29	10	S5660_208_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											162.27	28		28				148.84	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	208	0		29	10	S5660_208_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											52.23	50						49.77	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	208	0		29	10	S5660_208_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	209	0		29	10	S5660_209_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	209	0		29	10	S5660_209_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	209	0		29	10	S5660_209_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	209	0		29	10	S5660_209_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											170.14	28		28				156.70	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	209	0		29	10	S5660_209_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											48.86	50						43.30	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	209	0		29	10	S5660_209_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	210	0		29	10	S5660_210_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	210	0		29	10	S5660_210_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	210	0		29	10	S5660_210_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	210	0		29	10	S5660_210_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											157.69	28		28				144.39	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	210	0		29	10	S5660_210_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											44.16	50						41.16	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	210	0		29	10	S5660_210_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	211	0		29	10	S5660_211_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	211	0		29	10	S5660_211_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	211	0		29	10	S5660_211_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	211	0		29	10	S5660_211_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											173.07	28		28				155.00	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	211	0		29	10	S5660_211_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											49.69	50						46.93	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	211	0		29	10	S5660_211_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	212	0		29	10	S5660_212_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	212	0		29	10	S5660_212_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	212	0		29	10	S5660_212_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	212	0		29	10	S5660_212_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											158.19	28		28				150.24	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	212	0		29	10	S5660_212_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											96.23	32						52.36	30												32						32					32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	212	0		29	10	S5660_212_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	213	0		29	10	S5660_213_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	213	0		29	10	S5660_213_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	213	0		29	10	S5660_213_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	213	0		29	10	S5660_213_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											154.56	28		28				143.44	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	213	0		29	10	S5660_213_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											58.19	50						53.55	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	213	0		29	10	S5660_213_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	214	0		29	10	S5660_214_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	214	0		29	10	S5660_214_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	214	0		29	10	S5660_214_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	214	0		29	10	S5660_214_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											154.20	28		28				144.55	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	214	0		29	10	S5660_214_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											76.99	50						66.00	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	214	0		29	10	S5660_214_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	215	0		29	10	S5660_215_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	215	0		29	10	S5660_215_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	215	0		29	10	S5660_215_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	215	0		29	10	S5660_215_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											190.57	28		28				172.70	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	215	0		29	10	S5660_215_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											52.40	50						48.30	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	215	0		29	10	S5660_215_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	216	0		29	10	S5660_216_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	216	0		29	10	S5660_216_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	216	0		29	10	S5660_216_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	216	0		29	10	S5660_216_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											162.84	28		28				149.97	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	216	0		29	10	S5660_216_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											89.54	50						86.30	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	216	0		29	10	S5660_216_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	217	0		29	10	S5660_217_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	217	0		29	10	S5660_217_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	217	0		29	10	S5660_217_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	217	0		29	10	S5660_217_0	1	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											164.35	28		28				153.92	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5660	217	0		29	10	S5660_217_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											42.02	50						37.79	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	217	0		29	10	S5660_217_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	218	0		29	10	S5660_218_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	218	0		29	10	S5660_218_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	218	0		29	10	S5660_218_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.69	20		20				25.04	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	218	0		29	10	S5660_218_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											60.17	45						58.25	43												45						45					45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	218	0		29	10	S5660_218_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	219	0		29	10	S5660_219_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	219	0		29	10	S5660_219_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	219	0		29	10	S5660_219_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											28.29	20		20				25.49	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	219	0		29	10	S5660_219_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											60.25	44						58.04	42												44						44					44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	219	0		29	10	S5660_219_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	220	0		29	10	S5660_220_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	220	0		29	10	S5660_220_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	220	0		29	10	S5660_220_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											29.31	20		20				26.54	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	220	0		29	10	S5660_220_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											65.00	46						63.09	44												46						46					46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	220	0		29	10	S5660_220_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	221	0		29	10	S5660_221_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	221	0		29	10	S5660_221_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	221	0		29	10	S5660_221_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											28.22	20		20				25.43	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	221	0		29	10	S5660_221_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.85	46						60.61	44												46						46					46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	221	0		29	10	S5660_221_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	222	0		29	10	S5660_222_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	222	0		29	10	S5660_222_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	222	0		29	10	S5660_222_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											28.02	20		20				25.32	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	222	0		29	10	S5660_222_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											60.87	45						58.86	43												45						45					45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	222	0		29	10	S5660_222_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	223	0		29	10	S5660_223_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	223	0		29	10	S5660_223_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	223	0		29	10	S5660_223_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.81	20		20				25.13	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	223	0		29	10	S5660_223_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											59.21	44						57.16	42												44						44					44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	223	0		29	10	S5660_223_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	224	0		29	10	S5660_224_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	224	0		29	10	S5660_224_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	224	0		29	10	S5660_224_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.50	20		20				24.85	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	224	0		29	10	S5660_224_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											63.41	48						61.64	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	224	0		29	10	S5660_224_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	225	0		29	10	S5660_225_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	225	0		29	10	S5660_225_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	225	0		29	10	S5660_225_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											28.66	20		20				25.89	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	225	0		29	10	S5660_225_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											63.56	46						61.51	44												46						46					46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	225	0		29	10	S5660_225_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	226	0		29	10	S5660_226_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	226	0		29	10	S5660_226_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	226	0		29	10	S5660_226_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.20	20		20				24.61	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	226	0		29	10	S5660_226_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											61.59	47						59.76	45												47						47					47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	226	0		29	10	S5660_226_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	227	0		29	10	S5660_227_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	227	0		29	10	S5660_227_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	227	0		29	10	S5660_227_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											28.00	20		20				25.27	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	227	0		29	10	S5660_227_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.15	46						60.11	44												46						46					46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	227	0		29	10	S5660_227_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	228	0		29	10	S5660_228_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	228	0		29	10	S5660_228_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	228	0		29	10	S5660_228_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											26.96	20		20				24.44	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	228	0		29	10	S5660_228_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.07	48						60.56	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	228	0		29	10	S5660_228_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	229	0		29	10	S5660_229_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	229	0		29	10	S5660_229_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	229	0		29	10	S5660_229_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.67	20		20				25.01	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	229	0		29	10	S5660_229_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											61.47	46						59.46	44												46						46					46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	229	0		29	10	S5660_229_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	230	0		29	10	S5660_230_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	230	0		29	10	S5660_230_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	230	0		29	10	S5660_230_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.48	20		20				24.85	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	230	0		29	10	S5660_230_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											59.70	45						57.77	43												45						45					45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	230	0		29	10	S5660_230_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	231	0		29	10	S5660_231_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	231	0		29	10	S5660_231_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	231	0		29	10	S5660_231_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											26.59	20		20				24.04	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	231	0		29	10	S5660_231_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											61.23	48						59.59	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	231	0		29	10	S5660_231_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	232	0		29	10	S5660_232_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	232	0		29	10	S5660_232_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	232	0		29	10	S5660_232_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											26.48	20		20				23.88	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	232	0		29	10	S5660_232_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											59.95	47						58.02	45												47						47					47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	232	0		29	10	S5660_232_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	233	0		29	10	S5660_233_0	3	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	233	0		29	10	S5660_233_0	3	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	233	0		29	10	S5660_233_0	3	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.38	20		20				24.73	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	233	0		29	10	S5660_233_0	3	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											63.24	48						61.41	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	233	0		29	10	S5660_233_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	234	0		29	10	S5660_234_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	234	0		29	10	S5660_234_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	234	0		29	10	S5660_234_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											26.90	20		20				24.32	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	234	0		29	10	S5660_234_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											61.96	48						60.24	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	234	0		29	10	S5660_234_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	235	0		29	10	S5660_235_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	235	0		29	10	S5660_235_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	235	0		29	10	S5660_235_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											25.79	20		20				23.29	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	235	0		29	10	S5660_235_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											59.37	48						57.82	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	235	0		29	10	S5660_235_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	236	0		29	10	S5660_236_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	236	0		29	10	S5660_236_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	236	0		29	10	S5660_236_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											26.67	20		20				24.15	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	236	0		29	10	S5660_236_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.49	49						61.10	47												49						49					49			49									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	236	0		29	10	S5660_236_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	237	0		29	10	S5660_237_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	237	0		29	10	S5660_237_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	237	0		29	10	S5660_237_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.19	20		20				24.59	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	237	0		29	10	S5660_237_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.74	48						60.97	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	237	0		29	10	S5660_237_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	238	0		29	10	S5660_238_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	238	0		29	10	S5660_238_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	238	0		29	10	S5660_238_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											28.21	20		20				25.40	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	238	0		29	10	S5660_238_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.83	46						60.53	44												46						46					46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	238	0		29	10	S5660_238_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	239	0		29	10	S5660_239_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	239	0		29	10	S5660_239_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	239	0		29	10	S5660_239_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.40	20		20				24.77	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	239	0		29	10	S5660_239_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											63.18	48						61.42	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	239	0		29	10	S5660_239_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	240	0		29	10	S5660_240_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	240	0		29	10	S5660_240_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	240	0		29	10	S5660_240_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											26.17	20		20				23.59	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	240	0		29	10	S5660_240_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											60.38	48						58.53	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	240	0		29	10	S5660_240_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	241	0		29	10	S5660_241_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	241	0		29	10	S5660_241_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	241	0		29	10	S5660_241_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											26.89	20		20				24.25	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	241	0		29	10	S5660_241_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											60.84	47						58.91	45												47						47					47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	241	0		29	10	S5660_241_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	242	0		29	10	S5660_242_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	242	0		29	10	S5660_242_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	242	0		29	10	S5660_242_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											28.02	20		20				25.18	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	242	0		29	10	S5660_242_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.46	46						60.07	44												46						46					46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	242	0		29	10	S5660_242_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	243	0		29	10	S5660_243_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	243	0		29	10	S5660_243_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	243	0		29	10	S5660_243_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.83	20		20				25.07	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	243	0		29	10	S5660_243_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											60.68	45						58.31	43												45						45					45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	243	0		29	10	S5660_243_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	244	0		29	10	S5660_244_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	244	0		29	10	S5660_244_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	244	0		29	10	S5660_244_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											28.00	20		20				25.29	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	244	0		29	10	S5660_244_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.36	46						60.29	44												46						46					46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	244	0		29	10	S5660_244_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	245	0		29	10	S5660_245_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	245	0		29	10	S5660_245_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	245	0		29	10	S5660_245_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											28.27	20		20				25.54	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	245	0		29	10	S5660_245_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.80	46						60.79	44												46						46					46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	245	0		29	10	S5660_245_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	246	0		29	10	S5660_246_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	246	0		29	10	S5660_246_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	246	0		29	10	S5660_246_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.21	20		20				24.54	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	246	0		29	10	S5660_246_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											59.26	45						57.18	43												45						45					45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	246	0		29	10	S5660_246_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	247	0		29	10	S5660_247_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	247	0		29	10	S5660_247_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	247	0		29	10	S5660_247_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.35	20		20				24.77	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	247	0		29	10	S5660_247_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											63.04	48						61.39	46												48						48					48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	247	0		29	10	S5660_247_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	248	0		29	10	S5660_248_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	248	0		29	10	S5660_248_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	248	0		29	10	S5660_248_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											28.39	20		20				25.54	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	248	0		29	10	S5660_248_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											62.14	45						59.21	43												45						45					45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	248	0		29	10	S5660_248_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	249	0		29	10	S5660_249_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	249	0		29	10	S5660_249_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	249	0		29	10	S5660_249_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											28.66	20		20				25.66	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	249	0		29	10	S5660_249_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											65.31	47						62.61	45												47						47					47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	249	0		29	10	S5660_249_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	250	0		29	10	S5660_250_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	250	0		29	10	S5660_250_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	250	0		29	10	S5660_250_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											27.26	20		20				24.87	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	250	0		29	10	S5660_250_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											60.13	46						58.89	44												46						46					46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	250	0		29	10	S5660_250_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	251	0		29	10	S5660_251_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	251	0		29	10	S5660_251_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	251	0		29	10	S5660_251_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											29.59	20		20				26.64	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	251	0		29	10	S5660_251_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											68.56	47						65.64	45												47						47					47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5660	251	0		29	10	S5660_251_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	001	0		29	10	S5715_001_0	5	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	001	0		29	10	S5715_001_0	5	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	001	0		29	10	S5715_001_0	5	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	001	0		29	10	S5715_001_0	5	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											47.33	50		50				37.02	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	001	0		29	10	S5715_001_0	5	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											574.09	25		25				589.96	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	002	0		29	10	S5715_002_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	002	0		29	10	S5715_002_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5715	002	0		29	10	S5715_002_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						6.00				7.00				7.00			0.23	0.07				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	002	0		29	10	S5715_002_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						6.00				7.00				7.00			0.23	0.07				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5715	002	0		29	10	S5715_002_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					30.00		90.00													105.00						90.00				35.00				35.00			1.17	1.00				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	002	0		29	10	S5715_002_0	7	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					30.00		90.00													105.00						90.00				35.00				35.00			1.17	1.00				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	3	
S5715	002	0		29	10	S5715_002_0	7	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											42.03	45		45				32.59	35		35												45						35			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	002	0		29	10	S5715_002_0	7	Non-Preferred Brand	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											73.56	23		23				57.21	18		18												23						18			23			23									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	1	
S5715	002	0		29	10	S5715_002_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											624.64	33		33				648.23	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	002	0		29	10	S5715_002_0	7	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											766.76	24		24				814.74	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	2	
S5715	003	0		29	10	S5715_003_0	5	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	003	0		29	10	S5715_003_0	5	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	003	0		29	10	S5715_003_0	5	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	003	0		29	10	S5715_003_0	5	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											50.90	50		50				39.59	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	003	0		29	10	S5715_003_0	5	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											545.19	25		25				563.33	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	004	0		29	10	S5715_004_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	004	0		29	10	S5715_004_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5715	004	0		29	10	S5715_004_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						6.00				7.00				7.00			0.23	0.07				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	004	0		29	10	S5715_004_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						6.00				7.00				7.00			0.23	0.07				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5715	004	0		29	10	S5715_004_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					30.00		90.00													105.00						90.00				35.00				35.00			1.17	1.00				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	004	0		29	10	S5715_004_0	7	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					30.00		90.00													105.00						90.00				35.00				35.00			1.17	1.00				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	3	
S5715	004	0		29	10	S5715_004_0	7	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											30.48	45		45				23.72	35		35												45						35			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	004	0		29	10	S5715_004_0	7	Non-Preferred Brand	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											64.36	23		23				49.99	18		18												23						18			23			23									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	1	
S5715	004	0		29	10	S5715_004_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											628.85	33		33				632.08	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	004	0		29	10	S5715_004_0	7	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											684.21	24		24				686.92	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	2	
S5715	005	0		29	10	S5715_005_0	5	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	005	0		29	10	S5715_005_0	5	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	005	0		29	10	S5715_005_0	5	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	005	0		29	10	S5715_005_0	5	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											54.23	50		50				42.32	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	005	0		29	10	S5715_005_0	5	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											500.58	25		25				524.18	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	006	0		29	10	S5715_006_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	006	0		29	10	S5715_006_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5715	006	0		29	10	S5715_006_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						6.00				7.00				7.00			0.23	0.07				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	006	0		29	10	S5715_006_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						6.00				7.00				7.00			0.23	0.07				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5715	006	0		29	10	S5715_006_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					30.00		90.00													105.00						90.00				35.00				35.00			1.17	1.00				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	006	0		29	10	S5715_006_0	7	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					30.00		90.00													105.00						90.00				35.00				35.00			1.17	1.00				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	3	
S5715	006	0		29	10	S5715_006_0	7	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											43.05	45		45				33.49	35		35												45						35			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	006	0		29	10	S5715_006_0	7	Non-Preferred Brand	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											75.04	23		23				58.48	18		18												23						18			23			23									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	1	
S5715	006	0		29	10	S5715_006_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											765.65	33		33				790.21	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	006	0		29	10	S5715_006_0	7	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											915.95	24		24				954.30	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	2	
S5715	010	0		29	10	S5715_010_0	5	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	010	0		29	10	S5715_010_0	5	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	010	0		29	10	S5715_010_0	5	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	010	0		29	10	S5715_010_0	5	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											47.04	50		50				36.86	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	010	0		29	10	S5715_010_0	5	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											590.05	25		25				623.59	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	011	0		29	10	S5715_011_0	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	011	0		29	10	S5715_011_0	7	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5715	011	0		29	10	S5715_011_0	7	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						6.00				7.00				7.00			0.23	0.07				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	011	0		29	10	S5715_011_0	7	Generic	4	11	1	2	2	3		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						6.00				7.00				7.00			0.23	0.07				0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5715	011	0		29	10	S5715_011_0	7	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					30.00		90.00													105.00						90.00				35.00				35.00			1.17	1.00				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	011	0		29	10	S5715_011_0	7	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					30.00		90.00													105.00						90.00				35.00				35.00			1.17	1.00				1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	3	
S5715	011	0		29	10	S5715_011_0	7	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											37.76	45		45				29.40	35		35												45						35			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	011	0		29	10	S5715_011_0	7	Non-Preferred Brand	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											66.57	23		23				52.12	18		18												23						18			23			23									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	1	
S5715	011	0		29	10	S5715_011_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											770.20	33		33				758.42	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5715	011	0		29	10	S5715_011_0	7	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											963.83	24		24				972.95	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											2	2	
S5715	012	0		29	10	S5715_012_0	6	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					1.00		3.00													33.00						3.00				11.00				11.00			0.37	0.03				0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	012	0		29	10	S5715_012_0	6	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					4.00		12.00													42.00						12.00				14.00				14.00			0.47	0.13				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	012	0		29	10	S5715_012_0	6	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											35.28	21		21				26.07	16		16												21						16			21			21									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	012	0		29	10	S5715_012_0	6	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											27.19	34		34				22.62	29		29												34						29			34			34									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	012	0		29	10	S5715_012_0	6	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											380.30	25		25				403.77	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	013	0		29	10	S5715_013_0	6	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					1.00		3.00													33.00						3.00				11.00				11.00			0.37	0.03				0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	013	0		29	10	S5715_013_0	6	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					4.00		12.00													42.00						12.00				14.00				14.00			0.47	0.13				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	013	0		29	10	S5715_013_0	6	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.06	19		19				23.77	14		14												19						14			19			19									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	013	0		29	10	S5715_013_0	6	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											25.71	30		30				21.37	25		25												30						25			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	013	0		29	10	S5715_013_0	6	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											375.16	25		25				380.01	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	014	0		29	10	S5715_014_0	6	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					1.00		3.00													33.00						3.00				11.00				11.00			0.37	0.03				0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	014	0		29	10	S5715_014_0	6	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					4.00		12.00													42.00						12.00				14.00				14.00			0.47	0.13				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	014	0		29	10	S5715_014_0	6	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											35.79	19		19				25.61	14		14												19						14			19			19									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	014	0		29	10	S5715_014_0	6	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											28.62	32		32				23.76	27		27												32						27			32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	014	0		29	10	S5715_014_0	6	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											407.55	25		25				409.22	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	015	0		29	10	S5715_015_0	5	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					1.00		3.00													33.00						3.00				11.00				11.00			0.37	0.03				0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	015	0		29	10	S5715_015_0	5	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					4.00		12.00													42.00						12.00				14.00				14.00			0.47	0.13				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	015	0		29	10	S5715_015_0	5	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											37.41	21		21				28.36	16		16												21						16			21			21									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	015	0		29	10	S5715_015_0	5	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											31.26	37		37				26.40	32		32												37						32			37			37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5715	015	0		29	10	S5715_015_0	5	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											424.65	25		25				441.36	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5726	013	0		29	10	S5726_013_0	2	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					1.00	2.00	3.00					1.00	3.00	3.00																18.00				18.00			0.60	0.03	0.03			0.53		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	013	0		29	10	S5726_013_0	2	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					6.00	12.00	18.00					6.00	18.00	18.00																19.00				19.00			0.63	0.20	0.20			0.56		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	013	0		29	10	S5726_013_0	2	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					32.00	64.00	96.00					32.00	96.00	96.00																47.00				47.00			1.57	1.07	1.07			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	013	0		29	10	S5726_013_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											61.79	50	50	50				49.43	40	40	40				40	40	40															50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	013	0		29	10	S5726_013_0	2	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	013	0		29	10	S5726_013_0	2	Select Care Drugs	3	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					0.00	0.00	0.00					0.00	0.00	0.00																11.00				11.00			0.37	0.00	0.00			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	014	0		29	10	S5726_014_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	014	0		29	10	S5726_014_0	2	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5726	014	0		29	10	S5726_014_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	014	0		29	10	S5726_014_0	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	014	0		29	10	S5726_014_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											84.78	47	47	47				70.35	39	39	39				39	39	39															47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	014	0		29	10	S5726_014_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	014	0		29	10	S5726_014_0	2	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	014	0		29	10	S5726_014_0	2	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5726	015	0		29	10	S5726_015_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	015	0		29	10	S5726_015_0	3	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					1.00	2.00	3.00					1.00	3.00	3.00																10.00				10.00			0.33	0.03	0.03			0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5726	015	0		29	10	S5726_015_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	015	0		29	10	S5726_015_0	3	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5726	015	0		29	10	S5726_015_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					28.00	56.00	84.00					28.00	84.00	84.00																47.00				47.00			1.57	0.93	0.93			1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	015	0		29	10	S5726_015_0	3	Preferred Brand	4	11	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											123.13	28	28	28				120.89	27	27	27				28	28	28															28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											2	1	
S5726	015	0		29	10	S5726_015_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											89.23	40	40	40				78.08	35	35	35				35	35	35															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	015	0		29	10	S5726_015_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	015	0		29	10	S5726_015_0	3	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5726	015	0		29	10	S5726_015_0	3	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5743	001	0		29	10	S5743_001_0	2	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					1.00	2.00	2.00											15.00	30.00	30.00				1.00	2.00	2.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5743	001	0		29	10	S5743_001_0	2	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	38.00					5.00	10.00	10.00											19.00	38.00	38.00				5.00	10.00	10.00				19.00				19.00			0.63	0.17		0.63	0.17	0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5743	001	0		29	10	S5743_001_0	2	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.32	21	21	21				19.55	17	17	17										21	21	21				17	17	17			21			21									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5743	001	0		29	10	S5743_001_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.97	41	41	41				46.21	30	30	30										41	41	41				30	30	30			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5743	001	0		29	10	S5743_001_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5743	004	0		29	10	S5743_004_0	2	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					0.00	0.00	0.00											15.00	30.00	30.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5743	004	0		29	10	S5743_004_0	2	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					0.00	0.00	0.00											15.00	30.00	30.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5743	004	0		29	10	S5743_004_0	2	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					0.00	0.00	0.00											20.00	40.00	40.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5743	004	0		29	10	S5743_004_0	2	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					0.00	0.00	0.00											20.00	40.00	40.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5743	004	0		29	10	S5743_004_0	2	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											19.92	25	25	25				14.07	17	17	17										25	25	25				17	17	17			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5743	004	0		29	10	S5743_004_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.38	50	50	50				53.74	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5743	004	0		29	10	S5743_004_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5753	006	0		29	10	S5753_006_0	1	Preferred Generic	2	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00					0.00			0.00			0.20	0.00		0.20	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5753	006	0		29	10	S5753_006_0	1	Generic	2	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	50.00				15.00	30.00	37.50					15.00			15.00			0.67	0.50		0.67	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5753	006	0		29	10	S5753_006_0	1	Preferred Brand	2	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	117.50				42.00	84.00	105.00					42.00			42.00			1.57	1.40		1.57	1.40	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5753	006	0		29	10	S5753_006_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											88.80	50	50	50				83.47	47	47	47										50	50	50				47	47	47				47		47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5753	006	0		29	10	S5753_006_0	1	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				29	31												25							25												25						25						25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5753	007	0		29	10	S5753_007_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00					0.00			0.00			0.20	0.00		0.20	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5753	007	0		29	10	S5753_007_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00					0.00			0.00			0.20	0.00		0.20	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5753	007	0		29	10	S5753_007_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	50.00				15.00	30.00	37.50					15.00			15.00			0.67	0.50		0.67	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5753	007	0		29	10	S5753_007_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	50.00				15.00	30.00	37.50					15.00			15.00			0.67	0.50		0.67	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5753	007	0		29	10	S5753_007_0	1	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	117.50				42.00	84.00	105.00					42.00			42.00			1.57	1.40		1.57	1.40	1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5753	007	0		29	10	S5753_007_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											91.54	50	50	50				86.04	47	47	47										50	50	50				47	47	47				47		47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5753	007	0		29	10	S5753_007_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				29	31												33							33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	125	0		29	10	S5768_125_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	125	0		29	10	S5768_125_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	125	0		29	10	S5768_125_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	125	0		29	10	S5768_125_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	125	0		29	10	S5768_125_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	125	0		29	10	S5768_125_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.28	50	50	50				42.92	46	46	46										50	50	50				46	46	46				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	125	0		29	10	S5768_125_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	126	0		29	10	S5768_126_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	126	0		29	10	S5768_126_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	126	0		29	10	S5768_126_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	126	0		29	10	S5768_126_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	126	0		29	10	S5768_126_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	126	0		29	10	S5768_126_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.26	50	50	50				50.81	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	126	0		29	10	S5768_126_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.00	25	25	25				53.91	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	126	0		29	10	S5768_126_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	127	0		29	10	S5768_127_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	127	0		29	10	S5768_127_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	127	0		29	10	S5768_127_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	127	0		29	10	S5768_127_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	127	0		29	10	S5768_127_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	127	0		29	10	S5768_127_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.32	50	50	50				47.12	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	127	0		29	10	S5768_127_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.52	25	25	25				57.58	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	127	0		29	10	S5768_127_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	128	0		29	10	S5768_128_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	128	0		29	10	S5768_128_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	128	0		29	10	S5768_128_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	128	0		29	10	S5768_128_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	128	0		29	10	S5768_128_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	128	0		29	10	S5768_128_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.28	50	50	50				47.41	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	128	0		29	10	S5768_128_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.75	25	25	25				52.25	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	128	0		29	10	S5768_128_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	129	0		29	10	S5768_129_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	129	0		29	10	S5768_129_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	129	0		29	10	S5768_129_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	129	0		29	10	S5768_129_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	129	0		29	10	S5768_129_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	129	0		29	10	S5768_129_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.61	50	50	50				44.39	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	129	0		29	10	S5768_129_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.64	25	25	25				52.67	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	129	0		29	10	S5768_129_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	130	0		29	10	S5768_130_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	130	0		29	10	S5768_130_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	130	0		29	10	S5768_130_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	130	0		29	10	S5768_130_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	130	0		29	10	S5768_130_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	130	0		29	10	S5768_130_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.19	50	50	50				48.21	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	130	0		29	10	S5768_130_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.04	25	25	25				54.21	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	130	0		29	10	S5768_130_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	131	0		29	10	S5768_131_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	131	0		29	10	S5768_131_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	131	0		29	10	S5768_131_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	131	0		29	10	S5768_131_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	131	0		29	10	S5768_131_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	131	0		29	10	S5768_131_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.48	50	50	50				48.29	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	131	0		29	10	S5768_131_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.89	25	25	25				58.20	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	131	0		29	10	S5768_131_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	132	0		29	10	S5768_132_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	132	0		29	10	S5768_132_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	132	0		29	10	S5768_132_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	132	0		29	10	S5768_132_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	132	0		29	10	S5768_132_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	132	0		29	10	S5768_132_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.98	50	50	50				45.55	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	132	0		29	10	S5768_132_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.24	25	25	25				50.54	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	132	0		29	10	S5768_132_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	133	0		29	10	S5768_133_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	133	0		29	10	S5768_133_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	133	0		29	10	S5768_133_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	133	0		29	10	S5768_133_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	133	0		29	10	S5768_133_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	133	0		29	10	S5768_133_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.93	50	50	50				46.79	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	133	0		29	10	S5768_133_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.13	25	25	25				50.81	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	133	0		29	10	S5768_133_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	134	0		29	10	S5768_134_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	134	0		29	10	S5768_134_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	134	0		29	10	S5768_134_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	134	0		29	10	S5768_134_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	134	0		29	10	S5768_134_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	134	0		29	10	S5768_134_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.47	50	50	50				46.30	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	134	0		29	10	S5768_134_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.41	25	25	25				53.81	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	134	0		29	10	S5768_134_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	135	0		29	10	S5768_135_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	135	0		29	10	S5768_135_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	135	0		29	10	S5768_135_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	135	0		29	10	S5768_135_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	135	0		29	10	S5768_135_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	135	0		29	10	S5768_135_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.97	50	50	50				47.37	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	135	0		29	10	S5768_135_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.30	25	25	25				53.76	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	135	0		29	10	S5768_135_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	136	0		29	10	S5768_136_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	136	0		29	10	S5768_136_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	136	0		29	10	S5768_136_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	136	0		29	10	S5768_136_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	136	0		29	10	S5768_136_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	136	0		29	10	S5768_136_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.69	50	50	50				47.16	48	48	48										50	50	50				48	48	48				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	136	0		29	10	S5768_136_0	3	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.75	25	25	25				59.34	24	24	24										25	25	25				24	24	24				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	136	0		29	10	S5768_136_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	137	0		29	10	S5768_137_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	137	0		29	10	S5768_137_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	137	0		29	10	S5768_137_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	137	0		29	10	S5768_137_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	137	0		29	10	S5768_137_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	137	0		29	10	S5768_137_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.06	50	50	50				44.23	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	137	0		29	10	S5768_137_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.44	25	25	25				61.61	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	137	0		29	10	S5768_137_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	138	0		29	10	S5768_138_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	138	0		29	10	S5768_138_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	138	0		29	10	S5768_138_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	138	0		29	10	S5768_138_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	138	0		29	10	S5768_138_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	138	0		29	10	S5768_138_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.07	50	50	50				47.58	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	138	0		29	10	S5768_138_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.56	25	25	25				52.21	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	138	0		29	10	S5768_138_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	139	0		29	10	S5768_139_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	139	0		29	10	S5768_139_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	139	0		29	10	S5768_139_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	139	0		29	10	S5768_139_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	139	0		29	10	S5768_139_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	139	0		29	10	S5768_139_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.07	50	50	50				44.90	48	48	48										50	50	50				48	48	48				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	139	0		29	10	S5768_139_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.99	25	25	25				62.03	24	24	24										25	25	25				24	24	24				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	139	0		29	10	S5768_139_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	140	0		29	10	S5768_140_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	140	0		29	10	S5768_140_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	140	0		29	10	S5768_140_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	140	0		29	10	S5768_140_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	140	0		29	10	S5768_140_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	140	0		29	10	S5768_140_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.33	50	50	50				47.91	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	140	0		29	10	S5768_140_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.38	25	25	25				60.48	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	140	0		29	10	S5768_140_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	141	0		29	10	S5768_141_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	141	0		29	10	S5768_141_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	141	0		29	10	S5768_141_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	141	0		29	10	S5768_141_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	141	0		29	10	S5768_141_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	141	0		29	10	S5768_141_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.14	50	50	50				42.95	42	42	42										50	50	50				42	42	42				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	141	0		29	10	S5768_141_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	142	0		29	10	S5768_142_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	142	0		29	10	S5768_142_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	142	0		29	10	S5768_142_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	142	0		29	10	S5768_142_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	142	0		29	10	S5768_142_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	142	0		29	10	S5768_142_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.64	50	50	50				44.41	45	45	45										50	50	50				45	45	45				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	142	0		29	10	S5768_142_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	143	0		29	10	S5768_143_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	143	0		29	10	S5768_143_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	143	0		29	10	S5768_143_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	143	0		29	10	S5768_143_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	143	0		29	10	S5768_143_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	143	0		29	10	S5768_143_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.75	50	50	50				42.60	49	49	49										50	50	50				49	49	49				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	143	0		29	10	S5768_143_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	144	0		29	10	S5768_144_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	144	0		29	10	S5768_144_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	144	0		29	10	S5768_144_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	144	0		29	10	S5768_144_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	144	0		29	10	S5768_144_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	144	0		29	10	S5768_144_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.01	50	50	50				45.14	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	144	0		29	10	S5768_144_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.05	25	25	25				51.55	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	144	0		29	10	S5768_144_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	145	0		29	10	S5768_145_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	145	0		29	10	S5768_145_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	145	0		29	10	S5768_145_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	145	0		29	10	S5768_145_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	145	0		29	10	S5768_145_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	145	0		29	10	S5768_145_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.98	50	50	50				47.99	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	145	0		29	10	S5768_145_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.17	25	25	25				53.35	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	145	0		29	10	S5768_145_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	146	0		29	10	S5768_146_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	146	0		29	10	S5768_146_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	146	0		29	10	S5768_146_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	146	0		29	10	S5768_146_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	146	0		29	10	S5768_146_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	146	0		29	10	S5768_146_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.69	50	50	50				36.14	43	43	43										50	50	50				43	43	43				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	146	0		29	10	S5768_146_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	32												33						32						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	147	0		29	10	S5768_147_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	147	0		29	10	S5768_147_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	147	0		29	10	S5768_147_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	147	0		29	10	S5768_147_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	147	0		29	10	S5768_147_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	147	0		29	10	S5768_147_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.52	50	50	50				43.85	46	46	46										50	50	50				46	46	46				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	147	0		29	10	S5768_147_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	148	0		29	10	S5768_148_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	148	0		29	10	S5768_148_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	148	0		29	10	S5768_148_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	148	0		29	10	S5768_148_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	148	0		29	10	S5768_148_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	148	0		29	10	S5768_148_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.43	50	50	50				47.09	46	46	46										50	50	50				46	46	46				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	148	0		29	10	S5768_148_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	149	0		29	10	S5768_149_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	149	0		29	10	S5768_149_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	149	0		29	10	S5768_149_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	149	0		29	10	S5768_149_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	149	0		29	10	S5768_149_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	149	0		29	10	S5768_149_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.26	50	50	50				44.59	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	149	0		29	10	S5768_149_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	150	0		29	10	S5768_150_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	150	0		29	10	S5768_150_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	150	0		29	10	S5768_150_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	150	0		29	10	S5768_150_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	150	0		29	10	S5768_150_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	150	0		29	10	S5768_150_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.68	50	50	50				53.56	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	150	0		29	10	S5768_150_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	151	0		29	10	S5768_151_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	151	0		29	10	S5768_151_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	151	0		29	10	S5768_151_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	151	0		29	10	S5768_151_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	151	0		29	10	S5768_151_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	151	0		29	10	S5768_151_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.18	50	50	50				46.24	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	151	0		29	10	S5768_151_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.09	25	25	25				64.54	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	151	0		29	10	S5768_151_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	152	0		29	10	S5768_152_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	152	0		29	10	S5768_152_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	152	0		29	10	S5768_152_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	152	0		29	10	S5768_152_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	152	0		29	10	S5768_152_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	152	0		29	10	S5768_152_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.13	50	50	50				49.28	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	152	0		29	10	S5768_152_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	153	0		29	10	S5768_153_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	153	0		29	10	S5768_153_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	153	0		29	10	S5768_153_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	153	0		29	10	S5768_153_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	153	0		29	10	S5768_153_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	153	0		29	10	S5768_153_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.19	50	50	50				48.82	47	47	47										50	50	50				47	47	47				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	153	0		29	10	S5768_153_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	154	0		29	10	S5768_154_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	154	0		29	10	S5768_154_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	154	0		29	10	S5768_154_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	154	0		29	10	S5768_154_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	154	0		29	10	S5768_154_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	154	0		29	10	S5768_154_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.67	50	50	50				42.82	45	45	45										50	50	50				45	45	45				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	154	0		29	10	S5768_154_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	31												33						31						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	155	0		29	10	S5768_155_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	155	0		29	10	S5768_155_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	155	0		29	10	S5768_155_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	155	0		29	10	S5768_155_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	155	0		29	10	S5768_155_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	155	0		29	10	S5768_155_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.36	50	50	50				51.37	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	155	0		29	10	S5768_155_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.26	25	25	25				57.80	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	155	0		29	10	S5768_155_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	175	0		29	10	S5768_175_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	175	0		29	10	S5768_175_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	175	0		29	10	S5768_175_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	175	0		29	10	S5768_175_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	175	0		29	10	S5768_175_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	175	0		29	10	S5768_175_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.58	50	50	50				31.60	38	38	38										50	50	50				38	38	38				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	175	0		29	10	S5768_175_0	3	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.67	25	25	25				39.95	19	19	19										25	25	25				19	19	19				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	175	0		29	10	S5768_175_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	176	0		29	10	S5768_176_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	176	0		29	10	S5768_176_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	176	0		29	10	S5768_176_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	176	0		29	10	S5768_176_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	176	0		29	10	S5768_176_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	176	0		29	10	S5768_176_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.38	50	50	50				28.83	40	40	40										50	50	50				40	40	40				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	176	0		29	10	S5768_176_0	3	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.64	25	25	25				36.33	20	20	20										25	25	25				20	20	20				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	176	0		29	10	S5768_176_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	177	0		29	10	S5768_177_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	177	0		29	10	S5768_177_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	177	0		29	10	S5768_177_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	177	0		29	10	S5768_177_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	177	0		29	10	S5768_177_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	177	0		29	10	S5768_177_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.13	50	50	50				35.22	44	44	44										50	50	50				44	44	44				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	177	0		29	10	S5768_177_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.39	25	25	25				46.30	22	22	22										25	25	25				22	22	22				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	177	0		29	10	S5768_177_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	180	0		29	10	S5768_180_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	180	0		29	10	S5768_180_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	180	0		29	10	S5768_180_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	180	0		29	10	S5768_180_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	180	0		29	10	S5768_180_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	180	0		29	10	S5768_180_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											56.39	50	50	50				30.96	38	38	38										50	50	50				38	38	38				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	180	0		29	10	S5768_180_0	3	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.22	25	25	25				40.34	19	19	19										25	25	25				19	19	19				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	180	0		29	10	S5768_180_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	181	0		29	10	S5768_181_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	181	0		29	10	S5768_181_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	181	0		29	10	S5768_181_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	181	0		29	10	S5768_181_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	181	0		29	10	S5768_181_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	181	0		29	10	S5768_181_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.18	50	50	50				35.97	42	42	42										50	50	50				42	42	42				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	181	0		29	10	S5768_181_0	3	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.32	25	25	25				46.34	21	21	21										25	25	25				21	21	21				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	181	0		29	10	S5768_181_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	182	0		29	10	S5768_182_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	182	0		29	10	S5768_182_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	182	0		29	10	S5768_182_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	182	0		29	10	S5768_182_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	182	0		29	10	S5768_182_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	182	0		29	10	S5768_182_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.49	50	50	50				49.11	44	44	44										50	50	50				44	44	44				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	182	0		29	10	S5768_182_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.36	25	25	25				56.36	22	22	22										25	25	25				22	22	22				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	182	0		29	10	S5768_182_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	184	0		29	10	S5768_184_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	184	0		29	10	S5768_184_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	184	0		29	10	S5768_184_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	184	0		29	10	S5768_184_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	184	0		29	10	S5768_184_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	184	0		29	10	S5768_184_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.16	50	50	50				39.21	44	44	44										50	50	50				44	44	44				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	184	0		29	10	S5768_184_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											71.87	25	25	25				51.49	22	22	22										25	25	25				22	22	22				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	184	0		29	10	S5768_184_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	185	0		29	10	S5768_185_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	185	0		29	10	S5768_185_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	185	0		29	10	S5768_185_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	185	0		29	10	S5768_185_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	185	0		29	10	S5768_185_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	185	0		29	10	S5768_185_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.87	50	50	50				35.56	42	42	42										50	50	50				42	42	42				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	185	0		29	10	S5768_185_0	3	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.01	25	25	25				52.48	21	21	21										25	25	25				21	21	21				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	185	0		29	10	S5768_185_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	190	0		29	10	S5768_190_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	190	0		29	10	S5768_190_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	190	0		29	10	S5768_190_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	190	0		29	10	S5768_190_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	190	0		29	10	S5768_190_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	190	0		29	10	S5768_190_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.84	50	50	50				37.08	42	42	42										50	50	50				42	42	42				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	190	0		29	10	S5768_190_0	3	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.03	25	25	25				47.93	21	21	21										25	25	25				21	21	21				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	190	0		29	10	S5768_190_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	191	0		29	10	S5768_191_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	191	0		29	10	S5768_191_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	191	0		29	10	S5768_191_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	191	0		29	10	S5768_191_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	191	0		29	10	S5768_191_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	191	0		29	10	S5768_191_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.27	50	50	50				39.54	44	44	44										50	50	50				44	44	44				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	191	0		29	10	S5768_191_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.40	25	25	25				50.49	22	22	22										25	25	25				22	22	22				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	191	0		29	10	S5768_191_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	192	0		29	10	S5768_192_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	192	0		29	10	S5768_192_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	192	0		29	10	S5768_192_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	192	0		29	10	S5768_192_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	192	0		29	10	S5768_192_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	192	0		29	10	S5768_192_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.54	50	50	50				36.16	42	42	42										50	50	50				42	42	42				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	192	0		29	10	S5768_192_0	3	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.78	25	25	25				50.04	21	21	21										25	25	25				21	21	21				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	192	0		29	10	S5768_192_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	193	0		29	10	S5768_193_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	193	0		29	10	S5768_193_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	193	0		29	10	S5768_193_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	193	0		29	10	S5768_193_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	193	0		29	10	S5768_193_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	193	0		29	10	S5768_193_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											55.81	50	50	50				30.35	40	40	40										50	50	50				40	40	40				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	193	0		29	10	S5768_193_0	3	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.67	25	25	25				43.20	20	20	20										25	25	25				20	20	20				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	193	0		29	10	S5768_193_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	195	0		29	10	S5768_195_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	195	0		29	10	S5768_195_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	195	0		29	10	S5768_195_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	195	0		29	10	S5768_195_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	195	0		29	10	S5768_195_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	195	0		29	10	S5768_195_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.48	50	50	50				40.84	44	44	44										50	50	50				44	44	44				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	195	0		29	10	S5768_195_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.23	25	25	25				53.08	22	22	22										25	25	25				22	22	22				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	195	0		29	10	S5768_195_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	196	0		29	10	S5768_196_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	196	0		29	10	S5768_196_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	196	0		29	10	S5768_196_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	196	0		29	10	S5768_196_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	196	0		29	10	S5768_196_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	196	0		29	10	S5768_196_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.28	50	50	50				45.80	44	44	44										50	50	50				44	44	44				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	196	0		29	10	S5768_196_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.50	25	25	25				54.45	22	22	22										25	25	25				22	22	22				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	196	0		29	10	S5768_196_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	197	0		29	10	S5768_197_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	197	0		29	10	S5768_197_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	197	0		29	10	S5768_197_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	197	0		29	10	S5768_197_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	197	0		29	10	S5768_197_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	197	0		29	10	S5768_197_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.95	50	50	50				52.42	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	197	0		29	10	S5768_197_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	198	0		29	10	S5768_198_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	198	0		29	10	S5768_198_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	198	0		29	10	S5768_198_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	198	0		29	10	S5768_198_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	198	0		29	10	S5768_198_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	198	0		29	10	S5768_198_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.51	50	50	50				54.40	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	198	0		29	10	S5768_198_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	200	0		29	10	S5768_200_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	200	0		29	10	S5768_200_0	1	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	200	0		29	10	S5768_200_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	200	0		29	10	S5768_200_0	1	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5768	200	0		29	10	S5768_200_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	200	0		29	10	S5768_200_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.38	50	50	50				52.08	50	50	50										50	50	50				50	50	50				50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5768	200	0		29	10	S5768_200_0	1	Non-Preferred Drug	4	11	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.02	25	25	25				55.33	25	25	25										25	25	25				25	25	25				25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5768	200	0		29	10	S5768_200_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5795	002	0		29	10	S5795_002_0	6	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								9.00		18.00					2.00		4.00					2.00		4.00																9.00				2.00			0.30	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5795	002	0		29	10	S5795_002_0	6	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								9.00		18.00					2.00		4.00					2.00		4.00																9.00				2.00			0.30	0.07	0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5795	002	0		29	10	S5795_002_0	6	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		37.50					8.00		20.00					8.00		20.00																15.00				8.00			0.50	0.27	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5795	002	0		29	10	S5795_002_0	6	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		37.50					8.00		20.00					8.00		20.00																15.00				8.00			0.50	0.27	0.27			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5795	002	0		29	10	S5795_002_0	6	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					40.00		100.00					40.00		100.00																47.00				40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5795	002	0		29	10	S5795_002_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					90.00		225.00					90.00		225.00																100.00				90.00			3.33	3.00	3.00			2.90		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5795	002	0		29	10	S5795_002_0	6	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5795	003	0		29	10	S5795_003_0	6	Preferred Generic	3	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5795	003	0		29	10	S5795_003_0	6	Generic	3	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								13.00		32.50					6.00		15.00					6.00		15.00																13.00				6.00			0.43	0.20	0.20			0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5795	003	0		29	10	S5795_003_0	6	Preferred Brand	3	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					40.00		100.00					40.00		100.00																47.00				40.00			1.57	1.33	1.33			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5795	003	0		29	10	S5795_003_0	6	Non-Preferred Brand	3	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					93.00		232.50					93.00		232.50																100.00				93.00			3.33	3.10	3.10			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5795	003	0		29	10	S5795_003_0	6	Specialty Tier	3	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5805	001	0		29	10	S5805_001_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					5.00		15.00													18.00						0.00				6.00				6.00			0.20	0.16				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5805	001	0		29	10	S5805_001_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					10.00		30.00													36.00						0.00				12.00				12.00			0.40	0.33				0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5805	001	0		29	10	S5805_001_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5805	001	0		29	10	S5805_001_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5805	001	0		29	10	S5805_001_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											74.00	41		41				58.00	35		35												41						35			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5805	001	0		29	10	S5805_001_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											108.00	24		24				112.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5805	001	0		29	10	S5805_001_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1022.00	33		33				1022.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5805	001	0		29	10	S5805_001_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1346.00	24		24				1346.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5810	035	0		29	10	S5810_035_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	035	0		29	10	S5810_035_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	035	0		29	10	S5810_035_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	035	0		29	10	S5810_035_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.11	35	35	35				48.80	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	035	0		29	10	S5810_035_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	036	0		29	10	S5810_036_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	036	0		29	10	S5810_036_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	036	0		29	10	S5810_036_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	036	0		29	10	S5810_036_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.09	35	35	35				51.18	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	036	0		29	10	S5810_036_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	037	0		29	10	S5810_037_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	037	0		29	10	S5810_037_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	037	0		29	10	S5810_037_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	037	0		29	10	S5810_037_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.71	35	35	35				52.12	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	037	0		29	10	S5810_037_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	038	0		29	10	S5810_038_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	038	0		29	10	S5810_038_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	038	0		29	10	S5810_038_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	038	0		29	10	S5810_038_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.15	35	35	35				50.05	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	038	0		29	10	S5810_038_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	039	0		29	10	S5810_039_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	039	0		29	10	S5810_039_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	039	0		29	10	S5810_039_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	039	0		29	10	S5810_039_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.75	35	35	35				50.94	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	039	0		29	10	S5810_039_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	040	0		29	10	S5810_040_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	040	0		29	10	S5810_040_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	040	0		29	10	S5810_040_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	040	0		29	10	S5810_040_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.64	35	35	35				49.39	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	040	0		29	10	S5810_040_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	041	0		29	10	S5810_041_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	041	0		29	10	S5810_041_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	041	0		29	10	S5810_041_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	041	0		29	10	S5810_041_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.43	35	35	35				48.37	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	041	0		29	10	S5810_041_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	042	0		29	10	S5810_042_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	042	0		29	10	S5810_042_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	042	0		29	10	S5810_042_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	042	0		29	10	S5810_042_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.18	35	35	35				51.73	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	042	0		29	10	S5810_042_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	043	0		29	10	S5810_043_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	043	0		29	10	S5810_043_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	043	0		29	10	S5810_043_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	043	0		29	10	S5810_043_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.13	37	37	37				52.95	37	37	37										37	37	37				37	37	37				37		37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	043	0		29	10	S5810_043_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	044	0		29	10	S5810_044_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	044	0		29	10	S5810_044_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	044	0		29	10	S5810_044_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	044	0		29	10	S5810_044_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.41	35	35	35				47.42	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	044	0		29	10	S5810_044_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	045	0		29	10	S5810_045_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	045	0		29	10	S5810_045_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	045	0		29	10	S5810_045_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	045	0		29	10	S5810_045_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.80	35	35	35				44.32	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	045	0		29	10	S5810_045_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	046	0		29	10	S5810_046_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	046	0		29	10	S5810_046_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	046	0		29	10	S5810_046_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	046	0		29	10	S5810_046_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.23	35	35	35				47.77	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	046	0		29	10	S5810_046_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	047	0		29	10	S5810_047_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	047	0		29	10	S5810_047_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	047	0		29	10	S5810_047_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	047	0		29	10	S5810_047_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.88	35	35	35				51.02	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	047	0		29	10	S5810_047_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	048	0		29	10	S5810_048_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	048	0		29	10	S5810_048_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	048	0		29	10	S5810_048_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	048	0		29	10	S5810_048_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.64	35	35	35				48.79	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	048	0		29	10	S5810_048_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	049	0		29	10	S5810_049_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	049	0		29	10	S5810_049_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	049	0		29	10	S5810_049_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	049	0		29	10	S5810_049_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.93	35	35	35				51.67	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	049	0		29	10	S5810_049_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	050	0		29	10	S5810_050_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	050	0		29	10	S5810_050_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	050	0		29	10	S5810_050_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	050	0		29	10	S5810_050_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.71	35	35	35				49.64	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	050	0		29	10	S5810_050_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	051	0		29	10	S5810_051_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	051	0		29	10	S5810_051_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	051	0		29	10	S5810_051_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	051	0		29	10	S5810_051_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.20	35	35	35				51.27	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	051	0		29	10	S5810_051_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	052	0		29	10	S5810_052_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	052	0		29	10	S5810_052_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	052	0		29	10	S5810_052_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	052	0		29	10	S5810_052_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.63	35	35	35				46.51	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	052	0		29	10	S5810_052_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	053	0		29	10	S5810_053_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	053	0		29	10	S5810_053_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	053	0		29	10	S5810_053_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	053	0		29	10	S5810_053_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.39	35	35	35				47.96	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	053	0		29	10	S5810_053_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	054	0		29	10	S5810_054_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	054	0		29	10	S5810_054_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	054	0		29	10	S5810_054_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	054	0		29	10	S5810_054_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.64	35	35	35				48.76	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	054	0		29	10	S5810_054_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	055	0		29	10	S5810_055_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	055	0		29	10	S5810_055_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	055	0		29	10	S5810_055_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	055	0		29	10	S5810_055_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.79	35	35	35				48.38	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	055	0		29	10	S5810_055_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	056	0		29	10	S5810_056_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	056	0		29	10	S5810_056_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	056	0		29	10	S5810_056_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	056	0		29	10	S5810_056_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.24	37	37	37				54.57	37	37	37										37	37	37				37	37	37				37		37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	056	0		29	10	S5810_056_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	057	0		29	10	S5810_057_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	057	0		29	10	S5810_057_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	057	0		29	10	S5810_057_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	057	0		29	10	S5810_057_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.80	35	35	35				50.22	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	057	0		29	10	S5810_057_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	058	0		29	10	S5810_058_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	058	0		29	10	S5810_058_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	058	0		29	10	S5810_058_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	058	0		29	10	S5810_058_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.88	35	35	35				48.13	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	058	0		29	10	S5810_058_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	059	0		29	10	S5810_059_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	059	0		29	10	S5810_059_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	059	0		29	10	S5810_059_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	059	0		29	10	S5810_059_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.79	35	35	35				51.10	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	059	0		29	10	S5810_059_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	060	0		29	10	S5810_060_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	060	0		29	10	S5810_060_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	060	0		29	10	S5810_060_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	060	0		29	10	S5810_060_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.95	37	37	37				53.89	37	37	37										37	37	37				37	37	37				37		37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	060	0		29	10	S5810_060_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	061	0		29	10	S5810_061_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	061	0		29	10	S5810_061_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	061	0		29	10	S5810_061_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	061	0		29	10	S5810_061_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.98	35	35	35				52.20	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	061	0		29	10	S5810_061_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	062	0		29	10	S5810_062_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	062	0		29	10	S5810_062_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	062	0		29	10	S5810_062_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	062	0		29	10	S5810_062_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.60	45	45	45				65.39	45	45	45										45	45	45				45	45	45				45		45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	062	0		29	10	S5810_062_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	063	0		29	10	S5810_063_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	063	0		29	10	S5810_063_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	063	0		29	10	S5810_063_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	063	0		29	10	S5810_063_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.56	42	42	42				58.96	42	42	42										42	42	42				42	42	42				42		42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	063	0		29	10	S5810_063_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	064	0		29	10	S5810_064_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	064	0		29	10	S5810_064_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	064	0		29	10	S5810_064_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	064	0		29	10	S5810_064_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.55	35	35	35				50.25	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	064	0		29	10	S5810_064_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	065	0		29	10	S5810_065_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	065	0		29	10	S5810_065_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	065	0		29	10	S5810_065_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	065	0		29	10	S5810_065_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.91	35	35	35				50.65	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	065	0		29	10	S5810_065_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	066	0		29	10	S5810_066_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	066	0		29	10	S5810_066_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	066	0		29	10	S5810_066_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	066	0		29	10	S5810_066_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.43	35	35	35				52.41	35	35	35										35	35	35				35	35	35				35		35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	066	0		29	10	S5810_066_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	067	0		29	10	S5810_067_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	067	0		29	10	S5810_067_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	067	0		29	10	S5810_067_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	067	0		29	10	S5810_067_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.59	44	44	44				63.69	44	44	44										44	44	44				44	44	44				44		44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	067	0		29	10	S5810_067_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	068	0		29	10	S5810_068_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	068	0		29	10	S5810_068_0	1	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	6.00											13.00	26.00	39.00				2.00	4.00	6.00					13.00			13.00			0.43	0.07		0.43	0.07	0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	068	0		29	10	S5810_068_0	1	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								35.00	70.00	105.00					35.00	70.00	105.00											35.00	70.00	105.00				35.00	70.00	105.00					35.00			35.00			1.17	1.17		1.17	1.17	1.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	068	0		29	10	S5810_068_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											82.92	49	49	49				71.35	49	49	49										49	49	49				49	49	49				49		49									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	068	0		29	10	S5810_068_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	276	0		29	10	S5810_276_0	5	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	276	0		29	10	S5810_276_0	5	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	276	0		29	10	S5810_276_0	5	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	276	0		29	10	S5810_276_0	5	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	276	0		29	10	S5810_276_0	5	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	276	0		29	10	S5810_276_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											95.07	47	47	47				58.66	39	39	39																						47		47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	276	0		29	10	S5810_276_0	5	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	277	0		29	10	S5810_277_0	5	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	277	0		29	10	S5810_277_0	5	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	277	0		29	10	S5810_277_0	5	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	277	0		29	10	S5810_277_0	5	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	277	0		29	10	S5810_277_0	5	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	277	0		29	10	S5810_277_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											91.12	48	48	48				58.86	38	38	38																						48		48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	277	0		29	10	S5810_277_0	5	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	278	0		29	10	S5810_278_0	5	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	278	0		29	10	S5810_278_0	5	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	278	0		29	10	S5810_278_0	5	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	278	0		29	10	S5810_278_0	5	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	278	0		29	10	S5810_278_0	5	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	278	0		29	10	S5810_278_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											91.02	49	49	49				62.30	40	40	40																						49		49									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	278	0		29	10	S5810_278_0	5	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	279	0		29	10	S5810_279_0	4	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	279	0		29	10	S5810_279_0	4	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	279	0		29	10	S5810_279_0	4	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	279	0		29	10	S5810_279_0	4	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	279	0		29	10	S5810_279_0	4	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	279	0		29	10	S5810_279_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											94.20	47	47	47				62.07	42	42	42																						47		47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	279	0		29	10	S5810_279_0	4	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	280	0		29	10	S5810_280_0	4	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	280	0		29	10	S5810_280_0	4	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	280	0		29	10	S5810_280_0	4	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	280	0		29	10	S5810_280_0	4	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	280	0		29	10	S5810_280_0	4	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	280	0		29	10	S5810_280_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											89.04	48	48	48				57.24	39	39	39																						48		48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	280	0		29	10	S5810_280_0	4	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	281	0		29	10	S5810_281_0	4	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	281	0		29	10	S5810_281_0	4	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	281	0		29	10	S5810_281_0	4	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	281	0		29	10	S5810_281_0	4	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	281	0		29	10	S5810_281_0	4	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	281	0		29	10	S5810_281_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											84.78	50	50	50				58.69	41	41	41																						50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	281	0		29	10	S5810_281_0	4	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	282	0		29	10	S5810_282_0	5	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	282	0		29	10	S5810_282_0	5	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	282	0		29	10	S5810_282_0	5	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	282	0		29	10	S5810_282_0	5	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	282	0		29	10	S5810_282_0	5	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	282	0		29	10	S5810_282_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											85.69	50	50	50				53.32	37	37	37																						50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	282	0		29	10	S5810_282_0	5	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	283	0		29	10	S5810_283_0	2	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	283	0		29	10	S5810_283_0	2	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	283	0		29	10	S5810_283_0	2	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	283	0		29	10	S5810_283_0	2	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	283	0		29	10	S5810_283_0	2	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	283	0		29	10	S5810_283_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											87.84	44	44	44				65.29	44	44	44																						44		44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	283	0		29	10	S5810_283_0	2	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	284	0		29	10	S5810_284_0	4	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	284	0		29	10	S5810_284_0	4	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	284	0		29	10	S5810_284_0	4	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	284	0		29	10	S5810_284_0	4	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	284	0		29	10	S5810_284_0	4	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	284	0		29	10	S5810_284_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											82.62	50	50	50				59.00	42	42	42																						50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	284	0		29	10	S5810_284_0	4	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	285	0		29	10	S5810_285_0	2	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	285	0		29	10	S5810_285_0	2	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	285	0		29	10	S5810_285_0	2	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	285	0		29	10	S5810_285_0	2	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	285	0		29	10	S5810_285_0	2	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	285	0		29	10	S5810_285_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											93.17	45	45	45				66.58	45	45	45																						45		45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	285	0		29	10	S5810_285_0	2	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	286	0		29	10	S5810_286_0	5	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	286	0		29	10	S5810_286_0	5	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	286	0		29	10	S5810_286_0	5	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	286	0		29	10	S5810_286_0	5	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	286	0		29	10	S5810_286_0	5	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	286	0		29	10	S5810_286_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											76.38	50	50	50				53.92	39	39	39																						50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	286	0		29	10	S5810_286_0	5	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	287	0		29	10	S5810_287_0	5	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	287	0		29	10	S5810_287_0	5	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	287	0		29	10	S5810_287_0	5	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	287	0		29	10	S5810_287_0	5	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	287	0		29	10	S5810_287_0	5	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					41.00	82.00	123.00																								47.00			47.00			1.57	1.37				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	287	0		29	10	S5810_287_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											75.68	50	50	50				51.63	37	37	37																						50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	287	0		29	10	S5810_287_0	5	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	288	0		29	10	S5810_288_0	2	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	288	0		29	10	S5810_288_0	2	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	288	0		29	10	S5810_288_0	2	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	288	0		29	10	S5810_288_0	2	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	288	0		29	10	S5810_288_0	2	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	288	0		29	10	S5810_288_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											76.50	40	40	40				56.01	40	40	40																						40		40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	288	0		29	10	S5810_288_0	2	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	289	0		29	10	S5810_289_0	4	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	289	0		29	10	S5810_289_0	4	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	289	0		29	10	S5810_289_0	4	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	289	0		29	10	S5810_289_0	4	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	289	0		29	10	S5810_289_0	4	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					44.00	88.00	132.00																								47.00			47.00			1.57	1.47				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	289	0		29	10	S5810_289_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											71.82	50	50	50				50.33	37	37	37																						50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	289	0		29	10	S5810_289_0	4	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	290	0		29	10	S5810_290_0	2	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	290	0		29	10	S5810_290_0	2	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	290	0		29	10	S5810_290_0	2	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	290	0		29	10	S5810_290_0	2	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	290	0		29	10	S5810_290_0	2	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	290	0		29	10	S5810_290_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											59.75	32	32	32				42.56	32	32	32																						32		32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	290	0		29	10	S5810_290_0	2	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	291	0		29	10	S5810_291_0	4	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	291	0		29	10	S5810_291_0	4	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	291	0		29	10	S5810_291_0	4	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	291	0		29	10	S5810_291_0	4	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	291	0		29	10	S5810_291_0	4	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	291	0		29	10	S5810_291_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											84.33	50	50	50				58.06	41	41	41																						50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	291	0		29	10	S5810_291_0	4	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	292	0		29	10	S5810_292_0	5	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	292	0		29	10	S5810_292_0	5	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	292	0		29	10	S5810_292_0	5	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	292	0		29	10	S5810_292_0	5	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	292	0		29	10	S5810_292_0	5	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					46.00	92.00	138.00																								47.00			47.00			1.57	1.53				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	292	0		29	10	S5810_292_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											83.01	50	50	50				52.76	37	37	37																						50		50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	292	0		29	10	S5810_292_0	5	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	293	0		29	10	S5810_293_0	2	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	293	0		29	10	S5810_293_0	2	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	293	0		29	10	S5810_293_0	2	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	293	0		29	10	S5810_293_0	2	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	293	0		29	10	S5810_293_0	2	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	293	0		29	10	S5810_293_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											92.96	45	45	45				65.62	45	45	45																						45		45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	293	0		29	10	S5810_293_0	2	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	294	0		29	10	S5810_294_0	2	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	294	0		29	10	S5810_294_0	2	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								10.00	20.00	30.00					0.00	0.00	0.00																								10.00			10.00			0.33	0.00				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	294	0		29	10	S5810_294_0	2	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	294	0		29	10	S5810_294_0	2	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	294	0		29	10	S5810_294_0	2	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	294	0		29	10	S5810_294_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											93.09	45	45	45				66.33	45	45	45																						45		45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	294	0		29	10	S5810_294_0	2	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	295	0		29	10	S5810_295_0	4	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	295	0		29	10	S5810_295_0	4	Preferred Generic	4	01	1	2	1	3		111	10			1				30	60	90	1	2								10	31								15.00	30.00	45.00					0.00	0.00	0.00																								15.00			15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	295	0		29	10	S5810_295_0	4	Generic	4	01	1	2	2	1		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	295	0		29	10	S5810_295_0	4	Generic	4	01	1	2	2	3		111	10			1				30	60	90	1	2								10	31								20.00	40.00	60.00					3.00	6.00	9.00																								20.00			20.00			0.67	0.10				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5810	295	0		29	10	S5810_295_0	4	Preferred Brand	4	11	1	2	3	1		111	10			1				30	60	90	1	2								10	31								47.00	94.00	141.00					47.00	94.00	141.00																								47.00			47.00			1.57	1.57				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	295	0		29	10	S5810_295_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10			1				30	60	90	1	2								10	31											93.36	48	48	48				65.45	44	44	44																						48		48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5810	295	0		29	10	S5810_295_0	4	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31											1.00	25						1.00	25																								25		25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	001	0		29	10	S5820_001_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	001	0		29	10	S5820_001_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					10.00		30.00													36.00						0.00				12.00				12.00			0.40	0.33				0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	001	0		29	10	S5820_001_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						96.00				47.00				47.00			1.56	1.23				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	001	0		29	10	S5820_001_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						96.00				47.00				47.00			1.56	1.23				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	001	0		29	10	S5820_001_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											68.00	44		44				59.00	40		40												44						40			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	001	0		29	10	S5820_001_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											100.00	24		24				104.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	001	0		29	10	S5820_001_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1008.00	33		33				1008.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	001	0		29	10	S5820_001_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1339.00	24		24				1339.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	002	0		29	10	S5820_002_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					4.00		12.00													12.00						0.00				4.00				4.00			0.13	0.13				0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	002	0		29	10	S5820_002_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	002	0		29	10	S5820_002_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					38.00		114.00													138.00						99.00				46.00				46.00			1.53	1.26				1.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	002	0		29	10	S5820_002_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					38.00		114.00													138.00						99.00				46.00				46.00			1.53	1.26				1.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	002	0		29	10	S5820_002_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											70.00	44		44				59.00	38		38												44						38			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	002	0		29	10	S5820_002_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											102.00	24		24				106.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	002	0		29	10	S5820_002_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1076.00	33		33				1076.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	002	0		29	10	S5820_002_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1477.00	24		24				1477.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	003	0		29	10	S5820_003_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					6.00		18.00													21.00						0.00				7.00				7.00			0.23	0.20				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	003	0		29	10	S5820_003_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					10.00		30.00													33.00						0.00				11.00				11.00			0.36	0.33				0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	003	0		29	10	S5820_003_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	003	0		29	10	S5820_003_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	003	0		29	10	S5820_003_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											71.00	44		44				58.00	38		38												44						38			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	003	0		29	10	S5820_003_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											101.00	24		24				105.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	003	0		29	10	S5820_003_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1085.00	33		33				1085.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	003	0		29	10	S5820_003_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1437.00	24		24				1437.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	004	0		29	10	S5820_004_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					7.00		21.00													24.00						0.00				8.00				8.00			0.26	0.23				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	004	0		29	10	S5820_004_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	004	0		29	10	S5820_004_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					37.00		111.00													138.00						96.00				46.00				46.00			1.53	1.23				1.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	004	0		29	10	S5820_004_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					37.00		111.00													138.00						96.00				46.00				46.00			1.53	1.23				1.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	004	0		29	10	S5820_004_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											69.00	44		44				59.00	40		40												44						40			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	004	0		29	10	S5820_004_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											101.00	24		24				106.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	004	0		29	10	S5820_004_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1004.00	33		33				1004.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	004	0		29	10	S5820_004_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1306.00	24		24				1306.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	005	0		29	10	S5820_005_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					7.00		21.00													30.00						0.00				10.00				10.00			0.33	0.23				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	005	0		29	10	S5820_005_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					10.00		30.00													42.00						0.00				14.00				14.00			0.46	0.33				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	005	0		29	10	S5820_005_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	005	0		29	10	S5820_005_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	005	0		29	10	S5820_005_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											77.00	50		50				58.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	005	0		29	10	S5820_005_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											97.00	24		24				101.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	005	0		29	10	S5820_005_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1211.00	33		33				1211.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	005	0		29	10	S5820_005_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1643.00	24		24				1643.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	006	0		29	10	S5820_006_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					4.00		12.00													12.00						0.00				4.00				4.00			0.13	0.13				0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	006	0		29	10	S5820_006_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					17.00		51.00													60.00						0.00				20.00				20.00			0.66	0.56				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	006	0		29	10	S5820_006_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					38.00		114.00													141.00						99.00				47.00				47.00			1.56	1.26				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	006	0		29	10	S5820_006_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					38.00		114.00													141.00						99.00				47.00				47.00			1.56	1.26				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	006	0		29	10	S5820_006_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											77.00	50		50				59.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	006	0		29	10	S5820_006_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											97.00	24		24				101.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	006	0		29	10	S5820_006_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1170.00	33		33				1170.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	006	0		29	10	S5820_006_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1534.00	24		24				1534.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	007	0		29	10	S5820_007_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					5.00		15.00													21.00						0.00				7.00				7.00			0.23	0.16				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	007	0		29	10	S5820_007_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					9.00		27.00													39.00						0.00				13.00				13.00			0.43	0.30				0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	007	0		29	10	S5820_007_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	007	0		29	10	S5820_007_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	007	0		29	10	S5820_007_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											77.00	50		50				57.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	007	0		29	10	S5820_007_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											101.00	24		24				105.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	007	0		29	10	S5820_007_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1182.00	33		33				1182.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	007	0		29	10	S5820_007_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1542.00	24		24				1542.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	008	0		29	10	S5820_008_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					7.00		21.00													30.00						0.00				10.00				10.00			0.33	0.23				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	008	0		29	10	S5820_008_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					10.00		30.00													42.00						0.00				14.00				14.00			0.46	0.33				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	008	0		29	10	S5820_008_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	008	0		29	10	S5820_008_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	008	0		29	10	S5820_008_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											74.00	50		50				55.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	008	0		29	10	S5820_008_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											90.00	24		24				94.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	008	0		29	10	S5820_008_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1360.00	33		33				1360.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	008	0		29	10	S5820_008_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1732.00	24		24				1732.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	009	0		29	10	S5820_009_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	009	0		29	10	S5820_009_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					10.00		30.00													39.00						0.00				13.00				13.00			0.43	0.33				0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	009	0		29	10	S5820_009_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	009	0		29	10	S5820_009_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	009	0		29	10	S5820_009_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											79.00	50		50				58.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	009	0		29	10	S5820_009_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											97.00	24		24				101.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	009	0		29	10	S5820_009_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1238.00	33		33				1238.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	009	0		29	10	S5820_009_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1555.00	24		24				1555.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	010	0		29	10	S5820_010_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					4.00		12.00													12.00						0.00				4.00				4.00			0.13	0.13				0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	010	0		29	10	S5820_010_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					17.00		51.00													60.00						0.00				20.00				20.00			0.66	0.56				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	010	0		29	10	S5820_010_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					38.00		114.00													141.00						99.00				47.00				47.00			1.56	1.26				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	010	0		29	10	S5820_010_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					38.00		114.00													141.00						99.00				47.00				47.00			1.56	1.26				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	010	0		29	10	S5820_010_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											68.00	43		43				58.00	40		40												43						40			43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	010	0		29	10	S5820_010_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											99.00	24		24				103.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	010	0		29	10	S5820_010_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1245.00	33		33				1245.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	010	0		29	10	S5820_010_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1660.00	24		24				1660.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	011	0		29	10	S5820_011_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					5.00		15.00													18.00						0.00				6.00				6.00			0.20	0.16				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	011	0		29	10	S5820_011_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					9.00		27.00													36.00						0.00				12.00				12.00			0.40	0.30				0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	011	0		29	10	S5820_011_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					35.00		105.00													129.00						90.00				43.00				43.00			1.43	1.16				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	011	0		29	10	S5820_011_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					35.00		105.00													129.00						90.00				43.00				43.00			1.43	1.16				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	011	0		29	10	S5820_011_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											75.00	50		50				55.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	011	0		29	10	S5820_011_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											94.00	24		24				98.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	011	0		29	10	S5820_011_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1167.00	33		33				1167.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	011	0		29	10	S5820_011_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1494.00	24		24				1494.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	012	0		29	10	S5820_012_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					6.00		18.00													27.00						0.00				9.00				9.00			0.30	0.20				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	012	0		29	10	S5820_012_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					11.00		33.00													42.00						0.00				14.00				14.00			0.46	0.36				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	012	0		29	10	S5820_012_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	012	0		29	10	S5820_012_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	012	0		29	10	S5820_012_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											77.00	50		50				58.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	012	0		29	10	S5820_012_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											103.00	24		24				108.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	012	0		29	10	S5820_012_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1140.00	33		33				1140.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	012	0		29	10	S5820_012_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1438.00	24		24				1438.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	013	0		29	10	S5820_013_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					6.00		18.00													24.00						0.00				8.00				8.00			0.26	0.20				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	013	0		29	10	S5820_013_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								16.00		48.00					12.00		36.00													48.00						0.00				16.00				16.00			0.53	0.40				0.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	013	0		29	10	S5820_013_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					37.00		111.00													138.00						96.00				46.00				46.00			1.53	1.23				1.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	013	0		29	10	S5820_013_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					37.00		111.00													138.00						96.00				46.00				46.00			1.53	1.23				1.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	013	0		29	10	S5820_013_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											77.00	50		50				56.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	013	0		29	10	S5820_013_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											97.00	24		24				101.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	013	0		29	10	S5820_013_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1127.00	33		33				1127.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	013	0		29	10	S5820_013_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1538.00	24		24				1538.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	014	0		29	10	S5820_014_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					5.00		15.00													21.00						0.00				7.00				7.00			0.23	0.16				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	014	0		29	10	S5820_014_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					10.00		30.00													42.00						0.00				14.00				14.00			0.46	0.33				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	014	0		29	10	S5820_014_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	014	0		29	10	S5820_014_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	014	0		29	10	S5820_014_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											76.00	50		50				56.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	014	0		29	10	S5820_014_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											93.00	24		24				97.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	014	0		29	10	S5820_014_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1185.00	33		33				1185.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	014	0		29	10	S5820_014_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1549.00	24		24				1549.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	015	0		29	10	S5820_015_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					7.00		21.00													24.00						0.00				8.00				8.00			0.26	0.23				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	015	0		29	10	S5820_015_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					12.00		36.00													45.00						0.00				15.00				15.00			0.50	0.40				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	015	0		29	10	S5820_015_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					35.00		105.00													141.00						90.00				47.00				47.00			1.56	1.16				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	015	0		29	10	S5820_015_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					35.00		105.00													141.00						90.00				47.00				47.00			1.56	1.16				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	015	0		29	10	S5820_015_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											67.00	44		44				54.00	40		40												44						40			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	015	0		29	10	S5820_015_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											97.00	24		24				102.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	015	0		29	10	S5820_015_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1120.00	33		33				1120.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	015	0		29	10	S5820_015_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1538.00	24		24				1538.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	016	0		29	10	S5820_016_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					4.00		12.00													12.00						0.00				4.00				4.00			0.13	0.13				0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	016	0		29	10	S5820_016_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					14.00		42.00													60.00						0.00				20.00				20.00			0.66	0.46				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	016	0		29	10	S5820_016_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					38.00		114.00													141.00						99.00				47.00				47.00			1.56	1.26				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	016	0		29	10	S5820_016_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					38.00		114.00													141.00						99.00				47.00				47.00			1.56	1.26				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	016	0		29	10	S5820_016_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											80.00	50		50				59.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	016	0		29	10	S5820_016_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											99.00	24		24				103.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	016	0		29	10	S5820_016_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1043.00	33		33				1043.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	016	0		29	10	S5820_016_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1347.00	24		24				1347.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	017	0		29	10	S5820_017_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					6.00		18.00													24.00						0.00				8.00				8.00			0.26	0.20				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	017	0		29	10	S5820_017_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								16.00		48.00					10.00		30.00													48.00						0.00				16.00				16.00			0.53	0.33				0.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	017	0		29	10	S5820_017_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					35.00		105.00													129.00						90.00				43.00				43.00			1.43	1.16				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	017	0		29	10	S5820_017_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					35.00		105.00													129.00						90.00				43.00				43.00			1.43	1.16				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	017	0		29	10	S5820_017_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											79.00	50		50				54.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	017	0		29	10	S5820_017_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											95.00	24		24				99.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	017	0		29	10	S5820_017_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1008.00	33		33				1008.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	017	0		29	10	S5820_017_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1313.00	24		24				1313.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	018	0		29	10	S5820_018_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	018	0		29	10	S5820_018_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					10.00		30.00													36.00						0.00				12.00				12.00			0.40	0.33				0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	018	0		29	10	S5820_018_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	018	0		29	10	S5820_018_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	018	0		29	10	S5820_018_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											74.00	50		50				51.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	018	0		29	10	S5820_018_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											92.00	24		24				96.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	018	0		29	10	S5820_018_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1060.00	33		33				1060.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	018	0		29	10	S5820_018_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1319.00	24		24				1319.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	019	0		29	10	S5820_019_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	019	0		29	10	S5820_019_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					9.00		27.00													39.00						0.00				13.00				13.00			0.43	0.30				0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	019	0		29	10	S5820_019_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					34.00		102.00													126.00						87.00				42.00				42.00			1.40	1.13				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	019	0		29	10	S5820_019_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					34.00		102.00													126.00						87.00				42.00				42.00			1.40	1.13				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	019	0		29	10	S5820_019_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											73.00	50		50				51.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	019	0		29	10	S5820_019_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											91.00	24		24				95.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	019	0		29	10	S5820_019_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1229.00	33		33				1229.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	019	0		29	10	S5820_019_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1545.00	24		24				1545.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	020	0		29	10	S5820_020_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					4.00		12.00													21.00						0.00				7.00				7.00			0.23	0.13				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	020	0		29	10	S5820_020_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					8.00		24.00													33.00						0.00				11.00				11.00			0.36	0.26				0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	020	0		29	10	S5820_020_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					37.00		111.00													138.00						96.00				46.00				46.00			1.53	1.23				1.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	020	0		29	10	S5820_020_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					37.00		111.00													138.00						96.00				46.00				46.00			1.53	1.23				1.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	020	0		29	10	S5820_020_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											76.00	50		50				55.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	020	0		29	10	S5820_020_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											90.00	24		24				94.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	020	0		29	10	S5820_020_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1062.00	33		33				1062.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	020	0		29	10	S5820_020_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1280.00	24		24				1280.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	021	0		29	10	S5820_021_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					5.00		15.00													18.00						0.00				6.00				6.00			0.20	0.16				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	021	0		29	10	S5820_021_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					14.00		42.00													51.00						0.00				17.00				17.00			0.56	0.46				0.54		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	021	0		29	10	S5820_021_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					34.00		102.00													126.00						87.00				42.00				42.00			1.40	1.13				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	021	0		29	10	S5820_021_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					34.00		102.00													126.00						87.00				42.00				42.00			1.40	1.13				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	021	0		29	10	S5820_021_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											76.00	47		47				60.00	40		40												47						40			47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	021	0		29	10	S5820_021_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											96.00	24		24				100.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	021	0		29	10	S5820_021_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1073.00	33		33				1073.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	021	0		29	10	S5820_021_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1387.00	24		24				1387.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	022	0		29	10	S5820_022_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					5.00		15.00													27.00						0.00				9.00				9.00			0.30	0.16				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	022	0		29	10	S5820_022_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					9.00		27.00													45.00						0.00				15.00				15.00			0.50	0.30				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	022	0		29	10	S5820_022_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					34.00		102.00													126.00						87.00				42.00				42.00			1.40	1.13				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	022	0		29	10	S5820_022_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					34.00		102.00													126.00						87.00				42.00				42.00			1.40	1.13				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	022	0		29	10	S5820_022_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											76.00	50		50				54.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	022	0		29	10	S5820_022_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											92.00	24		24				96.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	022	0		29	10	S5820_022_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1294.00	33		33				1294.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	022	0		29	10	S5820_022_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1657.00	24		24				1657.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	023	0		29	10	S5820_023_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					5.00		15.00													15.00						0.00				5.00				5.00			0.16	0.16				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	023	0		29	10	S5820_023_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					12.00		36.00													45.00						0.00				15.00				15.00			0.50	0.40				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	023	0		29	10	S5820_023_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	023	0		29	10	S5820_023_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	023	0		29	10	S5820_023_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											78.00	50		50				53.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	023	0		29	10	S5820_023_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											93.00	24		24				97.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	023	0		29	10	S5820_023_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1057.00	33		33				1057.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	023	0		29	10	S5820_023_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1271.00	24		24				1271.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	024	0		29	10	S5820_024_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					5.00		15.00													18.00						0.00				6.00				6.00			0.20	0.16				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	024	0		29	10	S5820_024_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					12.00		36.00													45.00						0.00				15.00				15.00			0.50	0.40				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	024	0		29	10	S5820_024_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					37.00		111.00													114.00						96.00				38.00				38.00			1.26	1.23				1.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	024	0		29	10	S5820_024_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					37.00		111.00													114.00						96.00				38.00				38.00			1.26	1.23				1.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	024	0		29	10	S5820_024_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											81.00	50		50				58.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	024	0		29	10	S5820_024_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											100.00	24		24				105.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	024	0		29	10	S5820_024_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1093.00	33		33				1093.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	024	0		29	10	S5820_024_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1469.00	24		24				1469.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	025	0		29	10	S5820_025_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					7.00		21.00													24.00						0.00				8.00				8.00			0.26	0.23				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	025	0		29	10	S5820_025_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					12.00		36.00													45.00						0.00				15.00				15.00			0.50	0.40				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	025	0		29	10	S5820_025_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	025	0		29	10	S5820_025_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	025	0		29	10	S5820_025_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											68.00	46		46				51.00	40		40												46						40			46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	025	0		29	10	S5820_025_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											94.00	24		24				98.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	025	0		29	10	S5820_025_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1164.00	33		33				1164.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	025	0		29	10	S5820_025_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1747.00	24		24				1747.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	026	0		29	10	S5820_026_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					7.00		21.00													30.00						0.00				10.00				10.00			0.33	0.23				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	026	0		29	10	S5820_026_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					15.00		45.00													54.00						0.00				18.00				18.00			0.60	0.50				0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	026	0		29	10	S5820_026_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						96.00				47.00				47.00			1.56	1.23				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	026	0		29	10	S5820_026_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						96.00				47.00				47.00			1.56	1.23				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	026	0		29	10	S5820_026_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											47.00	31		31				47.00	31		31												31						31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	026	0		29	10	S5820_026_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											103.00	24		24				107.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	026	0		29	10	S5820_026_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1055.00	33		33				1055.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	026	0		29	10	S5820_026_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1429.00	24		24				1429.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	027	0		29	10	S5820_027_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					7.00		21.00													30.00						0.00				10.00				10.00			0.33	0.23				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	027	0		29	10	S5820_027_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					15.00		45.00													54.00						0.00				18.00				18.00			0.60	0.50				0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	027	0		29	10	S5820_027_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								39.00		117.00					37.00		111.00													117.00						96.00				39.00				39.00			1.30	1.23				1.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	027	0		29	10	S5820_027_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								39.00		117.00					37.00		111.00													117.00						96.00				39.00				39.00			1.30	1.23				1.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	027	0		29	10	S5820_027_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											62.00	42		42				55.00	40		40												42						40			42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	027	0		29	10	S5820_027_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											96.00	24		24				101.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	027	0		29	10	S5820_027_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1328.00	33		33				1328.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	027	0		29	10	S5820_027_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1893.00	24		24				1893.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	028	0		29	10	S5820_028_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					7.00		21.00													24.00						0.00				8.00				8.00			0.26	0.23				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	028	0		29	10	S5820_028_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					12.00		36.00													45.00						0.00				15.00				15.00			0.50	0.40				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	028	0		29	10	S5820_028_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	028	0		29	10	S5820_028_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	028	0		29	10	S5820_028_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											58.00	39		39				58.00	39		39												39						39			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	028	0		29	10	S5820_028_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											107.00	24		24				111.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	028	0		29	10	S5820_028_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1208.00	33		33				1208.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	028	0		29	10	S5820_028_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1623.00	24		24				1623.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	029	0		29	10	S5820_029_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					6.00		18.00													21.00						0.00				7.00				7.00			0.23	0.20				0.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	029	0		29	10	S5820_029_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					12.00		36.00													45.00						0.00				15.00				15.00			0.50	0.40				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	029	0		29	10	S5820_029_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	029	0		29	10	S5820_029_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	029	0		29	10	S5820_029_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											72.00	50		50				53.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	029	0		29	10	S5820_029_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											92.00	24		24				96.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	029	0		29	10	S5820_029_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1203.00	33		33				1203.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	029	0		29	10	S5820_029_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1638.00	24		24				1638.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	030	0		29	10	S5820_030_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					5.00		15.00													18.00						0.00				6.00				6.00			0.20	0.16				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	030	0		29	10	S5820_030_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					10.00		30.00													39.00						0.00				13.00				13.00			0.43	0.33				0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	030	0		29	10	S5820_030_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	030	0		29	10	S5820_030_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	030	0		29	10	S5820_030_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											70.00	50		50				49.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	030	0		29	10	S5820_030_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											87.00	24		24				91.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	030	0		29	10	S5820_030_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1354.00	33		33				1354.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	030	0		29	10	S5820_030_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1744.00	24		24				1744.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	031	0		29	10	S5820_031_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					6.00		18.00													24.00						0.00				8.00				8.00			0.26	0.20				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	031	0		29	10	S5820_031_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					12.00		36.00													45.00						0.00				15.00				15.00			0.50	0.40				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	031	0		29	10	S5820_031_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					37.00		111.00													114.00						96.00				38.00				38.00			1.26	1.23				1.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	031	0		29	10	S5820_031_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					37.00		111.00													114.00						96.00				38.00				38.00			1.26	1.23				1.22		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	031	0		29	10	S5820_031_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											74.00	43		43				58.00	37		37												43						37			43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	031	0		29	10	S5820_031_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											105.00	24		24				109.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	031	0		29	10	S5820_031_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1046.00	33		33				1046.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	031	0		29	10	S5820_031_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1314.00	24		24				1314.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	032	0		29	10	S5820_032_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					7.00		21.00													24.00						0.00				8.00				8.00			0.26	0.23				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	032	0		29	10	S5820_032_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					12.00		36.00													45.00						0.00				15.00				15.00			0.50	0.40				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	032	0		29	10	S5820_032_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	032	0		29	10	S5820_032_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	032	0		29	10	S5820_032_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											65.00	44		44				59.00	38		38												44						38			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	032	0		29	10	S5820_032_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											101.00	24		24				106.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	032	0		29	10	S5820_032_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1076.00	33		33				1076.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	032	0		29	10	S5820_032_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1344.00	24		24				1344.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	033	0		29	10	S5820_033_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					7.00		21.00													24.00						0.00				8.00				8.00			0.26	0.23				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	033	0		29	10	S5820_033_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					12.00		36.00													45.00						0.00				15.00				15.00			0.50	0.40				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	033	0		29	10	S5820_033_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	033	0		29	10	S5820_033_0	1	Preferred Brand	4	11	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					37.00		111.00													135.00						96.00				45.00				45.00			1.50	1.23				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	033	0		29	10	S5820_033_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											82.00	50		50				61.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	033	0		29	10	S5820_033_0	1	Non-Preferred Drug	4	11	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											97.00	24		24				101.00	23		23												24						23			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	033	0		29	10	S5820_033_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											917.00	33		33				917.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	033	0		29	10	S5820_033_0	1	Specialty Tier	4	11	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											1228.00	24		24				1228.00	24		24												24						24			24			24									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5820	034	0		29	10	S5820_034_0	1	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					6.00																2.00				2.00		0.06						0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	034	0		29	10	S5820_034_0	1	Generic	2	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.66						0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	034	0		29	10	S5820_034_0	1	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.56						1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	034	0		29	10	S5820_034_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				83.00	42		42																				42															42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	034	0		29	10	S5820_034_0	1	Specialty Tier	2	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				847.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	035	0		29	10	S5820_035_0	1	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	1.00		3.00																					3.00																1.00				1.00		0.03						.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	035	0		29	10	S5820_035_0	1	Generic	2	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.66						0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	035	0		29	10	S5820_035_0	1	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	23.00		69.00																					69.00																23.00				23.00		0.76						0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	035	0		29	10	S5820_035_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				68.00	41		41																				41															41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	035	0		29	10	S5820_035_0	1	Specialty Tier	2	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				784.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	036	0		29	10	S5820_036_0	1	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	1.00		3.00																					3.00																1.00				1.00		0.03						0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	036	0		29	10	S5820_036_0	1	Generic	2	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.66						0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	036	0		29	10	S5820_036_0	1	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	27.00		81.00																					81.00																27.00				27.00		0.90						0.87		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	036	0		29	10	S5820_036_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				47.00	43		43																				43															43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	036	0		29	10	S5820_036_0	1	Specialty Tier	2	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				576.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	037	0		29	10	S5820_037_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	037	0		29	10	S5820_037_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	037	0		29	10	S5820_037_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								30.00		90.00					30.00		90.00													90.00						90.00				30.00				30.00			1.00	1.00				0.96		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	037	0		29	10	S5820_037_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											69.00	50		50				52.00	40		40												50						40			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	037	0		29	10	S5820_037_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1225.00	25		25				1225.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	038	0		29	10	S5820_038_0	1	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	1.00		3.00																					3.00																1.00				1.00		0.03						0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	038	0		29	10	S5820_038_0	1	Generic	2	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.66						0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	038	0		29	10	S5820_038_0	1	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	23.00		69.00																					69.00																23.00				23.00		0.76						0.74		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	038	0		29	10	S5820_038_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				63.00	44		44																				44															44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5820	038	0		29	10	S5820_038_0	1	Specialty Tier	2	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				775.00	25		25																				25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5877	004	0		29	10	S5877_004_0	1	Preferred Generic	2	01	1	2	1	1	110		10	100		1	34		90				1	2			90					29	34	7.00		21.00																					21.00																	7.00			7.00		0.21						0.21		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5877	004	0		29	10	S5877_004_0	1	Preferred Brand	2	10	1	2	2	1	110		10	100		1	34		90				1	2			90					29	34	47.00		141.00																					141.00																	47.00			47.00		1.38						1.38		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5877	004	0		29	10	S5877_004_0	1	Non-Preferred Drug	2	10	1	2	3	1	110		10	100		1	34		90				1	2			90					29	34	100.00		300.00																					300.00																	100.00			100.00		2.94						2.94		Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5877	004	0		29	10	S5877_004_0	1	Specialty Tier	2	11	1	1	4	1	110		10	100		1	34		90				1	2			90					29	34				1.00	25		25																				25																25		25									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5877	007	0		29	10	S5877_007_0	1	Preferred Generic	4	01	1	1	1	1	110		10	100		1	34		90				1	2			90					29	34				2.00	10		10																				10																10		10									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5877	007	0		29	10	S5877_007_0	1	Preferred Brand	4	10	1	1	2	1	110		10	100		1	34		90				1	2			90					29	34				47.00	20		20																				20																20		20									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5877	007	0		29	10	S5877_007_0	1	Non-Preferred Drug	4	10	1	1	3	1	110		10	100		1	34		90				1	2			90					29	34				54.00	40		40																				40																40		40									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5877	007	0		29	10	S5877_007_0	1	Specialty Tier	4	11	1	1	4	1	110		10	100		1	34		90				1	2			90					29	34				1.00	33		33																				33																33		33									Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	001	0		29	10	S5884_001_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	001	0		29	10	S5884_001_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	001	0		29	10	S5884_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	001	0		29	10	S5884_001_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	001	0		29	10	S5884_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											59.00	50		50				48.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	001	0		29	10	S5884_001_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	001	0		29	10	S5884_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	002	0		29	10	S5884_002_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	002	0		29	10	S5884_002_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	002	0		29	10	S5884_002_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	002	0		29	10	S5884_002_0	3	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	002	0		29	10	S5884_002_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	50		50				56.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	002	0		29	10	S5884_002_0	3	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	002	0		29	10	S5884_002_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	004	0		29	10	S5884_004_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	004	0		29	10	S5884_004_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	004	0		29	10	S5884_004_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	004	0		29	10	S5884_004_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	004	0		29	10	S5884_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											65.00	50		50				53.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	004	0		29	10	S5884_004_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	004	0		29	10	S5884_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	005	0		29	10	S5884_005_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	005	0		29	10	S5884_005_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	005	0		29	10	S5884_005_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	005	0		29	10	S5884_005_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	005	0		29	10	S5884_005_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	50		50				52.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	005	0		29	10	S5884_005_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	005	0		29	10	S5884_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	008	0		29	10	S5884_008_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	008	0		29	10	S5884_008_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	008	0		29	10	S5884_008_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	008	0		29	10	S5884_008_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	008	0		29	10	S5884_008_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	50		50				51.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	008	0		29	10	S5884_008_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	008	0		29	10	S5884_008_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	009	0		29	10	S5884_009_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	009	0		29	10	S5884_009_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	009	0		29	10	S5884_009_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	009	0		29	10	S5884_009_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	009	0		29	10	S5884_009_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											57.00	50		50				48.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	009	0		29	10	S5884_009_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	009	0		29	10	S5884_009_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	010	0		29	10	S5884_010_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	010	0		29	10	S5884_010_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	010	0		29	10	S5884_010_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	010	0		29	10	S5884_010_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	010	0		29	10	S5884_010_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											65.00	50		50				54.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	010	0		29	10	S5884_010_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	010	0		29	10	S5884_010_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	015	0		29	10	S5884_015_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	015	0		29	10	S5884_015_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	015	0		29	10	S5884_015_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	015	0		29	10	S5884_015_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	015	0		29	10	S5884_015_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											66.00	50		50				56.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	015	0		29	10	S5884_015_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	015	0		29	10	S5884_015_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	019	0		29	10	S5884_019_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	019	0		29	10	S5884_019_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	019	0		29	10	S5884_019_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	019	0		29	10	S5884_019_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	019	0		29	10	S5884_019_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	50		50				52.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	019	0		29	10	S5884_019_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	019	0		29	10	S5884_019_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	020	0		29	10	S5884_020_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	020	0		29	10	S5884_020_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	020	0		29	10	S5884_020_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	020	0		29	10	S5884_020_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	020	0		29	10	S5884_020_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											60.00	50		50				49.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	020	0		29	10	S5884_020_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	020	0		29	10	S5884_020_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	021	0		29	10	S5884_021_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	021	0		29	10	S5884_021_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	021	0		29	10	S5884_021_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	021	0		29	10	S5884_021_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	021	0		29	10	S5884_021_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											59.00	50		50				49.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	021	0		29	10	S5884_021_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	021	0		29	10	S5884_021_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	022	0		29	10	S5884_022_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	022	0		29	10	S5884_022_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	022	0		29	10	S5884_022_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	022	0		29	10	S5884_022_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	022	0		29	10	S5884_022_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											60.00	50		50				50.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	022	0		29	10	S5884_022_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	022	0		29	10	S5884_022_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	024	0		29	10	S5884_024_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	024	0		29	10	S5884_024_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	024	0		29	10	S5884_024_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	024	0		29	10	S5884_024_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	024	0		29	10	S5884_024_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											59.00	50		50				50.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	024	0		29	10	S5884_024_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	024	0		29	10	S5884_024_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	028	0		29	10	S5884_028_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	028	0		29	10	S5884_028_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	028	0		29	10	S5884_028_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	028	0		29	10	S5884_028_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	028	0		29	10	S5884_028_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											59.00	50		50				49.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	028	0		29	10	S5884_028_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	028	0		29	10	S5884_028_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	030	0		29	10	S5884_030_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	030	0		29	10	S5884_030_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	030	0		29	10	S5884_030_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	030	0		29	10	S5884_030_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	030	0		29	10	S5884_030_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	50		50				54.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	030	0		29	10	S5884_030_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	030	0		29	10	S5884_030_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	062	0		29	10	S5884_062_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	062	0		29	10	S5884_062_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	062	0		29	10	S5884_062_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	062	0		29	10	S5884_062_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	062	0		29	10	S5884_062_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											65.00	50		50				54.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	062	0		29	10	S5884_062_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	062	0		29	10	S5884_062_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	065	0		29	10	S5884_065_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	065	0		29	10	S5884_065_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	065	0		29	10	S5884_065_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	065	0		29	10	S5884_065_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	065	0		29	10	S5884_065_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											60.00	50		50				49.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	065	0		29	10	S5884_065_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	065	0		29	10	S5884_065_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	066	0		29	10	S5884_066_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	066	0		29	10	S5884_066_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	066	0		29	10	S5884_066_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	066	0		29	10	S5884_066_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	066	0		29	10	S5884_066_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											58.00	50		50				48.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	066	0		29	10	S5884_066_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	066	0		29	10	S5884_066_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	071	0		29	10	S5884_071_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	071	0		29	10	S5884_071_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	071	0		29	10	S5884_071_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	071	0		29	10	S5884_071_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	071	0		29	10	S5884_071_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											63.00	50		50				50.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	071	0		29	10	S5884_071_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	071	0		29	10	S5884_071_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	072	0		29	10	S5884_072_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	072	0		29	10	S5884_072_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	072	0		29	10	S5884_072_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	072	0		29	10	S5884_072_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	072	0		29	10	S5884_072_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											65.00	50		50				54.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	072	0		29	10	S5884_072_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	072	0		29	10	S5884_072_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	073	0		29	10	S5884_073_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	073	0		29	10	S5884_073_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	073	0		29	10	S5884_073_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	073	0		29	10	S5884_073_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	073	0		29	10	S5884_073_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											63.00	50		50				51.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	073	0		29	10	S5884_073_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	073	0		29	10	S5884_073_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	074	0		29	10	S5884_074_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	074	0		29	10	S5884_074_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	074	0		29	10	S5884_074_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	074	0		29	10	S5884_074_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	074	0		29	10	S5884_074_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	50		50				52.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	074	0		29	10	S5884_074_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	074	0		29	10	S5884_074_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	076	0		29	10	S5884_076_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	076	0		29	10	S5884_076_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	076	0		29	10	S5884_076_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	076	0		29	10	S5884_076_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	076	0		29	10	S5884_076_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											59.00	50		50				48.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	076	0		29	10	S5884_076_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	076	0		29	10	S5884_076_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	077	0		29	10	S5884_077_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	077	0		29	10	S5884_077_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	077	0		29	10	S5884_077_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	077	0		29	10	S5884_077_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	077	0		29	10	S5884_077_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											56.00	50		50				46.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	077	0		29	10	S5884_077_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	077	0		29	10	S5884_077_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	078	0		29	10	S5884_078_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	078	0		29	10	S5884_078_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	078	0		29	10	S5884_078_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	078	0		29	10	S5884_078_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	078	0		29	10	S5884_078_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											58.00	50		50				47.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	078	0		29	10	S5884_078_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	078	0		29	10	S5884_078_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	083	0		29	10	S5884_083_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	083	0		29	10	S5884_083_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	083	0		29	10	S5884_083_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	083	0		29	10	S5884_083_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	083	0		29	10	S5884_083_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											60.00	50		50				50.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	083	0		29	10	S5884_083_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	083	0		29	10	S5884_083_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	085	0		29	10	S5884_085_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	085	0		29	10	S5884_085_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	085	0		29	10	S5884_085_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	085	0		29	10	S5884_085_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	085	0		29	10	S5884_085_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	50		50				53.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	085	0		29	10	S5884_085_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	085	0		29	10	S5884_085_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	086	0		29	10	S5884_086_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	086	0		29	10	S5884_086_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	086	0		29	10	S5884_086_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	086	0		29	10	S5884_086_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	086	0		29	10	S5884_086_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											58.00	50		50				48.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	086	0		29	10	S5884_086_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	086	0		29	10	S5884_086_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	087	0		29	10	S5884_087_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	087	0		29	10	S5884_087_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	087	0		29	10	S5884_087_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	087	0		29	10	S5884_087_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	087	0		29	10	S5884_087_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				61.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	087	0		29	10	S5884_087_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	087	0		29	10	S5884_087_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	089	0		29	10	S5884_089_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	089	0		29	10	S5884_089_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	089	0		29	10	S5884_089_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	089	0		29	10	S5884_089_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	089	0		29	10	S5884_089_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											52.00	50		50				43.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	089	0		29	10	S5884_089_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	089	0		29	10	S5884_089_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	092	0		29	10	S5884_092_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	092	0		29	10	S5884_092_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	092	0		29	10	S5884_092_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	092	0		29	10	S5884_092_0	3	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	092	0		29	10	S5884_092_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	50		50				53.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	092	0		29	10	S5884_092_0	3	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	092	0		29	10	S5884_092_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	093	0		29	10	S5884_093_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	093	0		29	10	S5884_093_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	093	0		29	10	S5884_093_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	093	0		29	10	S5884_093_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	093	0		29	10	S5884_093_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											60.00	50		50				59.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	093	0		29	10	S5884_093_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	093	0		29	10	S5884_093_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	094	0		29	10	S5884_094_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	094	0		29	10	S5884_094_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	094	0		29	10	S5884_094_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	094	0		29	10	S5884_094_0	2	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								23.50		70.50					21.00		63.00											23.50		70.50				21.00		58.00				23.50				23.50			0.78	0.70		0.78	0.70	0.76	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5884	094	0		29	10	S5884_094_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	50		50				56.00	44		44										50		50				44		44			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	094	0		29	10	S5884_094_0	2	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	3	
S5884	094	0		29	10	S5884_094_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	101	0		29	10	S5884_101_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	101	0		29	10	S5884_101_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	101	0		29	10	S5884_101_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											23.00	22		22				21.00	20		20										22		22				20		15			22			22								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	101	0		29	10	S5884_101_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											60.00	37		37				54.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	101	0		29	10	S5884_101_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	102	0		29	10	S5884_102_0	2	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	102	0		29	10	S5884_102_0	2	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	102	0		29	10	S5884_102_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											24.00	21		21				22.00	20		20										21		21				20		15			21			21								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	102	0		29	10	S5884_102_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											63.00	37		37				57.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	102	0		29	10	S5884_102_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	103	0		29	10	S5884_103_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	103	0		29	10	S5884_103_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	103	0		29	10	S5884_103_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	23		23				23.00	20		20										23		23				20		15			23			23								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	103	0		29	10	S5884_103_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	37		37				52.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	103	0		29	10	S5884_103_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	104	0		29	10	S5884_104_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	104	0		29	10	S5884_104_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	104	0		29	10	S5884_104_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	23		23				21.00	20		20										23		23				20		15			23			23								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	104	0		29	10	S5884_104_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											58.00	36		36				53.00	35		35										36		36				35		30			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	104	0		29	10	S5884_104_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	105	0		29	10	S5884_105_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	105	0		29	10	S5884_105_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	105	0		29	10	S5884_105_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				20.00	20		20										25		25				20		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	105	0		29	10	S5884_105_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	38		38				54.00	35		35										38		38				35		30			38			38								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	105	0		29	10	S5884_105_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	106	0		29	10	S5884_106_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	106	0		29	10	S5884_106_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	106	0		29	10	S5884_106_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	24		24				20.00	20		20										24		24				20		15			24			24								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	106	0		29	10	S5884_106_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											61.00	37		37				54.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	106	0		29	10	S5884_106_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	107	0		29	10	S5884_107_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	107	0		29	10	S5884_107_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	107	0		29	10	S5884_107_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				24.00	20		20										25		25				20		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	107	0		29	10	S5884_107_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	43		43				56.00	35		35										43		43				35		30			43			43								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	107	0		29	10	S5884_107_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	108	0		29	10	S5884_108_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	108	0		29	10	S5884_108_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	108	0		29	10	S5884_108_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	24		24				21.00	20		20										24		24				20		15			24			24								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	108	0		29	10	S5884_108_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	37		37				55.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	108	0		29	10	S5884_108_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	109	0		29	10	S5884_109_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	109	0		29	10	S5884_109_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	109	0		29	10	S5884_109_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	24		24				20.00	20		20										24		24				20		15			24			24								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	109	0		29	10	S5884_109_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											58.00	36		36				53.00	35		35										36		36				35		30			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	109	0		29	10	S5884_109_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	110	0		29	10	S5884_110_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	110	0		29	10	S5884_110_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	110	0		29	10	S5884_110_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				23.00	20		20										25		25				20		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	110	0		29	10	S5884_110_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	50		50				52.00	35		35										50		50				35		30			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	110	0		29	10	S5884_110_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	111	0		29	10	S5884_111_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	111	0		29	10	S5884_111_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	111	0		29	10	S5884_111_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	24		24				22.00	20		20										24		24				20		15			24			24								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	111	0		29	10	S5884_111_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	36		36				60.00	35		35										36		36				35		30			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	111	0		29	10	S5884_111_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	112	0		29	10	S5884_112_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	112	0		29	10	S5884_112_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	112	0		29	10	S5884_112_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				21.00	20		20										25		25				20		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	112	0		29	10	S5884_112_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											63.00	37		37				57.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	112	0		29	10	S5884_112_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	113	0		29	10	S5884_113_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	113	0		29	10	S5884_113_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	113	0		29	10	S5884_113_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				21.00	20		20										25		25				20		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	113	0		29	10	S5884_113_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											56.00	36		36				51.00	35		35										36		36				35		30			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	113	0		29	10	S5884_113_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	114	0		29	10	S5884_114_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	114	0		29	10	S5884_114_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	114	0		29	10	S5884_114_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	20		20				26.00	20		20										20		20				20		15			20			20								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	114	0		29	10	S5884_114_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											67.00	37		37				61.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	114	0		29	10	S5884_114_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	115	0		29	10	S5884_115_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	115	0		29	10	S5884_115_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	115	0		29	10	S5884_115_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	25		25				27.00	20		20										25		25				20		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	115	0		29	10	S5884_115_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											60.00	37		37				53.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	115	0		29	10	S5884_115_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	116	0		29	10	S5884_116_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	116	0		29	10	S5884_116_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	116	0		29	10	S5884_116_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	21		21				25.00	20		20										21		21				20		15			21			21								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	116	0		29	10	S5884_116_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											60.00	37		37				55.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	116	0		29	10	S5884_116_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	131	0		29	10	S5884_131_0	2	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	131	0		29	10	S5884_131_0	2	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	131	0		29	10	S5884_131_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	20		20				24.00	20		20										20		20				20		15			20			20								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	131	0		29	10	S5884_131_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	37		37				60.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	131	0		29	10	S5884_131_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	132	0		29	10	S5884_132_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	132	0		29	10	S5884_132_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	132	0		29	10	S5884_132_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	24		24				23.00	20		20										24		24				20		15			24			24								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	132	0		29	10	S5884_132_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											63.00	36		36				57.00	35		35										36		36				35		30			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	132	0		29	10	S5884_132_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	133	0		29	10	S5884_133_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	133	0		29	10	S5884_133_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	133	0		29	10	S5884_133_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	23		23				22.00	20		20										23		23				20		15			23			23								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	133	0		29	10	S5884_133_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											63.00	36		36				58.00	35		35										36		36				35		30			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	133	0		29	10	S5884_133_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	134	0		29	10	S5884_134_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	134	0		29	10	S5884_134_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	134	0		29	10	S5884_134_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				22.00	20		20										25		25				20		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	134	0		29	10	S5884_134_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	37		37				57.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	134	0		29	10	S5884_134_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	135	0		29	10	S5884_135_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	135	0		29	10	S5884_135_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	135	0		29	10	S5884_135_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	23		23				21.00	20		20										23		23				20		15			23			23								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	135	0		29	10	S5884_135_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											59.00	36		36				53.00	35		35										36		36				35		30			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	135	0		29	10	S5884_135_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	136	0		29	10	S5884_136_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	136	0		29	10	S5884_136_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	136	0		29	10	S5884_136_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											22.00	21		21				21.00	20		20										21		21				20		15			21			21								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	136	0		29	10	S5884_136_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	37		37				54.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	136	0		29	10	S5884_136_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	137	0		29	10	S5884_137_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	137	0		29	10	S5884_137_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	137	0		29	10	S5884_137_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	23		23				21.00	20		20										23		23				20		15			23			23								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	137	0		29	10	S5884_137_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											63.00	36		36				57.00	35		35										36		36				35		30			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	137	0		29	10	S5884_137_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	138	0		29	10	S5884_138_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	138	0		29	10	S5884_138_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	138	0		29	10	S5884_138_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	24		24				21.00	20		20										24		24				20		15			24			24								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	138	0		29	10	S5884_138_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	37		37				55.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	138	0		29	10	S5884_138_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	139	0		29	10	S5884_139_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	139	0		29	10	S5884_139_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	139	0		29	10	S5884_139_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	23		23				21.00	20		20										23		23				20		15			23			23								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	139	0		29	10	S5884_139_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											62.00	37		37				55.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	139	0		29	10	S5884_139_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	140	0		29	10	S5884_140_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	140	0		29	10	S5884_140_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	140	0		29	10	S5884_140_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				21.00	20		20										25		25				20		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	140	0		29	10	S5884_140_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	38		38				55.00	35		35										38		38				35		30			38			38								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	140	0		29	10	S5884_140_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	141	0		29	10	S5884_141_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	141	0		29	10	S5884_141_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	141	0		29	10	S5884_141_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				20.00	20		20										25		25				20		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	141	0		29	10	S5884_141_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											77.00	50		50				49.00	35		35										50		50				35		30			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	141	0		29	10	S5884_141_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	142	0		29	10	S5884_142_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	142	0		29	10	S5884_142_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	142	0		29	10	S5884_142_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	23		23				21.00	20		20										23		23				20		15			23			23								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	142	0		29	10	S5884_142_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											60.00	37		37				54.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	142	0		29	10	S5884_142_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	143	0		29	10	S5884_143_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	143	0		29	10	S5884_143_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	143	0		29	10	S5884_143_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	24		24				25.00	20		20										24		24				20		15			24			24								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	143	0		29	10	S5884_143_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											67.00	36		36				59.00	35		35										36		36				35		30			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	143	0		29	10	S5884_143_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	144	0		29	10	S5884_144_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	144	0		29	10	S5884_144_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	144	0		29	10	S5884_144_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	24		24				21.00	20		20										24		24				20		15			24			24								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	144	0		29	10	S5884_144_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	37		37				56.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	144	0		29	10	S5884_144_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	145	0		29	10	S5884_145_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	145	0		29	10	S5884_145_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	145	0		29	10	S5884_145_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											24.00	23		23				21.00	20		20										23		23				20		15			23			23								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	145	0		29	10	S5884_145_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											58.00	36		36				54.00	35		35										36		36				35		30			36			36								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	145	0		29	10	S5884_145_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	146	0		29	10	S5884_146_0	1	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	146	0		29	10	S5884_146_0	1	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	146	0		29	10	S5884_146_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	25		25				24.00	20		20										25		25				20		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	146	0		29	10	S5884_146_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	44		44				53.00	35		35										44		44				35		30			44			44								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	146	0		29	10	S5884_146_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	147	0		29	10	S5884_147_0	2	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	147	0		29	10	S5884_147_0	2	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	147	0		29	10	S5884_147_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											24.00	23		23				20.00	20		20										23		23				20		15			23			23								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	147	0		29	10	S5884_147_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											61.00	37		37				54.00	35		35										37		37				35		30			37			37								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	147	0		29	10	S5884_147_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	148	0		29	10	S5884_148_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	148	0		29	10	S5884_148_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	148	0		29	10	S5884_148_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	25		25				32.00	25		25										25		25				25		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	148	0		29	10	S5884_148_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											66.00	47		47				44.00	35		35										47		47				35		35			47			47								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	148	0		29	10	S5884_148_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	149	0		29	10	S5884_149_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	149	0		29	10	S5884_149_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	149	0		29	10	S5884_149_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	25		25				28.00	21		21										25		25				21		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	149	0		29	10	S5884_149_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	50		50				54.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	149	0		29	10	S5884_149_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	150	0		29	10	S5884_150_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	150	0		29	10	S5884_150_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	150	0		29	10	S5884_150_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	25		25				28.00	22		22										25		25				22		18			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	150	0		29	10	S5884_150_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											79.00	49		49				55.00	35		35										49		49				35		35			49			49								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	150	0		29	10	S5884_150_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	151	0		29	10	S5884_151_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	151	0		29	10	S5884_151_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	151	0		29	10	S5884_151_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	25		25				30.00	23		23										25		25				23		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	151	0		29	10	S5884_151_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	50		50				48.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	151	0		29	10	S5884_151_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	152	0		29	10	S5884_152_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	152	0		29	10	S5884_152_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	152	0		29	10	S5884_152_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	25		25				28.00	23		23										25		25				23		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	152	0		29	10	S5884_152_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				45.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	152	0		29	10	S5884_152_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	153	0		29	10	S5884_153_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	153	0		29	10	S5884_153_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	153	0		29	10	S5884_153_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				28.00	24		24										25		25				24		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	153	0		29	10	S5884_153_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	50		50				49.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	153	0		29	10	S5884_153_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	154	0		29	10	S5884_154_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	154	0		29	10	S5884_154_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	154	0		29	10	S5884_154_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				26.00	23		23										25		25				23		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	154	0		29	10	S5884_154_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	50		50				50.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	154	0		29	10	S5884_154_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	155	0		29	10	S5884_155_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	155	0		29	10	S5884_155_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	155	0		29	10	S5884_155_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				26.00	23		23										25		25				23		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	155	0		29	10	S5884_155_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				46.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	155	0		29	10	S5884_155_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	156	0		29	10	S5884_156_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	156	0		29	10	S5884_156_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	156	0		29	10	S5884_156_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				24.00	21		21										25		25				21		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	156	0		29	10	S5884_156_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				48.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	156	0		29	10	S5884_156_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	157	0		29	10	S5884_157_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	157	0		29	10	S5884_157_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					4.00		12.00											15.00		45.00				4.00		8.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	157	0		29	10	S5884_157_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				28.00	25		25										25		25				25		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	157	0		29	10	S5884_157_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	48		48				50.00	35		35										48		48				35		30			48			48								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	157	0		29	10	S5884_157_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	158	0		29	10	S5884_158_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	158	0		29	10	S5884_158_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	158	0		29	10	S5884_158_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				22.00	21		21										25		25				21		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	158	0		29	10	S5884_158_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	50		50				48.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	158	0		29	10	S5884_158_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	159	0		29	10	S5884_159_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	159	0		29	10	S5884_159_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	159	0		29	10	S5884_159_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				27.00	23		23										25		25				23		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	159	0		29	10	S5884_159_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											77.00	50		50				49.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	159	0		29	10	S5884_159_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	160	0		29	10	S5884_160_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	160	0		29	10	S5884_160_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	160	0		29	10	S5884_160_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				29.00	24		24										25		25				24		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	160	0		29	10	S5884_160_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				48.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	160	0		29	10	S5884_160_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	161	0		29	10	S5884_161_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	161	0		29	10	S5884_161_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	161	0		29	10	S5884_161_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				26.00	23		23										25		25				23		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	161	0		29	10	S5884_161_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	50		50				45.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	161	0		29	10	S5884_161_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	162	0		29	10	S5884_162_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	162	0		29	10	S5884_162_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	162	0		29	10	S5884_162_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	25		25				30.00	24		24										25		25				24		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	162	0		29	10	S5884_162_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				45.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	162	0		29	10	S5884_162_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	163	0		29	10	S5884_163_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	163	0		29	10	S5884_163_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	163	0		29	10	S5884_163_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	25		25				30.00	24		24										25		25				24		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	163	0		29	10	S5884_163_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	50		50				49.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	163	0		29	10	S5884_163_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	164	0		29	10	S5884_164_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	164	0		29	10	S5884_164_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	164	0		29	10	S5884_164_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				26.00	23		23										25		25				23		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	164	0		29	10	S5884_164_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	50		50				49.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	164	0		29	10	S5884_164_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	165	0		29	10	S5884_165_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	165	0		29	10	S5884_165_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	165	0		29	10	S5884_165_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				24.00	23		23										25		25				23		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	165	0		29	10	S5884_165_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											67.00	50		50				45.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	165	0		29	10	S5884_165_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	166	0		29	10	S5884_166_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	166	0		29	10	S5884_166_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	166	0		29	10	S5884_166_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				23.00	22		22										25		25				22		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	166	0		29	10	S5884_166_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				47.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	166	0		29	10	S5884_166_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	167	0		29	10	S5884_167_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	167	0		29	10	S5884_167_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	167	0		29	10	S5884_167_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				24.00	22		22										25		25				22		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	167	0		29	10	S5884_167_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				46.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	167	0		29	10	S5884_167_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	168	0		29	10	S5884_168_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	168	0		29	10	S5884_168_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	168	0		29	10	S5884_168_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	25		25				25.00	21		21										25		25				21		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	168	0		29	10	S5884_168_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											77.00	50		50				50.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	168	0		29	10	S5884_168_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	169	0		29	10	S5884_169_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	169	0		29	10	S5884_169_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	169	0		29	10	S5884_169_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				25.00	21		21										25		25				21		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	169	0		29	10	S5884_169_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				46.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	169	0		29	10	S5884_169_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	170	0		29	10	S5884_170_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	170	0		29	10	S5884_170_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	170	0		29	10	S5884_170_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				24.00	21		21										25		25				21		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	170	0		29	10	S5884_170_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				46.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	170	0		29	10	S5884_170_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	171	0		29	10	S5884_171_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	171	0		29	10	S5884_171_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	171	0		29	10	S5884_171_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	25		25				28.00	22		22										25		25				22		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	171	0		29	10	S5884_171_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	50		50				49.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	171	0		29	10	S5884_171_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	172	0		29	10	S5884_172_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	172	0		29	10	S5884_172_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	172	0		29	10	S5884_172_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				30.00	25		25										25		25				25		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	172	0		29	10	S5884_172_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											63.00	50		50				45.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	172	0		29	10	S5884_172_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	173	0		29	10	S5884_173_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	173	0		29	10	S5884_173_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	173	0		29	10	S5884_173_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	25		25				30.00	25		25										25		25				25		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	173	0		29	10	S5884_173_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	50		50				52.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	173	0		29	10	S5884_173_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	174	0		29	10	S5884_174_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	174	0		29	10	S5884_174_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	174	0		29	10	S5884_174_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				28.00	25		25										25		25				25		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	174	0		29	10	S5884_174_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	50		50				53.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	174	0		29	10	S5884_174_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	175	0		29	10	S5884_175_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		2.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	175	0		29	10	S5884_175_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	175	0		29	10	S5884_175_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				26.00	22		22										25		25				22		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	175	0		29	10	S5884_175_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	48		48				47.00	35		35										48		48				35		35			48			48								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	175	0		29	10	S5884_175_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	176	0		29	10	S5884_176_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	176	0		29	10	S5884_176_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	176	0		29	10	S5884_176_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				27.00	24		24										25		25				24		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	176	0		29	10	S5884_176_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	50		50				46.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	176	0		29	10	S5884_176_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	177	0		29	10	S5884_177_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	177	0		29	10	S5884_177_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	177	0		29	10	S5884_177_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				27.00	24		24										25		25				24		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	177	0		29	10	S5884_177_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	50		50				46.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	177	0		29	10	S5884_177_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	178	0		29	10	S5884_178_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	178	0		29	10	S5884_178_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	178	0		29	10	S5884_178_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				26.00	22		22										25		25				22		16			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	178	0		29	10	S5884_178_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	50		50				50.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	178	0		29	10	S5884_178_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	179	0		29	10	S5884_179_0	1	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	179	0		29	10	S5884_179_0	1	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	179	0		29	10	S5884_179_0	1	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											36.00	25		25				33.00	25		25										25		25				25		15			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	179	0		29	10	S5884_179_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											66.00	45		45				50.00	35		35										45		45				35		35			45			45								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	179	0		29	10	S5884_179_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	180	0		29	10	S5884_180_0	2	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	180	0		29	10	S5884_180_0	2	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	180	0		29	10	S5884_180_0	2	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	25		25				31.00	22		22										25		25				22		20			25			25								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	180	0		29	10	S5884_180_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											65.00	50		50				44.00	35		35										50		50				35		35			50			50								1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5884	180	0		29	10	S5884_180_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5904	001	0		29	10	S5904_001_0	10	Preferred Generic	3	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								12.00		36.00					2.00		6.00					2.00		6.00																12.00				2.00			0.39	0.06	0.06			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5904	001	0		29	10	S5904_001_0	10	Generic	3	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5904	001	0		29	10	S5904_001_0	10	Preferred Brand	3	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		141.00					47.00		141.00																47.00				47.00			1.52	1.52	1.52			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5904	001	0		29	10	S5904_001_0	10	Non-Preferred Brand	3	11	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											98.48	40		40				98.48	40		40				40		40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5904	001	0		29	10	S5904_001_0	10	Specialty Tier	3	11	1	1	5	1		010	01	010		1				31					31						31		31											710.37	25						710.37	25						25																	25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5904	002	0		29	10	S5904_002_0	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5904	002	0		29	10	S5904_002_0	7	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5904	002	0		29	10	S5904_002_0	7	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					10.00		30.00					10.00		30.00																20.00				10.00			0.65	0.32	0.32			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5904	002	0		29	10	S5904_002_0	7	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					10.00		30.00					10.00		30.00																20.00				10.00			0.65	0.32	0.32			0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5904	002	0		29	10	S5904_002_0	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5904	002	0		29	10	S5904_002_0	7	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5904	002	0		29	10	S5904_002_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											734.32	33						734.32	33						33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5916	001	0		29	10	S5916_001_0	7	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	001	0		29	10	S5916_001_0	7	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	001	0		29	10	S5916_001_0	7	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	001	0		29	10	S5916_001_0	7	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				67.80	30	30	30																		30	30	30															30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	001	0		29	10	S5916_001_0	7	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				1192.36	26																				26																	26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	001	0		29	10	S5916_001_0	7	Select Care Drugs	3	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	002	0		29	10	S5916_002_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	002	0		29	10	S5916_002_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5916	002	0		29	10	S5916_002_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	8.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	002	0		29	10	S5916_002_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	36.00	72.00	90.00																			36.00	72.00	90.00																36.00				36.00		1.20			1.20			1.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	002	0		29	10	S5916_002_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				90.40	40	40	40																		40	40	40															40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	002	0		29	10	S5916_002_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1513.38	33																				33																	33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	002	0		29	10	S5916_002_0	7	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs													
S5916	002	0		29	10	S5916_002_0	7	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs											1		
S5921	348	0		29	10	S5921_348_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	348	0		29	10	S5921_348_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					5.00		15.00													30.00						0.00				10.00				10.00			0.33	0.16				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	348	0		29	10	S5921_348_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					38.00		114.00													141.00						109.00				47.00				47.00			1.56	1.26				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	348	0		29	10	S5921_348_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											80.00	41		41				80.00	41		41												41						41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	348	0		29	10	S5921_348_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											647.00	25		25				647.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	349	0		29	10	S5921_349_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					1.00		3.00													12.00						0.00				4.00				4.00			0.13	0.03				0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	349	0		29	10	S5921_349_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					6.00		18.00													30.00						0.00				10.00				10.00			0.33	0.20				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	349	0		29	10	S5921_349_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								40.00		120.00					30.00		90.00													120.00						85.00				40.00				40.00			1.33	1.00				1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	349	0		29	10	S5921_349_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											77.00	39		39				77.00	39		39												39						39			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	349	0		29	10	S5921_349_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											653.00	25		25				653.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	350	0		29	10	S5921_350_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					1.00		3.00													15.00						0.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	350	0		29	10	S5921_350_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					5.00		15.00													30.00						0.00				10.00				10.00			0.33	0.16				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	350	0		29	10	S5921_350_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								44.00		132.00					34.00		102.00													132.00						97.00				44.00				44.00			1.46	1.13				1.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	350	0		29	10	S5921_350_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											83.00	41		41				83.00	41		41												41						41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	350	0		29	10	S5921_350_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											693.00	25		25				693.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	351	0		29	10	S5921_351_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					1.00		3.00													12.00						0.00				4.00				4.00			0.13	0.03				0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	351	0		29	10	S5921_351_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					8.00		24.00													39.00						0.00				13.00				13.00			0.43	0.26				0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	351	0		29	10	S5921_351_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						91.00				42.00				42.00			1.40	1.06				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	351	0		29	10	S5921_351_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											78.00	41		41				78.00	41		41												41						41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	351	0		29	10	S5921_351_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											786.00	25		25				786.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	352	0		29	10	S5921_352_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					1.00		3.00													18.00						0.00				6.00				6.00			0.20	0.03				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	352	0		29	10	S5921_352_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					9.00		27.00													42.00						0.00				14.00				14.00			0.46	0.30				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	352	0		29	10	S5921_352_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								44.00		132.00					34.00		102.00													132.00						97.00				44.00				44.00			1.46	1.13				1.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	352	0		29	10	S5921_352_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											74.00	38		38				74.00	38		38												38						38			38			38									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	352	0		29	10	S5921_352_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											810.00	25		25				810.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	353	0		29	10	S5921_353_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					1.00		3.00													15.00						0.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	353	0		29	10	S5921_353_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					8.00		24.00													39.00						0.00				13.00				13.00			0.43	0.26				0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	353	0		29	10	S5921_353_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								40.00		120.00					30.00		90.00													120.00						85.00				40.00				40.00			1.33	1.00				1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	353	0		29	10	S5921_353_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											75.00	38		38				75.00	38		38												38						38			38			38									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	353	0		29	10	S5921_353_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											711.00	25		25				711.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	354	0		29	10	S5921_354_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					1.00		3.00													18.00						0.00				6.00				6.00			0.20	0.03				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	354	0		29	10	S5921_354_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	354	0		29	10	S5921_354_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								40.00		120.00					30.00		90.00													120.00						85.00				40.00				40.00			1.33	1.00				1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	354	0		29	10	S5921_354_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											79.00	39		39				79.00	39		39												39						39			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	354	0		29	10	S5921_354_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											936.00	25		25				936.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	355	0		29	10	S5921_355_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					1.00		3.00													15.00						0.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	355	0		29	10	S5921_355_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					9.00		27.00													42.00						0.00				14.00				14.00			0.46	0.30				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	355	0		29	10	S5921_355_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								41.00		123.00					31.00		93.00													123.00						88.00				41.00				41.00			1.36	1.03				1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	355	0		29	10	S5921_355_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											80.00	40		40				59.00	30		30												40						30			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	355	0		29	10	S5921_355_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											813.00	25		25				813.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	356	0		29	10	S5921_356_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	356	0		29	10	S5921_356_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	356	0		29	10	S5921_356_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								41.00		123.00					31.00		93.00													123.00						93.00				41.00				41.00			1.36	1.03				1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	356	0		29	10	S5921_356_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											72.00	36		36				72.00	36		36												36						36			36			36									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	356	0		29	10	S5921_356_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											714.00	25		25				714.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	357	0		29	10	S5921_357_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	357	0		29	10	S5921_357_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					7.00		21.00													36.00						0.00				12.00				12.00			0.40	0.23				0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	357	0		29	10	S5921_357_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								41.00		123.00					31.00		93.00													123.00						88.00				41.00				41.00			1.36	1.03				1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	357	0		29	10	S5921_357_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											74.00	38		38				74.00	38		38												38						38			38			38									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	357	0		29	10	S5921_357_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											861.00	25		25				861.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	358	0		29	10	S5921_358_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	358	0		29	10	S5921_358_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					9.00		27.00													42.00						0.00				14.00				14.00			0.46	0.30				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	358	0		29	10	S5921_358_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						91.00				42.00				42.00			1.40	1.06				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	358	0		29	10	S5921_358_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											73.00	38		38				73.00	38		38												38						38			38			38									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	358	0		29	10	S5921_358_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											776.00	25		25				776.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	359	0		29	10	S5921_359_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	359	0		29	10	S5921_359_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						0.00				19.00				19.00			0.63	0.46				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	359	0		29	10	S5921_359_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								44.00		132.00					34.00		102.00													132.00						97.00				44.00				44.00			1.46	1.13				1.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	359	0		29	10	S5921_359_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											74.00	37		37				74.00	37		37												37						37			37			37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	359	0		29	10	S5921_359_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											900.00	25		25				900.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	360	0		29	10	S5921_360_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	360	0		29	10	S5921_360_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					12.00		36.00													51.00						0.00				17.00				17.00			0.56	0.40				0.54		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	360	0		29	10	S5921_360_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								40.00		120.00					30.00		90.00													120.00						85.00				40.00				40.00			1.33	1.00				1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	360	0		29	10	S5921_360_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											66.00	35		35				66.00	35		35												35						35			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	360	0		29	10	S5921_360_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											891.00	25		25				891.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	361	0		29	10	S5921_361_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	361	0		29	10	S5921_361_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	361	0		29	10	S5921_361_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													129.00						94.00				43.00				43.00			1.43	1.10				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	361	0		29	10	S5921_361_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											70.00	35		35				58.00	30		30												35						30			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	361	0		29	10	S5921_361_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											837.00	25		25				837.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	362	0		29	10	S5921_362_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	362	0		29	10	S5921_362_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					7.00		21.00													36.00						0.00				12.00				12.00			0.40	0.23				0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	362	0		29	10	S5921_362_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						91.00				42.00				42.00			1.40	1.06				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	362	0		29	10	S5921_362_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											78.00	41		41				78.00	41		41												41						41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	362	0		29	10	S5921_362_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											642.00	25		25				642.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	363	0		29	10	S5921_363_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	363	0		29	10	S5921_363_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					9.00		27.00													42.00						0.00				14.00				14.00			0.46	0.30				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	363	0		29	10	S5921_363_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								41.00		123.00					31.00		93.00													123.00						88.00				41.00				41.00			1.36	1.03				1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	363	0		29	10	S5921_363_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											76.00	39		39				76.00	39		39												39						39			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	363	0		29	10	S5921_363_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											668.00	25		25				668.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	364	0		29	10	S5921_364_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	364	0		29	10	S5921_364_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	364	0		29	10	S5921_364_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								34.00		102.00					24.00		72.00													102.00						67.00				34.00				34.00			1.13	0.80				1.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	364	0		29	10	S5921_364_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											62.00	33		33				62.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	364	0		29	10	S5921_364_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											860.00	25		25				860.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	365	0		29	10	S5921_365_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					1.00		3.00													12.00						0.00				4.00				4.00			0.13	0.03				0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	365	0		29	10	S5921_365_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					7.00		21.00													36.00						0.00				12.00				12.00			0.40	0.23				0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	365	0		29	10	S5921_365_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								36.00		108.00					26.00		78.00													108.00						73.00				36.00				36.00			1.20	0.86				1.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	365	0		29	10	S5921_365_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											78.00	41		41				78.00	41		41												41						41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	365	0		29	10	S5921_365_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											873.00	25		25				873.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	366	0		29	10	S5921_366_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					1.00		3.00													12.00						0.00				4.00				4.00			0.13	0.03				0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	366	0		29	10	S5921_366_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					6.00		18.00													30.00						0.00				10.00				10.00			0.33	0.20				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	366	0		29	10	S5921_366_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								37.00		111.00					30.00		90.00													111.00						85.00				37.00				37.00			1.23	1.00				1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	366	0		29	10	S5921_366_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											71.00	39		39				71.00	39		39												39						39			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	366	0		29	10	S5921_366_0	3	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											693.00	25		25				693.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	367	0		29	10	S5921_367_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					1.00		3.00													15.00						0.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	367	0		29	10	S5921_367_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								16.00		48.00					11.00		33.00													48.00						0.00				16.00				16.00			0.53	0.36				0.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	367	0		29	10	S5921_367_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													129.00						94.00				43.00				43.00			1.43	1.10				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	367	0		29	10	S5921_367_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											65.00	33		33				65.00	33		33												33						33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	367	0		29	10	S5921_367_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											663.00	25		25				663.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	368	0		29	10	S5921_368_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	368	0		29	10	S5921_368_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					7.00		21.00													36.00						0.00				12.00				12.00			0.40	0.23				0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	368	0		29	10	S5921_368_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								41.00		123.00					31.00		93.00													123.00						88.00				41.00				41.00			1.36	1.03				1.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	368	0		29	10	S5921_368_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											69.00	36		36				69.00	36		36												36						36			36			36									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	368	0		29	10	S5921_368_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											910.00	25		25				910.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	369	0		29	10	S5921_369_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	369	0		29	10	S5921_369_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					7.00		21.00													36.00						0.00				12.00				12.00			0.40	0.23				0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	369	0		29	10	S5921_369_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								44.00		132.00					34.00		102.00													132.00						97.00				44.00				44.00			1.46	1.13				1.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	369	0		29	10	S5921_369_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											67.00	36		36				67.00	36		36												36						36			36			36									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	369	0		29	10	S5921_369_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											562.00	25		25				562.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	370	0		29	10	S5921_370_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					1.00		3.00													18.00						0.00				6.00				6.00			0.20	0.03				0.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	370	0		29	10	S5921_370_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	370	0		29	10	S5921_370_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													129.00						94.00				43.00				43.00			1.43	1.10				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	370	0		29	10	S5921_370_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											73.00	37		37				73.00	37		37												37						37			37			37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	370	0		29	10	S5921_370_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											782.00	25		25				782.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	371	0		29	10	S5921_371_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	371	0		29	10	S5921_371_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	371	0		29	10	S5921_371_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								40.00		120.00					30.00		90.00													120.00						85.00				40.00				40.00			1.33	1.00				1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	371	0		29	10	S5921_371_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											70.00	41		41				70.00	41		41												41						41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	371	0		29	10	S5921_371_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											682.00	25		25				682.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	372	0		29	10	S5921_372_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	372	0		29	10	S5921_372_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					13.00		39.00													54.00						0.00				18.00				18.00			0.60	0.43				0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	372	0		29	10	S5921_372_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						91.00				42.00				42.00			1.40	1.06				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	372	0		29	10	S5921_372_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											99.00	44		44				69.00	34		34												44						34			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	372	0		29	10	S5921_372_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											815.00	25		25				815.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	373	0		29	10	S5921_373_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	373	0		29	10	S5921_373_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					12.00		36.00													51.00						0.00				17.00				17.00			0.56	0.40				0.54		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	373	0		29	10	S5921_373_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													129.00						94.00				43.00				43.00			1.43	1.10				1.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	373	0		29	10	S5921_373_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											56.00	30		30				56.00	30		30												30						30			30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	373	0		29	10	S5921_373_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											666.00	25		25				666.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	374	0		29	10	S5921_374_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	374	0		29	10	S5921_374_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					7.00		21.00													36.00						0.00				12.00				12.00			0.40	0.23				0.38		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	374	0		29	10	S5921_374_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								44.00		132.00					34.00		102.00													132.00						97.00				44.00				44.00			1.46	1.13				1.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	374	0		29	10	S5921_374_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											75.00	41		41				75.00	41		41												41						41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	374	0		29	10	S5921_374_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											769.00	25		25				769.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	375	0		29	10	S5921_375_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	375	0		29	10	S5921_375_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					8.00		24.00													39.00						0.00				13.00				13.00			0.43	0.26				0.41		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	375	0		29	10	S5921_375_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								39.00		117.00					29.00		87.00													117.00						82.00				39.00				39.00			1.30	0.96				1.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	375	0		29	10	S5921_375_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											68.00	41		41				68.00	41		41												41						41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	375	0		29	10	S5921_375_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											782.00	25		25				782.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	376	0		29	10	S5921_376_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					1.00		3.00													12.00						0.00				4.00				4.00			0.13	0.03				0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	376	0		29	10	S5921_376_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					6.00		18.00													30.00						0.00				10.00				10.00			0.33	0.20				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	376	0		29	10	S5921_376_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						91.00				42.00				42.00			1.40	1.06				1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	376	0		29	10	S5921_376_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											81.00	39		39				81.00	39		39												39						39			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	376	0		29	10	S5921_376_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											659.00	25		25				659.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	377	0		29	10	S5921_377_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					1.00		3.00													12.00						0.00				4.00				4.00			0.13	0.03				0.12		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	377	0		29	10	S5921_377_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					6.00		18.00													30.00						0.00				10.00				10.00			0.33	0.20				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	377	0		29	10	S5921_377_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								40.00		120.00					30.00		90.00													120.00						85.00				40.00				40.00			1.33	1.00				1.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	377	0		29	10	S5921_377_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											73.00	35		35				73.00	35		35												35						35			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	377	0		29	10	S5921_377_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											664.00	25		25				664.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	378	0		29	10	S5921_378_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	378	0		29	10	S5921_378_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					4.00		12.00													27.00						0.00				9.00				9.00			0.30	0.13				0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	378	0		29	10	S5921_378_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													141.00						115.00				47.00				47.00			1.56	1.33				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	378	0		29	10	S5921_378_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											76.00	41		41				76.00	41		41												41						41			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	378	0		29	10	S5921_378_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											647.00	25		25				647.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	379	0		29	10	S5921_379_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	379	0		29	10	S5921_379_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					9.00		27.00													42.00						0.00				14.00				14.00			0.46	0.30				0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	379	0		29	10	S5921_379_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								39.00		117.00					29.00		87.00													117.00						87.00				39.00				39.00			1.30	0.96				1.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	379	0		29	10	S5921_379_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											77.00	37		37				77.00	37		37												37						37			37			37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	379	0		29	10	S5921_379_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											779.00	25		25				779.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	380	0		29	10	S5921_380_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													24.00						0.00				8.00				8.00			0.26	0.03				0.25		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	380	0		29	10	S5921_380_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								16.00		48.00					11.00		33.00													48.00						0.00				16.00				16.00			0.53	0.36				0.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	380	0		29	10	S5921_380_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						100.00				45.00				45.00			1.50	1.16				1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	380	0		29	10	S5921_380_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											59.00	29		29				59.00	29		29												29						29			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	380	0		29	10	S5921_380_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											862.00	25		25				862.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	381	0		29	10	S5921_381_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	381	0		29	10	S5921_381_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					14.00		42.00													57.00						0.00				19.00				19.00			0.63	0.46				0.61		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	381	0		29	10	S5921_381_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													141.00						112.00				47.00				47.00			1.56	1.30				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	381	0		29	10	S5921_381_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											65.00	28		28				65.00	28		28												28						28			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	381	0		29	10	S5921_381_0	1	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											562.00	25		25				562.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	382	0		29	10	S5921_382_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	382	0		29	10	S5921_382_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	382	0		29	10	S5921_382_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	382	0		29	10	S5921_382_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											83.00	33		33				83.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	382	0		29	10	S5921_382_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											443.00	25		25				443.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	383	0		29	10	S5921_383_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	383	0		29	10	S5921_383_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	383	0		29	10	S5921_383_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	383	0		29	10	S5921_383_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											80.00	33		33				79.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	383	0		29	10	S5921_383_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											717.00	25		25				717.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	384	0		29	10	S5921_384_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	384	0		29	10	S5921_384_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	384	0		29	10	S5921_384_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	384	0		29	10	S5921_384_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											77.00	33		33				79.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	384	0		29	10	S5921_384_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											731.00	25		25				731.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	385	0		29	10	S5921_385_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	385	0		29	10	S5921_385_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	385	0		29	10	S5921_385_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	385	0		29	10	S5921_385_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											70.00	33		33				72.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	385	0		29	10	S5921_385_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											773.00	25		25				773.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	386	0		29	10	S5921_386_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	386	0		29	10	S5921_386_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	386	0		29	10	S5921_386_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	386	0		29	10	S5921_386_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											59.00	33		33				59.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	386	0		29	10	S5921_386_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											565.00	25		25				565.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	387	0		29	10	S5921_387_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	387	0		29	10	S5921_387_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	387	0		29	10	S5921_387_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	387	0		29	10	S5921_387_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											70.00	33		33				64.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	387	0		29	10	S5921_387_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											854.00	25		25				854.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	388	0		29	10	S5921_388_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	388	0		29	10	S5921_388_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	388	0		29	10	S5921_388_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	388	0		29	10	S5921_388_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											69.00	33		33				71.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	388	0		29	10	S5921_388_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											421.00	25		25				421.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	389	0		29	10	S5921_389_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	389	0		29	10	S5921_389_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	389	0		29	10	S5921_389_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	389	0		29	10	S5921_389_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											75.00	33		33				75.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	389	0		29	10	S5921_389_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											367.00	25		25				367.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	390	0		29	10	S5921_390_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	390	0		29	10	S5921_390_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	390	0		29	10	S5921_390_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	390	0		29	10	S5921_390_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											67.00	33		33				67.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	390	0		29	10	S5921_390_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											392.00	25		25				392.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	391	0		29	10	S5921_391_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	391	0		29	10	S5921_391_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	391	0		29	10	S5921_391_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	391	0		29	10	S5921_391_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											86.00	33		33				90.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	391	0		29	10	S5921_391_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											528.00	25		25				528.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	392	0		29	10	S5921_392_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	392	0		29	10	S5921_392_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	392	0		29	10	S5921_392_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	392	0		29	10	S5921_392_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											55.00	33		33				57.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	392	0		29	10	S5921_392_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											607.00	25		25				607.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	393	0		29	10	S5921_393_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	393	0		29	10	S5921_393_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	393	0		29	10	S5921_393_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	393	0		29	10	S5921_393_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											51.00	33		33				51.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	393	0		29	10	S5921_393_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											697.00	25		25				697.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	394	0		29	10	S5921_394_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	394	0		29	10	S5921_394_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	394	0		29	10	S5921_394_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	394	0		29	10	S5921_394_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											72.00	33		33				73.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	394	0		29	10	S5921_394_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											876.00	25		25				876.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	395	0		29	10	S5921_395_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	395	0		29	10	S5921_395_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	395	0		29	10	S5921_395_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	395	0		29	10	S5921_395_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											82.00	33		33				85.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	395	0		29	10	S5921_395_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											532.00	25		25				532.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	396	0		29	10	S5921_396_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	396	0		29	10	S5921_396_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	396	0		29	10	S5921_396_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	396	0		29	10	S5921_396_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											76.00	33		33				73.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	396	0		29	10	S5921_396_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											875.00	25		25				875.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	397	0		29	10	S5921_397_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	397	0		29	10	S5921_397_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	397	0		29	10	S5921_397_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	397	0		29	10	S5921_397_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											60.00	33		33				66.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	397	0		29	10	S5921_397_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											505.00	25		25				505.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	398	0		29	10	S5921_398_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	398	0		29	10	S5921_398_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	398	0		29	10	S5921_398_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	398	0		29	10	S5921_398_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											69.00	33		33				69.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	398	0		29	10	S5921_398_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											574.00	25		25				574.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	399	0		29	10	S5921_399_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	399	0		29	10	S5921_399_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	399	0		29	10	S5921_399_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	399	0		29	10	S5921_399_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											82.00	33		33				79.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	399	0		29	10	S5921_399_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											687.00	25		25				687.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	400	0		29	10	S5921_400_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	400	0		29	10	S5921_400_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	400	0		29	10	S5921_400_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	400	0		29	10	S5921_400_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											69.00	33		33				68.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	400	0		29	10	S5921_400_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											518.00	25		25				518.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	401	0		29	10	S5921_401_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	401	0		29	10	S5921_401_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	401	0		29	10	S5921_401_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	401	0		29	10	S5921_401_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											77.00	33		33				75.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	401	0		29	10	S5921_401_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											635.00	25		25				635.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	402	0		29	10	S5921_402_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	402	0		29	10	S5921_402_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	402	0		29	10	S5921_402_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	402	0		29	10	S5921_402_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											66.00	33		33				67.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	402	0		29	10	S5921_402_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											458.00	25		25				458.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	403	0		29	10	S5921_403_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	403	0		29	10	S5921_403_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	403	0		29	10	S5921_403_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	403	0		29	10	S5921_403_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											61.00	33		33				63.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	403	0		29	10	S5921_403_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											686.00	25		25				686.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	404	0		29	10	S5921_404_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	404	0		29	10	S5921_404_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	404	0		29	10	S5921_404_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	404	0		29	10	S5921_404_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											63.00	33		33				63.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	404	0		29	10	S5921_404_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											807.00	25		25				807.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	405	0		29	10	S5921_405_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	405	0		29	10	S5921_405_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	405	0		29	10	S5921_405_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	405	0		29	10	S5921_405_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											67.00	33		33				67.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	405	0		29	10	S5921_405_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											385.00	25		25				385.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	406	0		29	10	S5921_406_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	406	0		29	10	S5921_406_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	406	0		29	10	S5921_406_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	406	0		29	10	S5921_406_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											73.00	33		33				84.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	406	0		29	10	S5921_406_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											416.00	25		25				416.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	407	0		29	10	S5921_407_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	407	0		29	10	S5921_407_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	407	0		29	10	S5921_407_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	407	0		29	10	S5921_407_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											80.00	33		33				80.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	407	0		29	10	S5921_407_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											426.00	25		25				426.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	408	0		29	10	S5921_408_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	408	0		29	10	S5921_408_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	408	0		29	10	S5921_408_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	408	0		29	10	S5921_408_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											81.00	33		33				85.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	408	0		29	10	S5921_408_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											858.00	25		25				858.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	409	0		29	10	S5921_409_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	409	0		29	10	S5921_409_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	409	0		29	10	S5921_409_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	409	0		29	10	S5921_409_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											74.00	33		33				67.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	409	0		29	10	S5921_409_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											778.00	25		25				778.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	410	0		29	10	S5921_410_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	410	0		29	10	S5921_410_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	410	0		29	10	S5921_410_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	410	0		29	10	S5921_410_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											85.00	33		33				85.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	410	0		29	10	S5921_410_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1078.00	25		25				1078.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	411	0		29	10	S5921_411_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	411	0		29	10	S5921_411_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	411	0		29	10	S5921_411_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	411	0		29	10	S5921_411_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											58.00	33		33				60.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	411	0		29	10	S5921_411_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											754.00	25		25				754.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	412	0		29	10	S5921_412_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	412	0		29	10	S5921_412_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	412	0		29	10	S5921_412_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	412	0		29	10	S5921_412_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											64.00	33		33				66.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	412	0		29	10	S5921_412_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											815.00	25		25				815.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	413	0		29	10	S5921_413_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	413	0		29	10	S5921_413_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	413	0		29	10	S5921_413_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	413	0		29	10	S5921_413_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											82.00	33		33				80.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	413	0		29	10	S5921_413_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											595.00	25		25				595.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	414	0		29	10	S5921_414_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	414	0		29	10	S5921_414_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	414	0		29	10	S5921_414_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	414	0		29	10	S5921_414_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											97.00	31		31				97.00	30		30												31						30			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	414	0		29	10	S5921_414_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											572.00	25		25				572.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	415	0		29	10	S5921_415_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	415	0		29	10	S5921_415_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	415	0		29	10	S5921_415_0	1	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					31.00		93.00													141.00						93.00				47.00				47.00			1.56	1.03				1.51		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	415	0		29	10	S5921_415_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											83.00	33		33				84.00	32		32												33						32			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5921	415	0		29	10	S5921_415_0	1	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											472.00	25		25				472.00	25		25												25						25			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5953	001	0		29	10	S5953_001_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	2.50				6.00				1.00			0.20	0.03		0.20	0.03	0.03		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5953	001	0		29	10	S5953_001_0	1	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	37.50				20.00				15.00			0.67	0.50		0.67	0.50	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5953	001	0		29	10	S5953_001_0	1	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	92.50				47.00				37.00			1.57	1.23		1.57	1.23	1.19		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5953	001	0		29	10	S5953_001_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.71	50	50	50				41.14	45	45	45										50	50	50				45	45	45			50			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5953	001	0		29	10	S5953_001_0	1	Specialty Tier	3	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5953	002	0		29	10	S5953_002_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				0.00			0.17	0.00		0.17	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5953	002	0		29	10	S5953_002_0	1	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				0.00			0.17	0.00		0.17	0.00	0.00		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5953	002	0		29	10	S5953_002_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	7.50				10.00				3.00			0.33	0.10		0.33	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5953	002	0		29	10	S5953_002_0	1	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	7.50				10.00				3.00			0.33	0.10		0.33	0.10	0.10		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											1		
S5953	002	0		29	10	S5953_002_0	1	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	50.00				30.00				20.00			1.00	0.67		1.00	0.67	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5953	002	0		29	10	S5953_002_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.72	45	45	45				41.53	40	40	40										45	45	45				40	40	40			45			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5953	002	0		29	10	S5953_002_0	1	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	004	0		29	10	S5983_004_0	1	Preferred Generic	2	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													8.00						3.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	004	0		29	10	S5983_004_0	1	Generic	2	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													14.00						9.00				10.00				10.00			0.32	0.10				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	004	0		29	10	S5983_004_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								26.00		78.00					21.00		63.00													68.00						63.00				26.00				26.00			0.84	0.68				0.84		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	004	0		29	10	S5983_004_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				31								31			31		31											64.72	50						62.21	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	004	0		29	10	S5983_004_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	006	0		29	10	S5983_006_0	2	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	006	0		29	10	S5983_006_0	2	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	006	0		29	10	S5983_006_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	006	0		29	10	S5983_006_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				31		90	1	2						90	31		31											169.16	28		28				159.08	25		25												28						25			28			28									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier											2	1	
S5983	006	0		29	10	S5983_006_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											57.09	50						50.45	48												50						50					50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	006	0		29	10	S5983_006_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	007	0		29	10	S5983_007_0	1	Preferred Generic	4	11	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					1.00		3.00													7.00						2.00				5.00				5.00			0.16	0.03				0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	007	0		29	10	S5983_007_0	1	Generic	4	11	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					4.00		12.00													13.00						8.00				10.00				10.00			0.32	0.13				0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	007	0		29	10	S5983_007_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											29.57	20		20				26.72	18		18												18						18			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	007	0		29	10	S5983_007_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				31								31			31		31											65.70	46						63.41	44												46						46					46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5983	007	0		29	10	S5983_007_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S5993	001	0		29	10	S5993_001_0	4	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5993	001	0		29	10	S5993_001_0	4	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					4.00	8.00	12.00																15.00				15.00			0.50	0.27	0.13			0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5993	001	0		29	10	S5993_001_0	4	Preferred Brand	2	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					34.00	68.00	102.00					34.00	68.00	102.00																42.00				42.00			1.40	1.13	1.13			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5993	001	0		29	10	S5993_001_0	4	Non-Preferred Brand	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											99.22	30	30	30				82.68	25	25	25				25	25	25															30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5993	001	0		29	10	S5993_001_0	4	Specialty Tier	2	11	1	1	5	1		010	01			1				30											30		31											916.45	25						916.45	25																							25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5993	003	0		29	10	S5993_003_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5993	003	0		29	10	S5993_003_0	4	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5993	003	0		29	10	S5993_003_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					8.00	16.00	24.00					4.00	8.00	12.00																16.00				16.00			0.53	0.27	0.13			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5993	003	0		29	10	S5993_003_0	4	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					8.00	16.00	24.00					4.00	8.00	12.00																16.00				16.00			0.53	0.27	0.13			0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier											1		
S5993	003	0		29	10	S5993_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					32.00	64.00	96.00					32.00	64.00	96.00																42.00				42.00			1.40	1.07	1.07			1.35		Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5993	003	0		29	10	S5993_003_0	4	Non-Preferred Brand	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											92.69	30	30	30				77.24	25	25	25				25	25	25															30			30									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S5993	003	0		29	10	S5993_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1223.20	33						1223.20	33																							33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier													
S6506	001	0		29	10	S6506_001_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6506	001	0		29	10	S6506_001_0	1	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6506	001	0		29	10	S6506_001_0	1	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											30.01	23	23	23				17.51	15	15	15										23	23	23				15	15	15			23			23									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6506	001	0		29	10	S6506_001_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.38	44	44	44				60.16	32	32	32										44	44	44				32	32	32			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6506	001	0		29	10	S6506_001_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6506	002	0		29	10	S6506_002_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	37.50					0.00	0.00	0.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6506	002	0		29	10	S6506_002_0	1	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	50.00					4.00	8.00	10.00											20.00	40.00	50.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6506	002	0		29	10	S6506_002_0	1	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.76	25	25	25				47.32	18	18	18										25	25	25				18	18	18			25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6506	002	0		29	10	S6506_002_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.13	50	50	50				66.88	45	45	45										50	50	50				45	45	45			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6506	002	0		29	10	S6506_002_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	001	0		29	10	S6986_001_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	40.00					4.00	8.00	10.00											16.00	32.00	40.00				4.00	8.00	10.00				16.00				16.00			0.53	0.13		0.53	0.13	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	001	0		29	10	S6986_001_0	1	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	50.00					9.00	18.00	22.50											20.00	40.00	50.00				9.00	18.00	22.50				20.00				20.00			0.67	0.30		0.67	0.30	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	001	0		29	10	S6986_001_0	1	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											19.88	21	21	21				14.10	15	15	15										21	21	21				15	15	15			21			21									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	001	0		29	10	S6986_001_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											41.60	46	46	46				26.93	30	30	30										46	46	46				30	30	30			46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	001	0		29	10	S6986_001_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	002	0		29	10	S6986_002_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	40.00					4.00	8.00	10.00											16.00	32.00	40.00				4.00	8.00	10.00				16.00				16.00			0.53	0.13		0.53	0.13	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	002	0		29	10	S6986_002_0	1	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	50.00					9.00	18.00	22.50											20.00	40.00	50.00				9.00	18.00	22.50				20.00				20.00			0.67	0.30		0.67	0.30	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	002	0		29	10	S6986_002_0	1	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											20.14	21	21	21				14.28	15	15	15										21	21	21				15	15	15			21			21									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	002	0		29	10	S6986_002_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											41.79	46	46	46				27.05	30	30	30										46	46	46				30	30	30			46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	002	0		29	10	S6986_002_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	003	0		29	10	S6986_003_0	1	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	40.00					4.00	8.00	10.00											16.00	32.00	40.00				4.00	8.00	10.00				16.00				16.00			0.53	0.13		0.53	0.13	0.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	003	0		29	10	S6986_003_0	1	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	50.00					9.00	18.00	22.50											20.00	40.00	50.00				9.00	18.00	22.50				20.00				20.00			0.67	0.30		0.67	0.30	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	003	0		29	10	S6986_003_0	1	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											20.33	21	21	21				14.42	15	15	15										21	21	21				15	15	15			21			21									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	003	0		29	10	S6986_003_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											42.15	46	46	46				27.29	30	30	30										46	46	46				30	30	30			46			46									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S6986	003	0		29	10	S6986_003_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	001	0		29	10	S7694_001_0	4	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	001	0		29	10	S7694_001_0	4	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	001	0		29	10	S7694_001_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		87.00				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	001	0		29	10	S7694_001_0	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											57.39	47		47				48.84	40		40										47		47				40		40			47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	001	0		29	10	S7694_001_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											2409.11	27						2409.11	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	002	0		29	10	S7694_002_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	002	0		29	10	S7694_002_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	002	0		29	10	S7694_002_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		87.00				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	002	0		29	10	S7694_002_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											56.31	45		45				47.55	38		38										45		45				38		38			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	002	0		29	10	S7694_002_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1917.59	27						1917.59	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	003	0		29	10	S7694_003_0	3	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	003	0		29	10	S7694_003_0	3	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	003	0		29	10	S7694_003_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		87.00				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	003	0		29	10	S7694_003_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											57.72	45		45				48.74	38		38										45		45				38		38			45			45									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	003	0		29	10	S7694_003_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1333.83	27						1333.83	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	004	0		29	10	S7694_004_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	004	0		29	10	S7694_004_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	004	0		29	10	S7694_004_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											55.22	20		20				41.41	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	004	0		29	10	S7694_004_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											56.04	29		29				50.24	26		26										29		29				26		26			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	004	0		29	10	S7694_004_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1258.15	25						1258.15	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	005	0		29	10	S7694_005_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	005	0		29	10	S7694_005_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	005	0		29	10	S7694_005_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		87.00				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	005	0		29	10	S7694_005_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.76	48		48				50.99	39		39										48		48				39		39			48			48									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	005	0		29	10	S7694_005_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1194.23	27						1194.23	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	006	0		29	10	S7694_006_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	006	0		29	10	S7694_006_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	006	0		29	10	S7694_006_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		87.00				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	006	0		29	10	S7694_006_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											56.31	43		43				47.14	36		36										43		43				36		36			43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	006	0		29	10	S7694_006_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1676.59	27						1676.59	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	007	0		29	10	S7694_007_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	007	0		29	10	S7694_007_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	007	0		29	10	S7694_007_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											48.16	20		20				36.12	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	007	0		29	10	S7694_007_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											41.64	27		27				37.01	24		24										27		27				24		24			27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	007	0		29	10	S7694_007_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1251.02	25						1251.02	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	008	0		29	10	S7694_008_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	008	0		29	10	S7694_008_0	1	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	008	0		29	10	S7694_008_0	1	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		87.00				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	008	0		29	10	S7694_008_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											57.22	47		47				52.35	43		43										47		47				43		43			47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	008	0		29	10	S7694_008_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1479.19	27						1479.19	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	009	0		29	10	S7694_009_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	009	0		29	10	S7694_009_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	009	0		29	10	S7694_009_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		87.00				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	009	0		29	10	S7694_009_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											54.11	47		47				48.35	42		42										47		47				42		42			47			47									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	009	0		29	10	S7694_009_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1582.03	27						1582.03	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	010	0		29	10	S7694_010_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	010	0		29	10	S7694_010_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	010	0		29	10	S7694_010_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		87.00				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	010	0		29	10	S7694_010_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											53.14	43		43				49.43	40		40										43		43				40		40			43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	010	0		29	10	S7694_010_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1346.73	27						1346.73	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	011	0		29	10	S7694_011_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	011	0		29	10	S7694_011_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	011	0		29	10	S7694_011_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											56.20	20		20				42.15	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	011	0		29	10	S7694_011_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.19	34		34				81.69	28		28										34		34				28		28			34			34									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	011	0		29	10	S7694_011_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1544.22	25						1544.22	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	012	0		29	10	S7694_012_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	012	0		29	10	S7694_012_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	012	0		29	10	S7694_012_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											44.88	20		20				33.66	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	012	0		29	10	S7694_012_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											54.66	37		37				48.75	33		33										37		37				33		33			37			37									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	012	0		29	10	S7694_012_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1616.56	25						1616.56	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	014	0		29	10	S7694_014_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	014	0		29	10	S7694_014_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	014	0		29	10	S7694_014_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		87.00				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	014	0		29	10	S7694_014_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											53.16	41		41				45.38	35		35										41		41				35		35			41			41									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	014	0		29	10	S7694_014_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1631.68	27						1631.68	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	015	0		29	10	S7694_015_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	015	0		29	10	S7694_015_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	015	0		29	10	S7694_015_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.76	20		20				35.07	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	015	0		29	10	S7694_015_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											51.67	33		33				48.54	31		31										33		33				31		31			33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	015	0		29	10	S7694_015_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1565.53	25						1565.53	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	016	0		29	10	S7694_016_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	016	0		29	10	S7694_016_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	016	0		29	10	S7694_016_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											48.83	20		20				36.62	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	016	0		29	10	S7694_016_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											48.48	34		34				39.92	28		28										34		34				28		28			34			34									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	016	0		29	10	S7694_016_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1200.26	25						1200.26	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	017	0		29	10	S7694_017_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	017	0		29	10	S7694_017_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	017	0		29	10	S7694_017_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											44.57	20		20				33.43	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	017	0		29	10	S7694_017_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											53.08	34		34				46.83	30		30										34		34				30		30			34			34									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	017	0		29	10	S7694_017_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1101.69	25						1101.69	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	018	0		29	10	S7694_018_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	018	0		29	10	S7694_018_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	018	0		29	10	S7694_018_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.34	20		20				34.76	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	018	0		29	10	S7694_018_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.61	39		39				53.50	35		35										39		39				35		35			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	018	0		29	10	S7694_018_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1461.94	25						1461.94	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	019	0		29	10	S7694_019_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	019	0		29	10	S7694_019_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	019	0		29	10	S7694_019_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.34	20		20				34.76	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	019	0		29	10	S7694_019_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.61	39		39				53.50	35		35										39		39				35		35			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	019	0		29	10	S7694_019_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											2104.13	25						2104.13	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	020	0		29	10	S7694_020_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	020	0		29	10	S7694_020_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	020	0		29	10	S7694_020_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		87.00				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	020	0		29	10	S7694_020_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.06	50		50				49.61	42		42										50		50				42		42			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	020	0		29	10	S7694_020_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1347.13	27						1347.13	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	021	0		29	10	S7694_021_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	021	0		29	10	S7694_021_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	021	0		29	10	S7694_021_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.19	20		20				34.64	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	021	0		29	10	S7694_021_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											70.93	40		40				63.84	36		36										40		40				36		36			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	021	0		29	10	S7694_021_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1523.55	25						1523.55	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	022	0		29	10	S7694_022_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	022	0		29	10	S7694_022_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	022	0		29	10	S7694_022_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											49.49	20		20				37.12	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	022	0		29	10	S7694_022_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											66.71	38		38				61.45	35		35										38		38				35		35			38			38									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	022	0		29	10	S7694_022_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1296.95	25						1296.95	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	023	0		29	10	S7694_023_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	023	0		29	10	S7694_023_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	023	0		29	10	S7694_023_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.34	20		20				34.76	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	023	0		29	10	S7694_023_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											61.14	40		40				55.03	36		36										40		40				36		36			40			40									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	023	0		29	10	S7694_023_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1768.04	25						1768.04	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	024	0		29	10	S7694_024_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	024	0		29	10	S7694_024_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	024	0		29	10	S7694_024_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.67	20		20				35.00	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	024	0		29	10	S7694_024_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											60.73	42		42				54.95	38		38										42		42				38		38			42			42									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	024	0		29	10	S7694_024_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1732.04	25						1732.04	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	025	0		29	10	S7694_025_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	025	0		29	10	S7694_025_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	025	0		29	10	S7694_025_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.34	20		20				34.76	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	025	0		29	10	S7694_025_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											53.50	35		35				47.38	31		31										35		35				31		31			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	025	0		29	10	S7694_025_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1549.88	25						1549.88	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	026	0		29	10	S7694_026_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	026	0		29	10	S7694_026_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	026	0		29	10	S7694_026_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											43.79	20		20				32.84	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	026	0		29	10	S7694_026_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											56.60	39		39				47.89	33		33										39		39				33		33			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	026	0		29	10	S7694_026_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1504.07	25						1504.07	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	027	0		29	10	S7694_027_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	027	0		29	10	S7694_027_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	027	0		29	10	S7694_027_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											44.30	20		20				33.22	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	027	0		29	10	S7694_027_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											48.21	32		32				40.67	27		27										32		32				27		27			32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	027	0		29	10	S7694_027_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1395.20	25						1395.20	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	028	0		29	10	S7694_028_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	028	0		29	10	S7694_028_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	028	0		29	10	S7694_028_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.82	20		20				35.11	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	028	0		29	10	S7694_028_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											43.88	32		32				38.39	28		28										32		32				28		28			32			32									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	028	0		29	10	S7694_028_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1136.26	25						1136.26	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	029	0		29	10	S7694_029_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	029	0		29	10	S7694_029_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	029	0		29	10	S7694_029_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.34	20		20				34.76	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	029	0		29	10	S7694_029_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											53.50	35		35				47.38	31		31										35		35				31		31			35			35									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	029	0		29	10	S7694_029_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											2791.74	25						2791.74	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	030	0		29	10	S7694_030_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	030	0		29	10	S7694_030_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	030	0		29	10	S7694_030_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					34.00		102.00											47.00		141.00				34.00		102.00				47.00				47.00			1.57	1.13		1.57	1.13	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	030	0		29	10	S7694_030_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											54.41	43		43				50.61	40		40										43		43				40		40			43			43									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	030	0		29	10	S7694_030_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1691.83	27						1691.83	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	031	0		29	10	S7694_031_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	031	0		29	10	S7694_031_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	031	0		29	10	S7694_031_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											41.74	20		20				31.30	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	031	0		29	10	S7694_031_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											54.61	34		34				46.58	29		29										34		34				29		29			34			34									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	031	0		29	10	S7694_031_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1644.17	25						1644.17	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	032	0		29	10	S7694_032_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	032	0		29	10	S7694_032_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	032	0		29	10	S7694_032_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											54.59	20		20				40.94	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	032	0		29	10	S7694_032_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											55.97	29		29				52.11	27		27										29		29				27		27			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	032	0		29	10	S7694_032_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1180.70	25						1180.70	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	033	0		29	10	S7694_033_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	033	0		29	10	S7694_033_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	033	0		29	10	S7694_033_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.34	20		20				34.76	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	033	0		29	10	S7694_033_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											47.38	31		31				42.80	28		28										31		31				28		28			31			31									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	033	0		29	10	S7694_033_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1873.84	25						1873.84	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	034	0		29	10	S7694_034_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	034	0		29	10	S7694_034_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	034	0		29	10	S7694_034_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.84	20		20				35.13	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	034	0		29	10	S7694_034_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											64.12	39		39				54.25	33		33										39		39				33		33			39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	034	0		29	10	S7694_034_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1394.90	25						1394.90	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	070	0		29	10	S7694_070_0	2	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		2.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	070	0		29	10	S7694_070_0	2	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		9.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	070	0		29	10	S7694_070_0	2	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					29.00		87.00											47.00		141.00				29.00		87.00				47.00				47.00			1.57	0.97		1.57	0.97	1.52		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	070	0		29	10	S7694_070_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.86	50		50				50.62	43		43										50		50				43		43			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	070	0		29	10	S7694_070_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1869.08	27						1869.08	27												27						27					27			27									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	105	0		29	10	S7694_105_0	1	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	105	0		29	10	S7694_105_0	1	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	105	0		29	10	S7694_105_0	1	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.34	20		20				34.76	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	105	0		29	10	S7694_105_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											67.25	44		44				55.03	36		36										44		44				36		36			44			44									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	105	0		29	10	S7694_105_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											2585.02	25						2585.02	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	106	0		29	10	S7694_106_0	2	Preferred Generic	2	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					1.00		3.00											15.00		45.00				1.00		0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	106	0		29	10	S7694_106_0	2	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					3.00		9.00											18.00		54.00				3.00		4.50				18.00				18.00			0.60	0.10		0.60	0.10	0.58		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	106	0		29	10	S7694_106_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											46.34	20		20				34.76	15		15										20		20				15		15			20			20									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	106	0		29	10	S7694_106_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											44.33	29		29				36.68	24		24										29		29				24		24			29			29									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S7694	106	0		29	10	S7694_106_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											446.67	25						446.67	25												25						25					25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8067	001	0		29	10	S8067_001_0	6	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8067	001	0		29	10	S8067_001_0	6	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8067	001	0		29	10	S8067_001_0	6	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					38.00		114.00											45.00		135.00				38.00		114.00				45.00				45.00			1.50	1.27		1.50	1.27	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8067	001	0		29	10	S8067_001_0	6	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											63.98	50		50				62.68	50		50										50		50				50		50			50			50									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8067	001	0		29	10	S8067_001_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											350.17	33						350.17	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8067	003	0		29	10	S8067_003_0	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		12.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8067	003	0		29	10	S8067_003_0	5	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8067	003	0		29	10	S8067_003_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					38.00		114.00											45.00		135.00				38.00		114.00				45.00				45.00			1.50	1.27		1.50	1.27	1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8067	003	0		29	10	S8067_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								95.00		285.00					89.00		267.00											95.00		285.00				89.00		267.00				95.00				95.00			3.17	2.97		3.17	2.97	3.06		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8067	003	0		29	10	S8067_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											552.40	33						552.40	33												33						33					33			33									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8899	001	0		29	10	S8899_001_0	12	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								5.00	10.00	15.00					2.50	5.00	7.50					2.00	4.00	6.00																5.00				5.00			0.17	0.08	0.07			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8899	001	0		29	10	S8899_001_0	12	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								14.00	28.00	42.00					7.00	14.00	21.00					6.00	12.00	18.00																14.00				14.00			0.47	0.23	0.20			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8899	001	0		29	10	S8899_001_0	12	Preferred Brand	3	10	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								45.00	90.00	135.00					45.00	90.00	135.00					45.00	90.00	135.00																45.00				45.00			1.50	1.50	1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8899	001	0		29	10	S8899_001_0	12	Non-Preferred Drug	3	10	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											87.75	39	39	39				87.75	39	39	39				39	39	39															39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8899	001	0		29	10	S8899_001_0	12	Specialty Tier	3	10	1	1	5	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											1025.00	25	25	25				1025.00	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8899	002	0		29	10	S8899_002_0	12	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								5.00	10.00	15.00					2.50	5.00	7.50					2.00	4.00	6.00																5.00				5.00			0.17	0.08	0.07			0.16		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8899	002	0		29	10	S8899_002_0	12	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								14.00	28.00	42.00					7.00	14.00	21.00					6.00	12.00	18.00																14.00				14.00			0.47	0.23	0.20			0.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8899	002	0		29	10	S8899_002_0	12	Preferred Brand	3	10	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								45.00	90.00	135.00					45.00	90.00	135.00					45.00	90.00	135.00																45.00				45.00			1.50	1.50	1.50			1.45		Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8899	002	0		29	10	S8899_002_0	12	Non-Preferred Drug	3	10	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											87.75	39	39	39				87.75	39	39	39				39	39	39															39			39									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
S8899	002	0		29	10	S8899_002_0	12	Specialty Tier	3	10	1	1	5	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											1025.00	25	25	25				1025.00	25	25	25				25	25	25															25			25									Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier													
